[Federal Register Volume 82, Number 57 (Monday, March 27, 2017)]
[Notices]
[Pages 15263-15265]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-05959]


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SOCIAL SECURITY ADMINISTRATION

[Docket No. SSA-2012-0035]


Social Security Ruling (SSR) 17-2p: Titles II and XVI: Evidence 
Needed by Adjudicators at the Hearings and Appeals Council Levels of 
the Administrative Review Process To Make Findings About Medical 
Equivalence

AGENCY: Social Security Administration.

ACTION: Notice of Social Security Ruling (SSR).

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SUMMARY: We are providing notice of SSR 17-2p. This SSR provides 
guidance about how adjudicators at the hearings and Appeals Council 
(AC) levels of the administrative review process make findings about 
medical equivalence in disability claims under titles II and XVI of the 
Social Security Act.

DATES: Effective Date: March 27, 2017.

FOR FURTHER INFORMATION CONTACT: Joshua Silverman, Office of Disability 
Policy, Social Security Administration, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, (410) 594-2128. For information on 
eligibility or filing for benefits, call our national toll-free number 
1-800-772, 1213, or TTY 1-800-325-0778, or visit our Internet site, 
Social Security Online, at http://www.socialsecurity.gov.

SUPPLEMENTARY INFORMATION: Although 5 U.S.C. 552(a)(1) and (a)(2) do 
not require us to publish this SSR, we are doing so 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, and special veterans benefits programs. 
We may base SSRs on determinations or decisions made at

[[Page 15264]]

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.
    Although SSRs do not have the same force and effect as statutes or 
regulations, they are binding on all components of the Social Security 
Administration. 20 CFR 402.35(b)(1).
    This SSR will remain in effect until we publish a notice in the 
Federal Register that rescinds it, or we publish a new SSR that 
replaces or modifies it.

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

Nancy A. Berryhill,
Acting Commissioner of Social Security.
POLICY INTERPRETATION RULING
Social Security Ruling, SSR 17-2p: Titles II and XVI: Evidence Needed 
by Adjudicators at the Hearings and Appeals Council Levels of the 
Administrative Review Process to Make Findings about Medical 
Equivalence.
    This Social Security Ruling (SSR) rescinds and replaces SSR 96-6p: 
``Titles II and XVI: Consideration of Administrative Findings of Fact 
by State Agency Medical and Psychological Consultants and Other Program 
Physicians and Psychologists at the Administrative Law Judge and 
Appeals Council Levels of Administrative Review; Medical Equivalence.''
    PURPOSE: This SSR provides guidance on how adjudicators at the 
hearings and Appeals Council (AC) levels of our administrative review 
process make findings about medical equivalence in disability claims 
under titles II and XVI of the Social Security Act (Act).
    CITATIONS: Sections 216(i), 223(d), and 1614(a) of the Act, as 
amended; 20 CFR 404.1526 and 416.926.
    BACKGROUND:

The Sequential Evaluation Process

    We use a five-step sequential evaluation process to determine 
whether an adult is disabled under titles II or XVI of the Act.\1\ We 
use a different process to decide whether a child is disabled under 
title XVI of the Act.\2\ In both situations, if we can find an 
individual is disabled at a step, we make a determination or decision 
at that step and do not go on to the next step.\3\
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    \1\ See 20 CFR 404.1520 and 416.920.
    \2\ See 20 CFR 416.924.
    \3\ See 20 CFR 404.1520(a)(4) and 416.920(a)(4).
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    At step 3 of the sequential evaluation process for determining 
disability in adult and child claims, we make a medical assessment to 
determine whether an individual's impairment(s) meets a listing in the 
Listing of Impairments (listings).\4\ If an individual's impairment(s) 
meets all the criteria of any listed impairment in the listings, we 
will find that the individual is disabled. If an individual has an 
impairment(s) that does not meet all of the requirements of a listing, 
we then determine whether the individual's impairment(s) medically 
equals a listed impairment. An impairment is medically equivalent to a 
listed impairment if it is at least equal in severity and duration to 
the criteria of any listed impairment. We can find medical equivalence 
in three ways:
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    \4\ 20 CFR part 404, subpart P, Appendix 1.
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    1. If an individual has an impairment that is described in the 
listings, but either:
    a. the individual does not exhibit one or more of the findings 
specified in the particular listing, or
    b. the individual exhibits all of the findings, but one or more of 
the findings is not as severe as specified in the particular listing,
    then we will find that his or her impairment is medically 
equivalent to that listing if there are other findings related to the 
impairment that are at least of equal medical significance to the 
required criteria.
    2. If an individual has an impairment(s) that is not described in 
the listings, we will compare the findings with those for closely 
analogous listed impairments. If the findings related to the 
impairment(s) are at least of equal medical significance to those of a 
listed impairment, we will find that the impairment(s) is medically 
equivalent to the analogous listing.
    3. If an individual has a combination of impairments, no one of 
which meets a listing, we will compare the findings with those for 
closely analogous listed impairments. If the findings related to the 
impairments are at least of equal medical significance to those of a 
listed impairment, we will find that the combination of impairments is 
medically equivalent to that listing.\5\
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    \5\ See 20 CFR 404.1526 and 416.926.
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    If we determine an individual's impairment(s) does not meet or 
medically equal a listed impairment, we continue evaluating the claim 
using the sequential evaluation process.\6\
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    \6\ In adult claims, we will determine the individual's residual 
functional capacity and then go to step 4 of the sequential 
evaluation process. See 20 CFR 404.1520 and 416.920. In a child's 
claim under Title XVI, we will determine whether the child's 
impairment(s) functionally equals the Listings at step 3. See 20 CFR 
416.926a.
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Who decides whether an individual's impairment medically equals a 
listing?

