[Federal Register Volume 76, Number 176 (Monday, September 12, 2011)]
[Pages 56263-56271]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-23239]



[Social Security Ruling, SSR 11-2p; Docket No. SSA-2010-0079]

Titles II and XVI: Documenting and Evaluating Disability in Young 

AGENCY: Social Security Administration.

ACTION: Notice of Social Security Ruling (SSR).


SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of 
Social Security gives notice of Social Security Ruling, SSR-11-2p. This 
Ruling explains our policy on documenting and evaluating disability in 
young adults.

DATES: Effective Date: September 12, 2011.

Disability Programs, Social Security Administration, 6401 Security 
Boulevard, Baltimore, MD 21235-6401, (410) 965-1020.

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 SSR 
in accordance with 20 CFR 402.35(b)(1).
    Through SSRs, we make available to the public precedential 
decisions relating to the Federal old-age, survivors, disability, 
supplemental security income, special veterans benefits, and black lung 
benefits programs. We may base SSRs on determinations or decisions made 
at all levels of administrative adjudication, Federal court decisions, 
Commissioner's decisions, opinions of the Office of the General 
Counsel, or other interpretations of the law and regulations.

[[Page 56264]]

    Although SSRs do not have the same force and effect as statutes or 
regulations, they are binding on all of our components. 20 CFR 
    This SSR will be in effect until we publish a notice in the Federal 
Register that rescinds it, or publish a new SSR that replaces or 
modifies it.

(Catalog of Federal Domestic Assistance, Program Nos. 96.001, Social 
Security--Disability Insurance; 96.002, Social Security--Retirement 
Insurance; 96.004--Social Security--Survivors Insurance; 96.006--
Supplemental Security Income)

    Dated: September 6, 2011.
Michael J. Astrue,
Commissioner of Social Security.

Policy Interpretation Ruling

Titles II and XVI: Documenting and Evaluating Disability in Young 

    Purpose: This SSR consolidates information from our regulations on 
documenting and evaluating disability in young adults. We also provide 
guidance on how we apply our policies when we determine whether a young 
adult is disabled under our rules.
    Citations (Authority): Sections 216(i), 222(c), 223(a), 223(c), 
223(d), 223(f), 225(b), 1614(a)(3), 1614(a)(4), 1619, and 1631(a) of 
the Social Security Act, as amended; Regulations No. 4, subpart B, 
section 404.130; subpart D, sections 404.316, 404.327-404.330, 404.339-
404.340, 404.348, 404.350, 404.352, and 404.354; subpart P, sections 
404.1505, 404.1509-404.1510, 404.1513, 404.1520-404.1521, 404.1525-
404.1527, 404.1545-404.1546, 404.1560-404.1569a, 404.1571-404.1576, 
404.1584, 404.1590, 404.1594, appendix 1 and appendix 2; and 
Regulations No. 16, subpart I, sections 416.902, 416.905, 416.909-
416.910, 416.913, 416.920-416.921, 416.924a, 416.925-416.927, 416.945-
416.946, 416.960-416.969a, 416.971-416.976, 416.987, 416.990, and 
416.994, and subpart M, sections 416.1320, 416.1331, and 416.1338.


    We consider people between the ages of 18 to approximately 25 to be 
young adults. When we make disability determinations or decisions for 
young adults, we use the same definition for disability as we do for 
other adults.\1\ We also use adult rules to make disability 
determinations or decisions in several other situations:

    \1\ Under title II, we sometimes use the adult definition of 
disability to make disability determinations or decisions for people 
under age 18. In these situations, we will use the guidance in this 
SSR when we make our determination or decision.

     When a young adult files a claim for child \2\ benefits on 
a parent's record based on a disability that began before he or she 
attained age 22;

    \2\ For purposes of title II entitlement, a ``child'' is a 
person who has the required relationship to the insured worker. See 
20 CFR 404.330, 404.339-404.340, 404.348, 404.350, and 404.354.

     When a child \3\ who is receiving title XVI childhood 
disability benefits attains age 18 and must undergo a disability 
redetermination; \4\ and

    \3\ For purposes of determining disability under title XVI, a 
``child'' is ``a person who has not attained age 18.'' See 20 CFR 
    \4\ See 20 CFR 416.987.

     When a young adult receiving disability benefits under 
title II or XVI undergoes a continuing disability review (CDR) to 
determine whether he or she is still disabled.\5\

    \5\ See 20 CFR 404.1590 and 416.990.

    Like other adults, a young adult who applies for disability 
benefits under title II or XVI \6\ is ``disabled'' if he or she has a 
medically determinable physical or mental impairment(s) \7\ that 
results in ``an inability to do any substantial gainful activity.'' \8\

    \6\ For simplicity, we refer in this SSR only to initial claims 
for benefits. However, the policy interpretations in this SSR also 
apply, with some exceptions, to age-18 redeterminations under 
section 1614(a)(3)(H)(iii) of the Act and 20 CFR 416.987 and to CDRs 
under sections 223(f) and 1614(a)(4) of the Act and 20 CFR 404.1594 
and 416.994. When there is a difference in how the policy applies to 
age-18 redeterminations or to CDRs, we explain how the policy 
    \7\ We use the term ``impairment(s)'' in this SSR to refer to an 
``impairment or a combination of impairments.''
    \8\ The impairment(s) must also satisfy the duration requirement 
in sections 216(i)(1), 223(d)(1)(A), and 1614(a)(3)(A) of the Act; 
that is, it must be expected to result in death or must have lasted 
or be expected to last for a continuous period of not less than 12 
months. See also 20 CFR 404.1505, 404.1509, 416.905, and 416.909.

    We use a five-step sequential evaluation process to determine 
    1. Is the person engaging in substantial gainful activity (SGA)? 
\9\ If yes, the person is not disabled.

    \9\ For the definition of SGA and the rules for how we determine 
whether work shows that a person has the ability to do SGA, see 20 
CFR 404.1510, 404.1571-404.1576, 404.1584, and 416.910, and 416.971-

    2. Does the person have a medically determinable physical or mental 
impairment(s) that is severe? \10\ If no, the person is not disabled.

