[Federal Register Volume 68, Number 217 (Monday, November 10, 2003)]
[Notices]
[Pages 63833-63837]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-28239]


=======================================================================
-----------------------------------------------------------------------

SOCIAL SECURITY ADMINISTRATION

[Social Security Ruling, SSR 03-03p.]


Titles II and XVI: Evaluation of Disability and Blindness in 
Iinitial Claims for Individuals Aged 65 or Older

AGENCY: Social Security Administration.

ACTION: Notice of Social Security ruling.

-----------------------------------------------------------------------

SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of 
Social Security gives notice of Social Security Ruling, SSR 03-03p. We 
are revising Social Security Ruling (SSR) 99-3p, Title XVI: Evaluation 
of Disability and Blindness in Initial Claims for Individuals Age 65 or 
Older (64 FR 33337, June 22, 1999). SSR 99-3p was confined to 
individuals who apply for disability payments under title XVI of the 
Social Security Act (the Act). In this revised ruling, we are adding 
provisions for individuals who apply for disability benefits under 
title II of the Act. Section 216(l) of the Act phases in gradual 
increases in the full retirement age from age 65 to age 67. As a result 
of these increases we will be processing some disability claims under 
title II of the Act for individuals who are aged 65 or older. 
Therefore, this Ruling clarifies the Social Security Administration's 
standards and procedures for the adjudication of disability and 
blindness claims for individuals aged 65 or older under titles II and 
XVI of the Act. This Ruling supersedes SSR 99-3p.
    In addition to the revisions made to incorporate instructions for 
title II

[[Page 63834]]

claims we have updated SSR 99-3p. We have deleted the section that was 
titled ``Special Rule for Determining Disability for Individuals Age 65 
or Older Who Can Perform Medium Work But Who Are Illiterate in English 
or Unable to Communicate in English.'' We did this because those 
instructions actually applied to all individuals aged 60 or older-not 
just to individuals aged 65 and older. In addition, we are revising our 
regulations to make this clear. (See Notice of Proposed Rulemaking; 
Federal Old-Age, Survivors and Disability Insurance; Determining 
Disability and Blindness; Clarification of the Education and Previous 
Work Experience Categories in the Medical-Vocational Rules). We have 
also deleted obsolete information and made some minor revisions to the 
language of SSR 99-3p.

EFFECTIVE DATE: This ruling is effective on the date of its publication 
in the Federal Register (November 10, 2003).

FOR FURTHER INFORMATION CONTACT: Martin Sussman, Regulations Officer, 
Social Security Administration, 100 Altmeyer Building, 6401 Security 
Boulevard, Baltimore, MD 21235-6401, (410) 965-1767.

SUPPLEMENTARY INFORMATION: Although we are not required to do so 
pursuant to 5 U.S.C. 552(a)(1) and (a)(2), we are publishing this 
Social Security Ruling in accordance with 20 CFR 402.35(b)(1).
    Social Security Rulings make available to the public precedential 
decisions relating to the Federal old-age, survivors, disability, 
supplemental security income, and black lung benefits programs. Social 
Security Rulings may be based on case decisions made at all 
administrative levels of adjudication, Federal court decisions, 
Commissioner's decisions, opinions of the Office of the General 
Counsel, and policy interpretations of the law and regulations.
    Although Social Security Rulings do not have the same force and 
effect as the statute or regulations, they are binding on all 
components of the Social Security Administration, in accordance with 20 
CFR 402.35(b)(1), and are to be relied upon as precedents in 
adjudicating cases.
    If this Social Security Ruling is later superseded, modified, or 
rescinded, we will publish a notice in the Federal Register to that 
effect.

(Catalog of Federal Domestic Assistance, Programs 96.001 Social 
Security--Disability Insurance; 96.003 Social Security--Special 
Benefits for Persons Aged 72 and Over; 96.006 Supplemental Security 
Income)

    Dated: November 4, 2003.
Jo Anne B. Barnhart,
Commissioner of Social Security.