    At the initial and reconsideration levels of the administrative 
review process, Federal or State agency Medical Consultants (MC) or 
Psychological Consultants (PC) consider the evidence and make 
administrative medical findings about medical issues, including whether 
an individual's impairment(s) meets or medically equals a listing.\7\ 
MCs and PCs are highly qualified medical sources who are also experts 
in the evaluation of medical issues in disability claims under the Act. 
In most situations,\8\ we require adjudicators at the initial and 
reconsideration levels to obtain MC or PC administrative medical 
findings about medical equivalence.
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    \7\ In some States, we are testing modifications to the 
disability determination procedures that allow disability examiners 
to decide whether an individual's impairment(s) medically equals a 
listing without requiring consultation with an MC or PC, although 
such consultation is permissible. One modification authorizes 
specialized State agency disability examiners called ``single 
decisionmakers'' (SDM) to make initial and reconsideration 
determinations without consulting an MC or PC in some types of 
claims. See 20 CFR 404.906(b)(2) and 416.1406(b)(2). The other 
modification being tested allows disability examiners to make fully 
favorable determinations in quick disability determinations (QDD) 
and compassionate allowance (CAL) claims without requiring 
consultation with an MC or PC because those types of claims involve 
the most obviously disabling impairments. See 20 CFR 404.1615(c)(3) 
and 416.1015(c)(3). In those States using the testing modifications, 
there may not be an MC or PC medical assessment in the file. Both of 
these testing modifications are scheduled to end by the end of 
calendar year 2018. See 81 FR 73027 (2016) and 81 FR 58544 (2016).
    \8\ As stated in the prior footnote, disability examiners are 
not required to obtain MC or PC input about medical equivalence in 
certain SDM claims and in QDD and CAL claims. In those States using 
the testing modifications, there may not be a MC or PC medical 
assessment in the file.
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    At the hearings level of the administrative review process, 
administrative law judges (ALJ) and some attorney advisors \9\ 
determine whether an individual's impairment(s) meets or medically 
equals a listing at step 3 of the sequential evaluation process. To 
assist in evaluating this issue, adjudicators at the hearings level may 
ask for and consider evidence from medical experts (ME) about the 
individual's impairment(s), such as the nature and severity of the 
impairment(s).
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    \9\ See 20 CFR 404.942 and 416.1442.
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    At the AC level of the administrative review process, when the AC 
exercises its authority to issue a decision,\10\ it

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determines whether an individual's impairment(s) meets or medically 
equals a listing. The AC may ask its medical support staff to help 
decide whether an individual's impairment(s) medically equals a 
listing.
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    \10\ The Appeals Council issues decisions in cases after it 
grants a request for review or takes own motion review of a hearing 
decision. See 20 CFR 404.969-970 and 416.1469-1470. The Appeals 
Council may also make a decision after a Federal court remands a 
case. See 20 CFR 404.983 and 416.1483.
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POLICY INTERPRETATION