    \10\ An impairment(s) is not severe if it does not significantly 
limit the person's physical or mental ability to do basic work 
activities. 20 CFR 404.1521 and 416.921.

    3. Does the person have an impairment(s) that meets or medically 
equals a listing in the Listing of Impairments (listings)? \11\ If yes 
and the impairment(s) meets the duration requirement, the person is 

    \11\ The rules for how we determine whether an impairment(s) 
meets or medically equals a listing are in 20 CFR 404.1525, 
404.1526, 416.925, and 416.926. The listings are at 20 CFR part 404, 
subpart P, appendix 1.

    4. Does the person have the residual functional capacity (RFC) \12\ 
to do past relevant work? If yes, the person is not disabled.

    \12\ The basic rules for RFC are in 20 CFR 404.1545-404.1546, 
404.1569a, 416.945-416.946, and 416.969a. See also SSR 96-8p, 61 FR 
34474 (1996), available at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR96-08-di-01.html. (For the complete titles of all 
SSRs cited in this footnote and those following, see the CROSS-
REFERENCES section at the end of this SSR).

    5. Does the person have the RFC to adjust to other work that exists 
in significant numbers in the national economy, considering his or her 
age, education, and previous work experience? \13\ If no, the person is 
disabled. If yes, the person is not disabled.\14\

    \13\ The rules for determining whether a person can adjust to 
other work are in 20 CFR 404.1560-404.1569a, 20 CFR part 404, 
subpart P, appendix 2, and 20 CFR 416.960-416.969a.
    \14\ See 20 CFR 404.1520 and 416.920. The sequential evaluation 
process for age-18 redeterminations follows the process we use for 
initial claims, except that we do not consider whether the person is 
engaging in SGA (step 1). See 20 CFR 416.987. Unlike the sequential 
evaluation process for initial claims, the sequential evaluation 
process for CDRs first considers whether there has been medical 
improvement related to the ability to work. See 20 CFR 404.1594 and 

    This SSR explains the evidence we need to document a young adult's 
impairment-related limitations, other considerations for evaluating 
limitations, disability insured status, issues related to the 
sequential evaluation process, and resolving inconsistencies in the 
evidence. We also discuss continued payments for young adults 
participating in vocational rehabilitation plans.

Policy Interpretation

    The abilities, skills, and behaviors that young adults use to do 
basic work activities are essentially the same as those that older 
adolescents \15\ use for age-appropriate activities.\16\ Thus, the 
evidence we consider when we make disability determinations for young 
adults is generally the same as, or similar to, the evidence we 
consider for making disability determinations for older adolescents 
under title XVI. Because the abilities, skills, and behaviors are 
essentially the same, the same considerations for evaluating

[[Page 56265]]

limitations in an older adolescent also apply to young adults.

    \15\ An adolescent is a child ``age 12 to the attainment of age 
18.'' See 20 CFR 416.926a. An older adolescent is a child 
approximately age 16 to the attainment of age 18.
    \16\ See, for example, 20 CFR 416.926a(g)-(k). We include 
examples of work and work-related activities in the sections 
describing the domains for adolescents.

I. Sources of Evidence About a Young Adult's Ability To Work

    Once we have evidence from an acceptable medical source \17\ that 
establishes the existence of at least one medically determinable 
impairment (MDI), we consider all relevant evidence in the case record 
to determine whether a young adult is disabled. This evidence may come 
from acceptable medical sources and from a wide variety of ``other 
sources.'' \18\ Although we always need evidence from an acceptable 
medical source, we will determine what other evidence we need based on 
the facts of the case.

    \17\ See 20 CFR 404.1513(a) and 416.913(a).
    \18\ See 20 CFR 404.1513(d) and 416.913(d). For more information 
about how we consider opinion evidence from ``other sources,'' 
including opinions about functional limitations, see SSR 06-03p, 71 
FR 45593 (2006), available at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2006-03-di-01.html. For information about how 
we consider opinion evidence from acceptable medical sources, see 
generally 20 CFR 404.1527 and 416.927.

A. Medical Sources

    1. In addition to providing evidence establishing an MDI, 
acceptable medical sources can provide information about how an 
impairment(s) affects a young adult's ability to do work-related 
activities. For example, a physician might discuss the impact of asthma 
on a young adult's participation in physical activities, or a speech-
language pathologist might discuss how a language disorder contributes 
to limited attention and problems on a job.
    2. We may receive evidence from other medical sources who are not 
``acceptable medical sources,'' such as nurse-practitioners, 
physicians' assistants, naturopaths, chiropractors, audiologists, 
occupational therapists (OTs), physical therapists (PTs), and 
psychiatric social workers (PSWs). We cannot use evidence from these 
sources to establish that a young adult has an MDI. However, we can use 
evidence from these sources to determine the severity of the 
impairment(s) and how it affects the young adult's ability to do work-
related activities. This evidence can be very helpful, especially if a 
source sees the young adult regularly. For example:
     A PSW might comment on the young adult's ability to deal 
with changes in a routine work setting.
     An OT or PT might evaluate the impact of a neurological 
disorder on the young adult's activities and comment on muscle tone and 
strength and how it affects his or her ability to stand and walk.
     An OT might comment on the young adult's ability to use 
fine motor skills to use a computer.

B. Non-Medical Sources

    Evidence from other sources who are not medical sources, but who 
know and have contact with the young adult, can also help us evaluate 
the severity and impact of a young adult's impairment(s). These sources 
include family members, educational personnel (for example, teachers 
and counselors), public and private social welfare agency personnel, 
and others (for example, friends, neighbors, and clergy). Therefore, we 
consider evidence in the case record from non-medical sources when we 
determine the severity of the young adult's impairment(s) and how the 
young adult is able to function.