Policy Interpretation Ruling

    This Ruling supersedes SSR 99-3p, Title XVI: Evaluation of 
Disability and Blindness in Initial Claims for Individuals Age 65 or 
Older (64 FR 33337, June 22, 1999).
    Purpose: To clarify SSA's standards and procedures for the 
adjudication of titles II and XVI of the Social Security Act (the Act) 
disability and blindness claims for individuals aged 65 or older. In 
particular, this Ruling explains that:
    [sbull] In general, the regulations and procedures for determining 
disability for adults who are under age 65 are used when determining 
whether an individual aged 65 or older is disabled.
    [sbull] Adjudicators are required to consider any impairment(s) the 
individual has, including those that are often found in older 
individuals.
    [sbull] If an individual aged 72 or older has a medically 
determinable impairment, that impairment will be considered to be 
``severe.''
    [sbull] If the individual's impairment(s) prevents the performance 
of his or her past relevant work (PRW), or if the individual does not 
have PRW, the adjudicator must consider two special medical-vocational 
profiles showing an inability to make an adjustment to other work 
before referring to appendix 2 to subpart P of 20 CFR part 404.
    [sbull] Generally, adjudicators should use the rules for 
individuals aged 60-64 when determining whether an individual aged 65 
or older can adjust to other work.
    [sbull] Some individuals aged 65 or older may not understand, or be 
able to comply with, our requests to submit evidence or attend a 
consultative examination (CE). Therefore, adjudicators must make 
special efforts in situations in which it appears that an individual 
aged 65 or older may not be cooperating.
    Citations: Section 5301 of Public Law (Pub. L.) 105-33, sections 
402 and 431 of Pub. L. 104-193, as amended, sections 216(l), 223(a)(1), 
223(d), 1614(a), 1616, 1619(b) and 1621(f)(1) of the Act, as amended; 
20 CFR part 404, subpart P, appendices 1 and 2, Sec. Sec.  404.1501-
1599, and 20 CFR part 416, subpart I, Sec. Sec.  416.901-416.923, 
416.925-416.926, 416.927-416.986, 416.988-416.994, and 416.995-416.998.
    Background: Section 216(l) of the Act phases in a gradual increase 
in the full retirement age from age 65 to age 67. These changes first 
affect individuals who were born in 1938; that is, who turn age 65 in 
2003. By 2027, the incremental increases will be complete, and a full 
retirement age of 67 will be applicable to all individuals who were 
born in 1960 or later. These provisions do not change the age at which 
an individual can take early retirement at a reduced benefit amount, 
which remains at age 62. Under title II, an individual can establish 
entitlement to benefits based on disability or blindness until the 
month in which he or she attains full retirement age. Therefore, as a 
result of the increases in the full retirement age, we will be 
processing some disability claims under title II of the Act for 
individuals who are aged 65 or older.
    On August 5, 1997, Pub. L. 105-33, the Balanced Budget Act of 1997, 
amended Pub. L. 104-193, the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996, as amended, and added 
additional alien eligibility criteria. Under the new criteria, 
``qualified'' aliens who were lawfully residing in the United States on 
August 22, 1996, and who are disabled or blind as defined in section 
1614(a) of the Act are eligible for benefits under title XVI provided 
all other eligibility requirements are met. Individuals can establish 
eligibility based on disability or blindness at any age, even on or 
after attainment of age 65.
    In addition to qualified aliens, determinations of disability under 
title XVI also may be needed for other individuals aged 65 or older to 
determine:
    [sbull] State supplements in some States (section 1616 of the Act);
    [sbull] Whether the work incentive provisions of section 1619(b) of 
the Act are applicable; or
    [sbull] Appropriate deeming of income and resources (section 
1621(f)(1) of the Act; 20 CFR 416.1160, 416.1161, 416.1166a, and 
416.1204).
    Ruling: Evaluation Issues. In general, the regulations and 
procedures for determining disability for adults who are under age 65 
are used when determining whether an individual aged 65 or older is 
disabled, except as provided later in this Ruling.
    To determine if an adult is disabled as defined in the Act, 
adjudicators generally use the 5-step sequential evaluation process set 
out in 20 CFR 404.1520 and 416.920.
    Step 1--Is the Individual Working? If the individual is working and 
the work is substantial gainful activity (see 20 CFR 404.1571-404.1576 
and 416.971-416.976), we will find that the individual is not disabled 
regardless of his or her medical condition, age, education, or work 
experience.