Evidentiary requirements

    At the hearings level or at the AC level when the AC issues its own 
decision, the adjudicator is responsible for the finding of medical 
equivalence. The adjudicator must base his or her decision about 
whether the individual's impairment(s) medically equals a listing on 
the preponderance of the evidence in the record. To demonstrate the 
required support of a finding that an individual is disabled based on 
medical equivalence at step 3, the record must contain one of the 
following:
    1. A prior administrative medical finding from an MC or PC from the 
initial or reconsideration adjudication levels supporting the medical 
equivalence finding, or
    2. ME evidence, which may include testimony or written responses to 
interrogatories, obtained at the hearings level supporting the medical 
equivalence finding, or
    3. A report from the AC's medical support staff supporting the 
medical equivalence finding.
    When an MC or PC makes administrative medical findings at the 
initial or reconsideration levels, the findings are part of the 
Commissioner's determination; therefore, they are not evidence at that 
level of adjudication.\11\ At subsequent levels of the administrative 
review process, the MCs' or PCs' administrative medical findings made 
at the initial or reconsideration levels are prior administrative 
medical findings, which are evidence.\12\ Although adjudicators at the 
hearings and AC levels are not required to adopt prior administrative 
medical findings when issuing decisions, adjudicators must consider 
them and articulate how they considered them in the decision.\13\
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    \11\ See 20 CFR 404.1513a(a)(1) and 416.913a(a)(1).
    \12\ See 20 CFR 404.1513a(b)-(c) and 416.913a(b)-(c). It is 
possible for an MC or PC to have found that an individual's 
impairment(s) medically equal(s) the requirements of a listed 
impairment(s), but we would still not make a favorable 
determination. For example, we could find that the individual does 
not meet nonmedical requirements for eligibility.
    \13\ See 20 CFR 404.1513a(b)-(c), 404.1520c, 416.913a(b)-(c), 
and 416.920c. In States using the two testing modifications 
discussed in footnote 7, the record may not contain any MC or PC 
prior administrative medical finding about medical equivalence that 
an adjudicator is able to consider. In these situations, the 
adjudicator may find that an individual's impairment(s) medically 
equals a listed impairment using the second or third method, but not 
the first method. In these situations, the adjudicator is not 
required to obtain ME evidence or medical support staff input before 
making a finding that the claimant's impairment(s) do not medically 
equal a listing.
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    When an adjudicator at the hearings level obtains ME testimony or 
written responses to interrogatories about whether an individual's 
impairment(s) medically equals a listing, the adjudicator cannot rely 
on an ME's conclusory statement that an individual's impairment(s) 
medically equals a listed impairment(s). Whether an impairment(s) 
medically equals the requirements of a listed impairment is an issue 
reserved to the Commissioner. If the ME states that the individual's 
impairment(s) medically equals a listed impairment, the adjudicator 
must ask the ME to identify medical evidence in the record that 
supports the ME's statements. Adjudicators will consider ME testimony 
and interrogatories using our rules for considering evidence. The 
adjudicator will then consider whether an individual's impairment(s) 
medically equals a listing using one of the three methods specified in 
20 CFR 404.1526 and 416.926.
    Similarly, when the AC obtains a report from its medical support 
staff to evaluate medical equivalence, the AC retains final 
responsibility for determining whether an individual's impairment(s) 
medically equals a listed impairment. The AC will consider the medical 
support staff's report and all other supporting medical evidence using 
our rules for considering evidence. The AC will then consider whether 
an individual's impairment(s) medically equals a listing using one of 
the three methods specified in 20 CFR 404.1526 and 416.926.
    If an adjudicator at the hearings or AC level believes that the 
evidence does not reasonably support a finding that the individual's 
impairment(s) medically equals a listed impairment, we do not require 
the adjudicator to obtain ME evidence or medical support staff input 
prior to making a step 3 finding that the individual's impairment(s) 
does not medically equal a listed impairment.

Articulation requirements

    An adjudicator at the hearings or AC level must consider all 
evidence in making a finding that an individual's impairment(s) 
medically equals a listing. To make a finding of medical equivalence, 
the adjudicator must articulate how the record establishes medical 
equivalency using one of the three methods specified in 20 CFR 404.1526 
and 416.926. An adjudicator must provide a rationale for a finding of 
medical equivalence in a decision that is sufficient for a subsequent 
reviewer or court to understand the decision. Generally, this will 
entail the adjudicator identifying the specific listing section 
involved, articulating how the record does not meet the requirements of 
the listed impairment(s), and how the record, including ME or medical 
support staff evidence, establishes an impairment of equivalent 
severity.
    Similarly, an adjudicator at the hearings or AC level must consider 
all evidence in making a finding that an individual's impairment(s) 
does not medically equal a listing. If an adjudicator at the hearings 
or AC level believes that the evidence already received in the record 
does not reasonably support a finding that the individual's 
impairment(s) medically equals a listed impairment, the adjudicator is 
not required to articulate specific evidence supporting his or her 
finding that the individual's impairment(s) does not medically equal a 
listed impairment. Generally, a statement that the individual's 
impairment(s) does not medically equal a listed impairment constitutes 
sufficient articulation for this finding. An adjudicator's articulation 
of the reason(s) why the individual is or is not disabled at a later 
step in the sequential evaluation process will provide rationale that 
is sufficient for a subsequent reviewer or court to determine the basis 
for the finding about medical equivalence at step 3.
    EFFECTIVE DATE: This SSR is effective on March 27, 2017.
    CROSS-REFERENCES: 20 CFR 404.1526 and 416.926.

[FR Doc. 2017-05959 Filed 3-24-17; 8:45 am]
 BILLING CODE 4191-02-P