C. School Programs

    Evidence from school programs, including secondary and post-
secondary schools, can also help us evaluate the severity and impact of 
a young adult's impairment(s).
    1. Many young adults who received special education (including 
transition services) or related services \19\ before they attained age 
18 continue to receive these services until they are age 22. Other 
young adults may participate in postsecondary programs, including 
college or vocational training.\20\

    \19\ In this context, special education refers to instructional 
services provided to students through age 21 in primary and 
secondary education under the Individuals with Disabilities 
Education Improvement Act of 2004 (commonly referred to as 
    Transition services means a coordinated set of special education 
services that is designed to facilitate the student's movement from 
school to post-school activities, including postsecondary education, 
vocational education, integrated employment, independent living, or 
community participation. Such services include instruction, related 
services, community services, the development of employment and 
other post-school adult living objectives, and, if appropriate, 
acquisition of daily living skills and provision of a functional 
vocational evaluation.
    Related services include transportation and developmental, 
corrective, and other supportive services (for example, occupational 
therapy) as are required to assist a student with a disability to 
benefit from special education. A student who does not qualify for 
special education may qualify for related services under section 504 
of the Rehabilitation Act of 1973 to ensure a free, appropriate 
public education.
    \20\ The Higher Education Opportunity Act of 2008 authorizes 
postsecondary educational services for students with disabilities.

    2. Young adults who receive special education services after age 17 
will have an Individualized Education Program (IEP),\21\ including an 
IEP transition plan. The IEP transition plan describes a student's 
levels of functioning based on reasonable estimates by both the student 
and the special education team. It also identifies the kinds of 
vocational and living skills the young adult needs to develop in order 
to function independently as an adult.

    \21\ We provide an extensive discussion of IEPs in SSR 09-2p, 74 
FR 7625 (2009), available at: http://www.socialsecurity.gov/OP_Home/rulings/ssi/02/SSR2009-02-ssi-02.html. The information about 
IEPs applies equally to people age 18-22 who are still in special 
education. We may also consider IEPs from a period before the person 
attained age 18 (for example, senior year of high school) if they 
are relevant to the period we are considering in connection with an 
application, age-18 redetermination, or CDR. Recent IEPs will 
frequently be relevant in age-18 redeterminations.

    3. The IEP transition goals may range from the development of 
skills appropriate to supervised and supported work and living settings 
to those needed in independent work and living situations. For example, 
an IEP transition goal for an 18-year-old might be, ``The student will 
independently use public transportation,'' while specific objectives 
would identify the skills to be developed (for example, reading a bus 
schedule) and the particular instruction methods to be used to develop 
the skills (for example, one-to-one tutoring with practice reading a 
bus schedule).
    4. The goals in an IEP may be set at a level that the young adult 
can readily achieve to foster a sense of accomplishment and may be 
lower than what would be expected of a young adult without impairments. 
In this regard:
     A young adult who achieves a goal may or may not have 
limitations. The young adult may be developing or acquiring skills at a 
slower rate than young adults without impairments and may have achieved 
the goal simply because it was set low.
     A young adult who does not achieve a goal likely has an 
impairment-related limitation(s). A young adult's failure to achieve a 
goal, however, does not, by itself, establish that the impairment(s) is 

II. Considerations Related To Evaluating a Young Adult's Impairment-
Related Limitations

    We evaluate a young adult's impairment-related limitations when we:
     Determine whether his or her MDI(s) is ``severe''--that 
is, significantly limits his or her physical or mental ability to do 
basic work activities;
     Determine whether his or her MDI(s) meets or medically 
equals a listed impairment; and
     Assess his or her RFC.
    The examples in the sections below do not necessarily establish 
that a young

[[Page 56266]]

adult is disabled, only that the person may have limitations that 
affect what work he or she may be able to do.

A. Evidence Regarding Functioning From Educational Programs

    As we discussed in section I.C above, we may have evidence about a 
young adult's functioning from school programs, including IEPs. This 
evidence may indicate how well a young adult can use his or her 
physical or mental abilities to perform work activities. The following 
examples of school-reported difficulties might indicate difficulty with 
work activities:
     Difficulty in understanding, remembering, and carrying out 
simple instructions and work procedures during a school-sponsored work 
     Difficulty communicating spontaneously and appropriately 
in the classroom;
     Difficulty with maintaining attention for extended periods 
in a classroom;
     Difficulty relating to authority figures and responding 
appropriately to correction or criticism during school or a work-study 
     Difficulty using motor skills to move from one classroom 
to another.

B. Community Experiences, Including Job Placements

    1. A young adult may receive services in a community setting(s) 
through a school or a community agency, such as a mental health center 
or vocational rehabilitation agency. These services may include:
     Community-based instruction (CBI), or instruction in a 
natural, age-appropriate setting (for example, trips to the grocery 
store to develop math, sequencing, travel, and social skills).
     On-the-job training (OJT), or placement in various work 
sites in the community for vocational training and experience, 
frequently in an ``enclave'' (small group) of students with a job coach 
(for example, placement in an enclave in a motel to learn housekeeping 
tasks such as bed-making and vacuuming).
     Work experience, or supervised part-time or full-time 
employment to assist a young adult in acquiring job skills and good 
work attitudes and habits.
    2. A young adult may participate in several--or even many--OJT or 
work experience placements that are unpaid, paid at SGA levels, or paid 
at less than SGA levels. Some young adults have multiple placements as 
part of a transition plan that expose them to a variety of work 
settings. Other young adults have multiple placements because of 
unsatisfactory performance.
    Regardless of whether the work was SGA, information about how well 
a young adult performed in these placements can help us assess how the 
young adult functions. For example, a young adult who was unable to 
sustain OJT placements may have limitations in the ability to 
understand and remember instructions or to persist at work-related 
tasks. In contrast, a young adult who performed OJT placements 
successfully may have a good ability to respond appropriately to 
supervision. In addition, information about the degree to which a young 
adult needs special supports in order to work (such as in supported or 
transitional employment programs) may also help us assess the young 
adult's functioning.

C. Psychosocial Supports and Highly Structured or Supportive Settings

    As for all adults, psychosocial supports and highly structured or 
supportive settings may reduce the demands on a young adult and help 
him or her function. However, the young adult's ability to function in 
settings that are less demanding, more structured, or more supportive 
than those in which people typically work does not necessarily show how 
the young adult will be able to function in a work setting. We will 
consider the kind and extent of support or assistance and the 
characteristics of any structured setting in which the young adult 
spends his or her time when we evaluate the effects of his or her 
impairment(s) on functioning.