[[Page 63835]]

    Step 2--Does the Individual Have a Severe Impairment?
    At step 2 of the sequential evaluation process, a determination is 
made about whether an individual has a medically determinable 
impairment and whether the individual's medically determinable 
impairment--or combination of impairments--is ``severe.'' An individual 
who does not have an impairment or combination of impairments that is 
``severe'' will be found not disabled.
    An impairment(s) is considered ``severe'' if it significantly 
limits an individual's physical or mental abilities to do basic work 
activities. An impairment(s) that is ``not severe'' must be a slight 
abnormality, or a combination of slight abnormalities, that has no more 
than a minimal effect on the ability to do basic work activities. It is 
incorrect to disregard an impairment or consider it to be ``not 
severe'' because the impairment's effects are ``normal'' for a person 
of that age.
    As in any claim, adjudicators must consider signs, symptoms, and 
laboratory findings when determining whether an individual aged 65 or 
older has a medically determinable impairment (see 20 CFR 404.1508 and 
404.1528, and 416.908 and 416.928). The likelihood of the occurrence of 
some impairments increases with advancing age; e.g., osteoporosis, 
osteoarthritis, certain cancers, adult-onset diabetes mellitus, 
impairments of memory, hypertension, and impairments of vision or 
hearing. Adjudicators are required to consider any impairment(s) the 
individual has, including impairments like the ones listed above that 
are often found in older individuals. It is incorrect to disregard any 
of an individual's impairments because they are ``normal'' for the 
person's age.
    When an individual has more than one medically determinable 
impairment and each impairment by itself is ``not severe,'' 
adjudicators must still assess the impact of the combination of those 
impairments on the individual's ability to function. A claim may be 
denied at step 2 only if the evidence shows that the individual's 
impairments, when considered in combination, are ``not severe''; i.e., 
do not have more than a minimal effect on the individual's physical or 
mental ability(ies) to perform basic work activities.
    Special Rule for Individuals Applying for Title XVI Benefits Who 
Are Aged 72 or Older. Generally, we use step 2 of the sequential 
evaluation process as a ``screen'' to deny individuals with impairments 
that would have no more than a minimal effect on their ability to work 
even if we considered their age, education, and work experience. 
However, with advancing age, it is increasingly unlikely that 
individuals with medically determinable impairments will be found to 
have minimal limitations in their ability to do basic work activities. 
By age 72, separate consideration of whether an individual's medically 
determinable impairment(s) is ``severe'' does not serve the useful 
screening purpose that it does for individuals who have not attained 
age 72. Therefore, if an individual aged 72 or older has a medically 
determinable impairment(s), that impairment(s) will be considered to be 
``severe,'' and evaluation must proceed to the next step of the 
sequential evaluation process.
    Step 3--Does the Individual Have an Impairment(s) That Meets or 
Equals an Impairment Listed in Appendix 1? When an individual has a 
severe impairment(s) that meets or medically equals the requirements 
for one of the impairments in the Listing of Impairments in appendix 1 
to subpart P of 20 CFR part 404 and meets the duration requirement, the 
individual is disabled.
    When Disability Cannot Be Found at Step 3--Assessing Residual 
Functional Capacity. When the individual does not have an impairment(s) 
that meets or equals the requirements for a listed impairment, the 
adjudicator is required to assess the individual's residual functional 
capacity (RFC). The RFC assessment is an adjudicator's finding about 
the ability of an individual to perform both physical and mental work-
related activities despite his or her impairment(s). The assessment 
considers all of the individual's medically determinable impairments, 
including those that are ``not severe,'' and all limitations or 
restrictions caused by symptoms, such as pain, that are related to the 
medically determinable impairment(s). The assessment is based upon 
consideration of all relevant evidence in the case record, including 
medical evidence and relevant nonmedical evidence, such as observations 
of lay witnesses of an individual's apparent symptomatology, or an 
individual's own statement of what he or she is able or unable to do.
    When assessing RFC in an initial claim, an adjudicator should not 
find that an individual has limitations or restrictions beyond those 
caused by his or her medically determinable impairment(s). Limitations 
or restrictions due to factors such as age, height, or whether the 
individual has ever engaged in certain activities in his or her PRW 
(e.g., lifting heavy weights) are, per se, not considered in assessing 
RFC. (See SSR 96-8p, ``Titles II and XVI: Assessing Residual Functional 
Capacity in Initial Claims.'')
    Step 4--Does the Individual Have an Impairment(s) That Prevents Him 
or Her from Performing Past Relevant Work (PRW)? The RFC assessment 
discussed above is first used at step 4 of the sequential evaluation 
process to determine whether the individual is capable of doing PRW. 
The rules and procedures we use to make this determination for 
individuals under age 65 are also applicable to individuals aged 65 or 
older. This includes consideration of whether the individual can 
perform his or her PRW as he or she actually performed it or as it is 
generally performed in the national economy. If the individual's PRW 
was performed in a foreign economy, we will generally consider only 
whether the individual can perform his or her PRW as he or she 
described it. However, if the work the individual did in a foreign 
economy also exists in the United States, we will consider whether he 
or she can perform the work as it is generally performed in the 
national economy. If the individual can perform his or her PRW, he or 
she will be found not disabled. (See SSR 82-40, ``Titles II and XVI: 
The Vocational Relevance of the Past Work Performed in a Foreign 
Country.'')
    Step 5--Can the Individual Do Other Work? The last step of the 
sequential evaluation process requires us to determine whether an 
individual can do other work considering his or her RFC, age, 
education, and work experience.
    Special Medical-Vocational Profiles Showing an Inability to Make an 
Adjustment to Other Work. If the individual's impairment(s) does 
preclude the performance of PRW, or if the individual does not have 
PRW, two special medical-vocational profiles must be considered before 
referring to appendix 2 to subpart P of 20 CFR part 404. The special 
profiles are discussed in SSR 82-63, ``Titles II and XVI: Medical-
Vocational Profiles Showing an Inability to Make an Adjustment to Other 
Work.''
    The ``arduous unskilled physical labor'' profile applies when an 
individual:
    [sbull] Is not working;
    [sbull] Has a history of 35 years or more of arduous unskilled 
physical labor \1\;
---------------------------------------------------------------------------

    \1\ Training, or isolated, brief, or remote periods of 
semiskilled or skilled work will not preclude a finding of arduous, 
unskilled work, if such training or experience did not result in 
skills that enable the individual to adjust to other work.
---------------------------------------------------------------------------

    [sbull] Can no longer perform this past arduous work because of a 
severe impairment(s); and

[[Page 63836]]

    [sbull] Has no more than a marginal education (generally 6th grade 
or less).
    The ``no work experience'' profile applies when an individual:
    [sbull] Has a severe impairment(s);
    [sbull] Has no PRW;
    [sbull] Is aged 55 or older; and
    [sbull] Has no more than a limited education (generally, 11th grade 
or less).
    If either of these profiles applies, a finding of ``disabled'' must 
be made. This finding is made without considering the criteria in 
appendix 2 to subpart P of 20 CFR part 404.
    Applying the Criteria in Appendix 2 to Subpart P of 20 CFR Part 
404. If the special medical-vocational profiles are not applicable, we 
use the rules in appendix 2 to subpart P of 20 CFR part 404 to 
determine whether the individual has the ability to do other work. The 
highest age category used in appendix 2 is aged 60-64, ``closely 
approaching retirement age.'' However, we have longstanding internal 
procedures that direct our adjudicators to use the rules for ages 60-64 
when making determinations for individuals aged 65 or older at step 5.
    Under those rules, individuals aged 65 or older who are limited to 
``sedentary'' or ``light'' work will be found disabled unless their PRW 
provided them with transferable skills or they are at least a high 
school graduate and their education provides for direct entry into 
skilled work. As set out in Sec. Sec.  201.00(f) and 202.00(f) of 
appendix 2, to find transferability of skills for individuals aged 65 
or older who are limited to ``sedentary'' or ``light'' work, there must 
be very little, if any, vocational adjustment required in terms of 
tools, work processes, work settings, or the industry.
    Individuals aged 65 or older who can perform the full range of 
``medium'' work are found disabled when they have no more than a 
limited education (including individuals who are illiterate in English 
or unable to communicate in English) and no PRW. Individuals aged 65 or 
older who can perform a full range of ``medium'' work are also found 
disabled when they have no more than a marginal education (including 
individuals who are illiterate in English or unable to communicate in 
English) and no PRW or their PRW is unskilled or their skilled or semi-
skilled PRW provides no transferable skills.
    Duration. As indicated earlier, the likelihood of the occurrence of 
some impairments, such as osteoporosis, osteoarthritis, certain 
cancers, adult-onset diabetes mellitus, impairments of memory, 
hypertension, and impairments of vision or hearing, increases with 
advancing age. Moreover, such impairments are more likely to be chronic 
than acute. Therefore, adjudicators must be especially careful before 
concluding that an impairment in an individual aged 65 or older will 
not meet the 12-month duration requirement.
    Development Issues. Developing Allegations of Impairment(s). When 
obtaining the medical history of an individual aged 65 or older, it is 
important to be alert to and address allegations of impairments that 
are commonly associated with the aging process, such as osteoporosis, 
arthritis, loss of vision, hearing loss, and memory loss. Allegations 
may be raised in response to specific questions about the individual's 
impairment(s); e.g., on Form SSA-3368-BK. However, adjudicators must 
also be alert to allegations raised in other evidence in the file. For 
example, questionnaires about activities of daily living may contain 
statements like ``I have difficulty walking or climbing stairs because 
my legs hurt,'' ``I can't clean my apartment because my back hurts,'' 