D. Extra Help and Accommodations

    Working requires a person to be able to do the tasks of a job 
independently, appropriately, effectively, and on a sustained basis. In 
this regard, the analysis for adult disability determination purposes 
is similar to our ``extra help'' rules for children.\22\ If an adult 
with an impairment(s) needs or would need greater supervision or 
assistance, or some other type of accommodation, because of the 
impairment(s) than an employee who does not have an impairment, the 
adult has a work-related limitation.

    \22\ See, 20 CFR 416.924a(b)(5)(ii).

    We consider how independently a young adult is able to function, 
including whether the young adult needs help from other people or 
special equipment, devices, or medications to perform day-to-day 
activities. If a young adult can function only if he or she receives 
more help than would generally be provided to people without medical 
impairments, we consider how well the young adult would function 
without the extra help. The more extra help or support of any kind that 
a young adult receives because of his or her impairment(s), the less 
independent he or she is in functioning, and the more severe we will 
find the limitation to be.
1. Accommodations
    a. Accommodations are practices and procedures that allow a person 
to complete the same activity or task as other people. Accommodations 
can include a change in setting, timing, or scheduling, or an assistive 
or adaptive device.
    b. Some young adults with impairments need accommodations in their 
educational program in order to participate in the general curriculum 
or in a transitional program.\23\ The fact that a young adult receives 
or has received accommodations as a part of his or her IEP or Section 
504 plan,\24\ may be an indication that he or she has a work-related 
limitation. For example, evidence showing that a student requires an 
audiotape recording of oral directions for replay at school because he 
cannot remember more than a one-step instruction might indicate that 
the student will have the same inability to remember more than a one-
step instruction without special assistance in a work setting.

    \23\ We provide more detail about accommodations in IEPs in SSR 
    \24\ Section 504 of the Rehabilitation Act of 1973 prohibits 
discrimination on the basis of disability in programs and activities 
that receive Federal financial assistance. P.L. 93-112, section 504; 
29 U.S.C. 794(a), as amended. Under this section, schools must 
provide a free, appropriate public education to each student with a 
disability. See 34 CFR 104.33(a). When a student has a disability 
that limits his or her access to the educational setting, the school 
will conduct an evaluation of specific areas of educational need 
and, if necessary, have a written plan for the aids and services 
that will be provided.

    c. Some accommodations may indicate an impairment(s) that meets or 
medically equals a listing. For example, the need for an augmentative 
or alternative communication or AAC device (for example, an electronic 
picture board or an electrolarynx) might indicate a speech impairment 
that meets listing 2.09 or an impairment that meets one of the 
neurological listings in section 11.00 of the listings.
    d. When we determine whether a person can perform his or her past 
relevant work, we do not consider potential accommodations unless his 
or her employer actually made the accommodation. This means that we 
cannot find that a young adult can do past relevant work with 
accommodations unless the young adult

[[Page 56267]]

actually performed that work with those same accommodations and is 
still able to do so now.
    e. When we determine whether a person can do other work that exists 
in significant numbers in the national economy, we do not consider 
whether he or she could do so with accommodations, even if an employer 
would be required to provide reasonable accommodations under the 
Americans with Disabilities Act of 1990.\25\

    \25\ The Americans with Disabilities Act of 1990 requires an 
employer to provide ``reasonable accommodations'' to a qualified 
person with a disability. See Sec.  101, 104 Stat. 331, 42 U.S.C. 
12111(9); and SSR 00-1c, 65 FR 1215 (2000), available at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2000-01-di-01.html.

2. Effects of Treatment, Including Medications
    Treatment, including medications, can have a positive effect on a 
person's ability to function in a work setting. For example, a young 
adult who takes an antidepressant medication may be able to interact 
appropriately with supervisors and co-workers. Treatment, however, may 
not resolve all of the functional limitations that result from an 
impairment(s). Medications or other treatment may cause side effects 
that affect the mental or physical ability to work. For example, an 
anti-epileptic medication may cause drowsiness that affects the ability 
to concentrate; daily chest percussion therapy for cystic fibrosis may 
cause fatigue because of the physical effort involved in the therapy. 
The frequency of a young adult's treatment may preclude him or her from 
maintaining a full-time work schedule; that is, 8 hours a day, 5 days a 
week on a sustained basis.

E. Work-Related Stress

    1. Working involves many factors and demands that can be stressful. 
For example, some people may experience stress related to the demands 
of getting to work regularly, having work performance supervised, or 
remaining in the workplace for a full day, 5 days a week on a sustained 
basis. Moreover, one person's reaction to stress associated with the 
demands of work may be different from another's, even among people with 
the same impairments.
    2. Sources familiar with the young adult may provide insight about 
the effect of stress on his or her physical or mental functioning and 
what, if any, psychosocial supports or structure he or she would need 
when experiencing work-related stress.\26\ We consider impairment-
related limitations created by a person's response to the demands of 
work when we assess RFC.

    \26\ See SSR 85-15 for further discussion of mental disorders 
and stress. SSR 85-15 is available at: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR85-15-di-02.html.

III. Insured Status for Young Adults

    A. When a young adult has worked, we consider whether he or she is 
insured for purposes of establishing a period of disability or becoming 
entitled to disability insurance benefits. While the Social Security 
Act provides the standard for determining insured status for young 
adults aged 21 up to age 24, there is no similar statutory standard for 
young adults under the age of 21. We use the same rule for both 
groups--a young adult meets the disability insured status requirements 
if he or she has 6 quarters of coverage in the 12-quarter period ending 
with the quarter in which the disability began.\27\

    \27\ Claimants age 24 to the attainment of age 31 meet the 
disability insured status requirement when they have quarters of 
coverage in at least one-half of the quarters beginning with the 
quarter after the quarter they attained age 21 and ending with the 
quarter in which disability began. For example, a claimant who 
becomes disabled in the quarter in which he or she attains age 25 
needs 8 quarters of coverage during the 16 quarters ending in the 
quarter in which he or she became disabled. If the number of 
quarters in the period we are considering is an odd number, we 
reduce it by one to determine how many quarters of coverage the 
young adult needs. See 20 CFR 404.130(c).