or ``I don't read much anymore because I don't see well.'' These 
statements constitute allegations of impairment(s). Therefore, 
adjudicators must:
    [sbull] Review the case file thoroughly to identify all allegations 
or other indications of impairment.
    [sbull] Be aware that the medical evidence or third party 
statements can raise additional allegations.
    [sbull] When contacting an individual aged 65 or older, be alert to 
statements indicating the presence of an impairment(s) commonly 
associated with the aging process.
    [sbull] Consider all signs or symptoms indicative of an 
impairment(s), including those impairments caused by degenerative 
changes associated with the aging process.
    Purchasing Medical Evidence. Our regulations, at 20 CFR 
404.1512(f), 404.1517, 416.912(f) and 416.917, indicate that we will 
purchase CEs when the individual's medical sources cannot or will not 
give us sufficient medical evidence about the individual's impairment 
for us to determine if he or she is disabled. Sections 404.1519f and 
416.919f further provide that we will purchase only the specific 
examinations and tests that we need to make a determination or 
decision. Due to the wide range of allegations contained in cases of 
individuals aged 65 or older, evidence addressing more than one body 
system may need to be purchased. In these situations, it is usually 
appropriate to purchase general medical examinations rather than 
examinations targeted at particular body systems. This will ensure that 
all allegations of impairment are evaluated, and will reduce the burden 
on the individual. For example, if the individual alleges back and knee 
pain, shortness of breath on exertion, and numbness and weakness in his 
or her arm, a general medical examination would usually be preferable 
to separate orthopedic, neurologic, respiratory, or cardiac 
examinations.
    Failure to Cooperate. Individuals filing for benefits based on 
disability or blindness have certain responsibilities for furnishing us 
with, or helping us obtain, needed evidence. Our regulations at 20 CFR 
404.1512(c), 404.1516, 404.1518, 416.912(c), 416.916, and 416.918 
describe these responsibilities. However, due to factors such as 
possible language barriers or limited education, some individuals aged 
65 or older may not understand, or be able to comply with, our requests 
to submit evidence or attend a CE.
    If it appears that an individual aged 65 or older is not 
cooperating, adjudicators must take the following additional actions 
when the individual does not have an appointed representative, or when 
the appointed representative has asked us to deal directly with the 
individual.
    If an individual aged 65 or older has not supplied evidence or 
taken an action we requested and still need, the adjudicator must:
    [sbull] Contact the individual to determine why he or she has not 
complied with our request. If it appears that the individual needs 
personal assistance, including interpreter assistance, to complete 
forms, request field office assistance.
    [sbull] Contact a third party (i.e., someone other than the 
individual's representative), if one has been identified, about 
assisting the individual at the same time the adjudicator contacts the 
individual.
    If an individual aged 65 or older did not attend a CE, the 
adjudicator must:
    [sbull] Contact the individual to determine why he or she did not 
attend the CE.
    [sbull] Make at least two attempts at different times on different 
days to contact the individual by telephone. (A busy signal does not 
constitute an attempt.)
    [sbull] Send the claimant a call-in letter if telephone contact is 
not possible or successful.
    [sbull] Contact a third party, if one has been identified, about 
assisting the claimant at the same time contact is attempted with the 
claimant.
    [sbull] When contact is made with the individual or the third 
party, explain that the CE is for evaluation purposes