    B. When our records do not establish disability insured status but 
the claimant alleges sufficient work and earnings for that purpose, we 
will look to see if there are any covered earnings that are not yet 
shown in our records. Covered earnings from an unsuccessful work 
attempt may also provide work credits that can establish disability 
insured status.

IV. Determining Disability

 A. Determining Whether a Young Adult's Work Activity is SGA \28\

    \28\ The SGA step of the sequential evaluation process applies 
only to applications under titles II and XVI and to CDRs under title 
II. We do not consider the SGA step in age-18 redeterminations or in 
title XVI CDRs. See 20 CFR 416.987(b) for the rules on determining 
disability in age-18 redeterminations. See 20 CFR 416.994(b)(5) for 
the sequential evaluation process for title XVI CDRs for adults.

    When we determine a young adult's earnings for SGA purposes, we 
count only those earnings that are attributable to his or her own 
productivity. We assume that a young adult's reported earnings are 
attributable to his or her own productivity unless there is evidence 
indicating that those earnings are greater than would be attributable 
to his or her productivity.
1. Work Activity
    Many young adults with disabilities have worked. The work 
experience may have been (or may be, if the person is still working) 
subsidized, in a sheltered setting, or performed under special 
conditions. As for any adult, we exclude subsidized earnings.\29\ In 

    \29\ See 20 CFR 404.1574 and 416.974 for evaluating work as an 
employee and 20 CFR 404.1575 and 416.975 for work in self-
employment. See also SSR 83-33, and SSR 83-34. SSR 83-33 is 
available at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR83-33-di-03.html; SSR 83-34 is available at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR83-34-di-03.html.

     Some young adults whose impairments arose during military 
service continue on active duty and receive full pay while they are in 
treatment for their impairments. They may also receive payments while 
working in a designated therapy program or on limited duty. Active duty 
status or receipt of pay (for example, sick pay) by a member of the 
military does not indicate by itself that the service person has 
demonstrated the ability to do SGA. We will consider the actual work 
activity, not the amount of pay the service person receives or the duty 
status of the service person, when we determine whether the work is 

    \30\ See 20 CFR 404.1574(a)(3) and 416.974(a)(3) and SSR 84-24: 
Titles II and XVI. SSR 84-24 is available at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR84-24-di-03.html.

     Young adults may have impairment-related work expenses; 
that is, expenses for an item or service that directly enables a person 
to work and that the person necessarily incurs because of an 
impairment(s). We deduct impairment-related work expenses from a 
person's wages or self-employment income before we determine whether 
the wages or self-employment income constitute SGA.\31\

    \31\ See 20 CFR 404.1576 and 416.976 and SSR 84-26. SSR 84-26 is 
available at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR84-26-di-03.html.

2. Volunteer Service
    Young adults with disabilities may participate in government-
sponsored programs for volunteer activity, such as AmeriCorps VISTA. We 
do not count as earnings payments a person receives from some of these 

    \32\ See 20 CFR 404.1574(d), 416.974(d), and SSR 84-24.

3. Unsuccessful Work Attempts
    Some people have brief periods of work with earnings at the SGA 
level. We will consider the possibility that a brief period of work was 
an unsuccessful work attempt when we are determining whether the work 
was SGA. If a period

[[Page 56268]]

of work is an unsuccessful work attempt, we will not consider that work 
to be SGA when we determine if the young adult is under a 
disability.\33\ However, as we noted in section III.A, covered wages or 
self-employment income from an unsuccessful work attempt may provide 
work credits that establish disability insured status under title II.

    \33\ See 20 CFR 404.1574(c) and 416.974(c) for employees and 
404.1575(d) and 416.975(d) for self-employed; see also SSR 84-25 and 
SSR 05-2, 70 FR 9692 (2005). SSR 84-25 is available at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR84-25-di-03.html; SSR 05-02 is 
at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR2005-02-di-03.html.

B. Determining Whether the Young Adult Has an MDI(s)

    Young adults often have the same kinds of impairments as children; 
for example, attention deficit/hyperactivity disorder, language 
disorders, or learning disorders. Sometimes, the impairment may be 
evident before age 18; at other times, the impairment may not be 
identified until later. We will consider all MDIs the young adult has, 
including MDIs that are usually found in children.

C. Determining Whether a Young Adult Can Do Past Relevant Work

    Many young adults have performed work that was SGA for at least 
brief periods. This work will usually meet the 15-year recency test for 
past relevant work. If the work also lasted long enough for the young 
adult to learn to do it, it will be past relevant work.\34\ We do not 
consider work done during a period of entitlement to disability 
benefits under title II or title XVI to be past relevant work; \35\ 
however, we may consider the young adult's job performance when we 
assess his or her RFC.

    \34\ 20 CFR 404.1560 and 416.960; see also SSR 82-61 and SSR 82-
62. SSR 82-61 is available at: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR82-61-di-02.html; SSR 82-62, at: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR82-62-di-02.html.
    \35\ 20 CFR 404.1594(i) and 416.994(b)(8)

D. Determining Whether a Young Adult Can Adjust to Other Work

    1. As for any adult, we consider a young adult's RFC, age, 
education, and work experience to determine if he or she can make an 
adjustment to other work. A young adult does not need to have an 
impairment(s) that meets or medically equals a listing to qualify for 
disability benefits. We may find that a young adult is disabled because 
of an inability to adjust to other work.
    2. When a young adult has only exertional (strength) limitations 
and has an RFC and vocational factors that match the criteria of a rule 
in the Medical-Vocational Guidelines in appendix 2 of subpart P of the 
Regulations No. 4 (grid rules), the grid rules always direct a decision 
of ``not disabled'' for young adults.
    3. In many young adult cases, however, the grid rules will not 
direct a conclusion of ``disabled'' or ``not disabled.'' For example, 
many young adults who qualify for disability benefits have impairments 
(such as mental and neurological disorders) that cause non-exertional 
limitations. These limitations may erode the occupational base at some, 
or even all, levels of exertion.\36\ Other young adults have solely 
exertional limitations but are unable to do a full range of work in one 
of the exertional categories in appendix 2. Some young adults have 
limitations that prevent them from performing even the full range of 
sedentary work. In these cases, we consider the type and extent of the 
young adult's limitations and the extent of the erosion of the 
occupational base and other relevant factors. The following guidelines 

    \36\ See 20 CFR 404.1545(c) and 416.945(c).

    a. If the young adult has solely exertional limitations but is able 
to do somewhat more than the full range of sedentary work, the young 
adult will not be disabled based on a framework of a grid rule. In this 
case, the exertional capacity will always fall between two rules (that 
is, a sedentary and a light rule) that direct a conclusion of ``not 
disabled.'' \37\

    \37\ See 20 CFR 404.1569 and 416.969 and SSR 83-14. SSR 83-14 is 
available at: http://www.ssa.gov/OP_Home/rulings/di/02/SSR83-14-di-02.html.

    b. If a young adult has solely nonexertional limitations or both 
exertional and nonexertional limitations, we follow the guidance in the 
regulations and the relevant SSRs to determine any erosion of the 
occupational base.\38\ If the occupational base is significantly 
eroded, we will find the young adult disabled despite his or her young 

    \38\ See, for example, SSRs 83-12; 83-14; 85-15; and 96-9p, 61 
FR 34478 (1996). SSR 83-12 is available at: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR83-12-di-02.html; 
SSR 96-9p, at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR96-09-di-01.html.
    \39\ See 20 CFR part 404, subpart P, appendix 2, Sec.  
201.00(h)(3) and SSR 96-9p.

    c. If a young adult has a substantial loss of one or more of the 
basic mental demands of competitive, remunerative, unskilled work, the 
occupational base will be significantly eroded, despite vocational 
factors that we would ordinarily consider favorable (for example, young 
age, college education, and skilled work experience).\40\ The basic 
mental demands of competitive, remunerative, unskilled work include the 
abilities to:

    \40\ See SSR 85-15 and SSR 96-9p.

     Understand, remember, and carry out instructions;
     Make simple work-related judgments typically required for 
unskilled work;
     Respond appropriately to supervision, coworkers, and work 
situations; and
     Deal with changes in a routine work setting.
    d. Adjudicators must remember that young adults are more likely to 
have recent educational experience that provides for direct entry into 
skilled work; some will also have vocational experiences (see section 
C. above) that provide them with skills they can use in skilled or 
semiskilled work.
    4. A young adult needs only basic communication abilities to do 
unskilled work.\41\ Basic communication abilities include the ability 
to hear and understand simple oral messages, including instructions, 
and to communicate simple messages orally. If the person has these 
basic communication abilities, there will not be a significant impact 
on the unskilled occupational base.

    \41\ See SSR 96-9p.

    a. Nevertheless, when a person has a physical or mental 
impairment(s) that affects communication, it is important to consider 
the nature of the impairment and whether the person has other 
associated limitations. Many disorders that cause limitations in basic 
communication may cause other limitations as well. For example, a 
physical disorder like cerebral palsy that can affect a person's facial 
muscles and limit the ability to communicate simple messages orally may 
also affect the arm muscles and limit the ability to lift and carry. 
Language disorders, as well as mental and neurological impairments 
commonly found in young adults who allege disability, may also cause 
limitations in abilities such as the ability to concentrate, persist, 
or maintain pace in job tasks, and the ability to adapt to changes in a 
work setting.
    b. Language disorders are not the only kinds of impairments that 
can affect communication. Some physical impairments may also affect 
communication, particularly speech. For example, congenital or acquired 
facial deformities may affect speech because a person cannot use his or 
her facial muscles for articulation; cerebral palsy may affect speech 
because of muscle spasms that make it difficult to speak clearly.

[[Page 56269]]

    5. Under the grid rules, we find younger individuals not disabled 
even if we determine that their vocational factor of education is 
    a. However, a young adult's educational level can be an indication 
of an underlying impairment(s) that affects our assessment of RFC.\42\ 
For example, if a young adult, despite having attended high school, is 
illiterate or has a limited reading ability, he or she may have an MDI, 
such as a learning disability or language disorder. Any such underlying 
MDI may affect a young adult's RFC. As we noted in Section III.F.4.b, 
these types of disorders can cause limitations in many areas.


    b. When illiteracy or limited reading ability is related to an MDI, 
we consider how the underlying MDI affects the person's ability to meet 
the requirements of work when we assess RFC. For example, a person who 
has borderline intellectual functioning (BIF) may be limited in her 
ability to understand and remember instructions, which results in an 
inability to read and write. The BIF also affects her ability to 
maintain attention on tasks that she has difficulty remembering. When 
we assess her RFC, we assess limitations in maintaining attention as 
well as in understanding and remembering instructions. When we 
determine whether she can do other work, we consider the vocational 
factor of illiteracy.\43\

    \43\ The impairment need not be mental. The same principles 
apply to adults as in the 2009 SSRs for children. Those SSRs provide 
examples of how physical impairments, especially neurological 
impairments and their associated medical treatments, can affect 
various functional abilities.