[[Page 63837]]

only and that no treatment will be required.
    [sbull] Reschedule the CE if the individual had a good reason for 
not attending the prior CE (e.g., he or she had transportation problems 
or was out of the country at the time of the CE) and indicates a 
willingness to attend a rescheduled CE.
    Non-English-Speaking or Limited-English-Proficiency Individuals. 
For all the development issues discussed above, adjudicators must 
remember that we are responsible for obtaining the services of a 
qualified interpreter if the individual requests or needs one. This 
includes providing an interpreter at a CE if the CE provider is not 
sufficiently fluent in the individual's language.
    Effective Date: This Ruling is effective on the date of its 
publication in the Federal Register (November 10, 2003).
    Cross-References: SSR 82-40, ``Titles II and XVI: The Vocational 
Relevance of the Past Work Performed in a Foreign Country''; SSR 82-61, 
``Titles II and XVI: Past Relevant Work--The Particular Job or the 
Occupation as Generally Performed''; SSR 82-62, ``Titles II and XVI: A 
Disability Claimant's Capacity To Do Past Relevant Work, In General''; 
SSR 82-63, ``Titles II and XVI: Medical-Vocational Profiles Showing an 
Inability To Make an Adjustment to Other Work''; SSR 85-28, ``Titles II 
and XVI: Medical Impairments That Are Not Severe''; SSR 96-3p, ``Titles 
II and XVI: Considering Allegations of Pain and Other Symptoms in 
Determining Whether a Medically Determinable Impairment Is Severe''; 
SSR 96-4p, ``Titles II and XVI: Symptoms, Medically Determinable 
Physical and Mental Impairments, and Exertional and Nonexertional 
Limitations''; SSR 96-8p, ``Titles II and XVI: Assessing Residual 
Functional Capacity in Initial Claims''; SSR 96-9p, ``Titles II and 
XVI: Determining Capability to do Other Work--Implications of Residual 
Functional Capacity for Less Than a Full Range of Sedentary Work''; and 
Program Operations Manual System, sections DI 22505.015, DI 22510.018, 
DI 22510.019, DI 23515.010, DI 23515.025, DI 25010.001, SI 00502.142, 
and GN 00203.001.

[FR Doc. 03-28239 Filed 11-7-03; 8:45 am]
BILLING CODE 4191-02-P