E. Additional considerations for age-18 redeterminations

1. Young Adult Previously Found Disabled as a Child Under a Listing 

    \44\ See 20 CFR 404.1525(b) and 416.925(b). When we are making a 
disability determination or decision under title II for a person 
under age 18, we consider part B of the listings until the person 
attains age 18. We may also consider part A for the period before 
the person attains age 18 if there is no appropriate part B listing 
and the disease processes have a similar effect on adults and 
children. As for all adults, we use only part A of the Listing of 
Impairments when we determine whether a young adult's impairment(s) 
meets or medically equals a listing. We never use part B listings 
for people who are at least 18 years old.

    a. Although our rules use different words to describe the concept, 
``listing-level severity'' is generally the same for both parts A and B 
of the listings. Most of the part B listings have an equivalent listing 
in part A, and many contain identical criteria. Listings that include 
functioning among their criteria are generally based on a standard of 
``extreme'' limitation in a specific function (such as walking) or in a 
broad area (domain) of functioning (such as concentration, persistence, 
or pace), or on ``marked'' limitations in two areas of functioning.
    b. While the areas of functioning may differ between analogous 
listings in parts A and B, we intend for these criteria to be equally 
severe. Therefore, a child's impairment(s) that met or medically 
equaled a part B listing will often meet or medically equal a part A 
listing at age 18 unless the impairment(s) has medically improved. Note 
though that we do not use the medical improvement review standard for 
CDRs in age-18 redeterminations.\45\

    \45\ A young adult who was eligible for disability benefits 
under title XVI may also file an application under title II; for 
example, for Child's Insurance Benefits based on disability. The 
same principle applies in such claims.

2. Young Adult Previously Found Disabled as a Child Based on Functional 
    a. To functionally equal the listings under title XVI, a child's 
impairment(s) must result in ``marked'' limitations in two of the 
childhood domains or an ``extreme'' limitation in one.\46\ Although we 
do not use these domains for adults, they describe aspects of 
functioning that are relevant to our evaluation of a young adult's 
work-related limitations. We use similar domains when we evaluate a 
child's mental impairments and some physical impairments, such as 
immune disorders. We may find that the young adult has the same 
severity rating for a domain under a part A listing as he or she had as 
a child under a similar functional equivalence domain. For example, 
absent medical improvement or new evidence demonstrating that the prior 
finding was in error, a young adult who had an extreme limitation in 
the ability to interact and relate with others as a child will probably 
have extreme limitation in social functioning as an adult. Similarly, 
unless the impairment(s) has improved or there is new evidence 
indicating that the prior finding was in error, a finding of marked 
limitation in the ability to attend and complete tasks as a child is 
likely to translate to a marked limitation in the ability to 
concentrate, persist, or maintain pace in work-related task completion 
as an adult.

    \46\ See 20 CFR 416.926a for the rules on functional 
equivalence, including a description of the six domains we use.

    b. The broad domains of functioning we used to evaluate a child's 
impairment-related limitations may also provide guidance for findings 
about a young adult's RFC on redetermination. Accordingly, it is 
important to remember that the descriptions of the childhood functional 
equivalence domains in the regulations include work-related functions 
for adolescents, defined as children age 12-18.\47\

    \47\ See generally 20 CFR 416.926a(g)-(l). See also the examples 
of typical functioning and limitations in SSRs 09-3 through 09-7 and 
the examples of limitations in SSR 09-8 (citations at the end of 
this SSR). These rulings are available at: http://www.ssa.gov/OP_Home/rulings/rulfind1.html#YRT2009.

V. Continued Payments for Young Adults Participating in a Vocational 
Rehabilitation or Similar Program \48\ (``Section 301'') \49\

    \48\ See 20 CFR 404.316(c), 404.352(d), 416.1320(d), and 
    \49\ We commonly refer to this provision as ``Section 301'' 
because the initial legislative authority for continued payment of 
benefits was provided in Section 301 of the Social Security 
Disability Amendments of 1980 (Pub. L. 96-265).

    A. When we determine that a young adult is no longer disabled due 
to medical improvement, we will continue payments if:
    (1) He or she is participating in the Ticket to Work and Self-
Sufficiency program or another appropriate program of vocational 
rehabilitation (VR), employment, or other support services \50\; and

    \50\ See 20 CFR 404.327(a) and 416.1338(c).

    (2) Completion of the program or continued participation for a 
specified period will increase the likelihood that he or she will not 
return to the disability or blindness benefit rolls.\51\

    \51\ See 20 CFR 404.328 and 416.1338(e).

    The title XVI provision for Section 301 payments also applies to a 
person age 18 or older whose disability has ended as a result of a 
title XVI age-18 redetermination.\52\

    \52\ See 20 CFR 416.1338(a).

B. Likelihood Determination

    1. When a young adult is a student age 18 through 21 participating 
in an IEP under the provisions of the IDEA, we will find that 
completion of or continuation in the IEP will increase the likelihood 
that he or she will not return to the disability or blindness benefit 
rolls.\53\ In this circumstance, we will continue benefit payments 
until the IEP is completed or the person stops participating in the IEP 
for any reason.

    \53\ See 20 CFR 404.328(b) and 416.1338(e)(2).

    2. When a young adult is participating in another appropriate 
program, we will find that completion of or continuation in that 
program will increase the likelihood that the person will not return to 
the disability or blindness benefit rolls if the program provides the 
person with:

[[Page 56270]]

    a. Work experience that will increase the likelihood of doing past 
relevant work; or,
    b. Education or skilled or semi-skilled work experience that will 
increase the likelihood of adjusting to other work.\54\

    \54\ See 20 CFR 404.328(a) and 416.1338(e)(1).

    For example, the young adult is in a VR-sponsored training program 
to become a certified computer technician. She is acquiring computer 
skills that will permit direct entry into semiskilled or skilled 
occupations, thus increasing her overall ability to adjust to other 
work. We would determine that the training program would increase the 
likelihood that she will not return to the disability or blindness 
benefit rolls.

VI. Resolving Inconsistencies in the Evidence

    We evaluate relevant evidence for consistency and resolve any 
inconsistencies that need to be resolved.
    1. After reviewing all of the relevant evidence, we determine 
whether there is sufficient evidence to make a finding about 
disability. ``All of the relevant evidence'' means:
     The relevant objective medical evidence and other relevant 
evidence from medical sources;
     Relevant information from other sources, such as school 
teachers, family members, or friends;
     The claimant's statements (including statements from the 
young adult's roommates or family members); and
     Any other relevant evidence in the case record, including 
how the young adult functions over time and across settings.
    2. If there is sufficient evidence and there are no inconsistencies 
in the case record, we will make a determination or decision. If there 
are inconsistencies in the record, we may be able to make a 
determination or decision if the majority of the evidence or the most 
probative evidence outweighs the inconsistent evidence, and additional 
information would not change the determination or decision.
    3. An inconsistency is not ``material'' if it would not affect the 
outcome of the case or any of the major findings. If we can make a 
fully favorable decision despite the inconsistent evidence, that 
inconsistency would be immaterial. For example, if a young adult has a 
digestive disorder that causes weight loss, and one piece of evidence 
shows a Body Mass Index (BMI) of 16.75 and another a BMI of 17.00, the 
inconsistency is not material because we would find that the young 
adult's impairment(s) meets listing 5.08 based on either BMI.
    4. An inconsistency could also be immaterial in an unfavorable 
determination or decision when resolution of the inconsistency would 
not affect the outcome. This could occur, for example, if there is 
inconsistent evidence about a limitation in a specific work-related 
activity; for example, whether the person is able to climb ladders. If 
the person's overall exertional level was consistent with sedentary 
work, the ability (or inability) to climb a ladder would not reduce the 
number of sedentary occupations he or she could do.
    5. An apparent inconsistency is not always a true inconsistency. 
For example, the record for a young adult with attention-deficit/
hyperactivity disorder may include good, longitudinal evidence of 
hyperactivity at home, in the classroom, and on work experience 
placements in the classroom, but show a lack of hyperactivity during a 
consultative examination (CE). The observations during the CE may 
represent a ``good'' day, rather than the overall level of functioning 
or the effect of an unusual setting.\55\ In this case, there would be 
only a normal variation in functioning at the time of the CE.

    \55\ See section 12.00C.3 of the listings. Accepting the 
observation of the young adult's behavior or performance in an 
unusual setting, like a CE, without considering the rest of the 
evidence could lead to an erroneous conclusion about the young 
adult's overall functioning.

    6. In all other cases in which the evidence is insufficient, 
including when a material inconsistency exists that we cannot resolve 
based on an evaluation of all of the relevant evidence in the case 
record, we will try to complete the record by requesting additional or 
clarifying information.\56\

    \56\ See 20 CFR 404.1527(c) and 416.927(c).

    Effective Date: This SSR is effective on September 12, 2011.
    Cross-References: SSR 82-61: Title 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 83-12: Titles II and XVI: Capability To Do Other 
Work--The Medical-Vocational Rules as a Framework for Evaluating 
Exertional Limitations Within a Range of Work or Between Ranges of 
Work; SSR 83-14: Titles II and XVI: Capability To Do Other Work--The 
Medical-Vocational Rules as a Framework for Evaluating a Combination of 
Exertional and Nonexertional Impairments; SSR 83-33: Titles II and XVI: 
Determining Whether Work is Substantial Gainful Activity--Employees; 
SSR 83-34: Titles II and XVI: Determining Whether Work Is Substantial 
Gainful Activity--Self-Employed Persons; SSR 84-24: Titles II and XVI: 
Determination of Substantial Gainful Activity for Persons Working in 
Special Circumstances--Work Therapy Programs in Military Service--Work 
Activity in Certain Government-Sponsored Programs; SSR 84-25: Titles II 
and XVI: Determination of Substantial Gainful Activity If Substantial 
Work Activity Is Discontinued or Reduced--Unsuccessful Work Attempt; 
SSR 84-26: Titles II and XVI: Deducting Impairment-Related Work 
Expenses from Earnings in Determinations as to Substantial Gainful 
Activity Under Titles II and XVI and as to Countable Earned Income 
Under Title XVI; SSR 85-15: Titles II and XVI: Capability To Do Other 
Work--The Medical-Vocational Rules as a Framework for Evaluating Solely 
Nonexertional Impairments; 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 a 
Residual Functional Capacity for Less Than a Full Range of Sedentary 
Work; SSR 00-1c: Sections 222(c) and 223(a), (d)(2)(a), and (e)(1) of 
the Social Security Act (42 U.S.C. 422(c) and 423(a), (d)(2)(A), and 
(e)(1)) Disability Insurance Benefits--Claims Filed Under Both the 
Social Security Act and the Americans with the Disabilities Act; SSR 
05-2: Titles II and XVI: Determination of Substantial Gainful Activity 
if Substantial Work Activity is Discontinued or Reduced--Unsuccessful 
Work Attempt; SSR 06-03p: Titles II and XVI: Considering Opinions and 
Other Evidence from Sources Who Are Not ``Acceptable Medical Sources'' 
in Disability Claims; Considering Decisions on Disability by Other 
Governmental and Nongovernmental Agencies; SSR 09-2p: Title XVI: 
Determining Childhood Disability--Documenting a Child's Impairment-
Related Limitations; SSR 09-3p: Title XVI: Determining Childhood 
Disability--The Functional Equivalence Domain of ``Acquiring and Using 
Information''; SSR 09-4p: Title XVI: Determining Childhood Disability--
The Functional Equivalence Domain of ``Attending and Completing 
Tasks''; SSR 09-5p: Title XVI: Determining Childhood Disability--The 
Functional Equivalence Domain of ``Interacting and Relating with 
Others''; SSR 09-6p: Title XVI: Determining Childhood Disability--The 
Functional Equivalence Domain of ``Moving About and Manipulating 
Objects''; SSR 09-7p: Title XVI: Determining Childhood Disability--The 
Functional Equivalence

[[Page 56271]]

Domain of ``Caring for Yourself''; SSR 09-8p: Title XVI: Determining 
Childhood Disability--The Functional Equivalence Domain of ``Health and 
Physical Well-Being''; Program Operations Manual System (POMS) RS 
00301.120, RS 00301.140, DI 10501.055, DI 10505.00 ff., DI 10510.000 
ff., DI 10520.000 ff., DI 11070.001--DI 11070.010, DI 11070.030, DI 
14510.000 ff., DI 22001.001--DI 22001.035, DI 23570.010, DI 23570.020, 
DI 24510.000 ff., DI 25015.000 ff., DI 25020.000 ff., and DI 
28005.001--DI 28005.017.

[FR Doc. 2011-23239 Filed 9-9-11; 8:45 am]