The Social Security Administration (SSA) has issued a ruling regarding evaluation of symptoms.  This ruling rescinds SSR 96-7p and eliminates the term “credibility” from policy.

In evaluating symptoms, SSA first determines whether there is an underlying medically determinable physical or mental impairment that is reasonably expected to produce the individual’s symptoms.  Medical signs or laboratory findings must show a medically determinable impairment.  SSA does not consider whether the severity of the alleged symptoms is supported by objective medical evidence.

If there an underlying physical or medical impairment, then SSA evaluates the intensity and persistence of the symptoms to determine the extent to which the symptoms limit an individual’s ability to perform work-related activities for an adult, or to function independently in an age-appropriate manner for children.  In considering the intensity, persistence and limiting effects of an individual’s symptoms, SSA examines the entire case record, including objective medical evidence, the individual’s statements, other information provided by medical sources and individuals and any other relevant evidence in the record.

SSA first examines objective medical evidence.  However, an individual’s statements about intensity, persistence and limiting effects of symptoms cannot be disregarded because objective medical evidence does not substantiate the degree of impairment the individual alleges.

If objective medical evidence does not allow for a fully favorable decision, then SSA considers other evidence, including the individual’s statements, medical sources, and non-medical sources.  Factors SSA considers are: daily activities; location, duration, frequency, and intensity of pain or other symptoms; factors that precipitate and aggravate symptoms; dosage, effectiveness and side effects of medication; treatment other than medication and other measures used to relieve symptoms such as lying on the back or sleeping on a board.

If the individual’s statements are consistent with objective medical evidence, SSA will determine that the symptoms are more likely to reduce capacity for work related activities.  SSA also considers the consistency of the individual’s statements.  However, inconsistent statements do not necessarily mean statements are inaccurate because symptoms may vary, worsen or improve over time.

SSA considers attempts to seek and follow medical treatment once it is prescribed in evaluating symptom intensity and persistence.  However, SSA will not find an individual’s symptoms inconsistent with the evidence without considering possible reasons for not seeking or complying with treatment.  Factors SSA may consider include: the individual may have structured activities to reduce symptoms to a tolerable level, the individual may receive periodic treatment or evaluation for medication refills because symptoms have plateaued, medication side effects are less tolerable than the symptoms, inability to afford treatment, a medical source advises that there is no further effective treatment, or a mental impairment limits the ability to understand the need for treatment.

Determinations or decisions must contain specific reasons for the weight given to symptoms consistent with and supported by the evidence, and be clearly articulated to allow the individual and any subsequent reviewer to assess how the adjudicator evaluated the symptoms.  Adjudicators cannot assess overall character or truthfulness.  Adjudicators can only focus on the evidence presented.  SSR 16-3p (March 28, 2016).

Social Security has rewritten the listings for neurological disorders effective September 29, 2016.

The revised introduction to Listing Section 11.00 includes criteria for how to establish “disorganization of motor function” and how to evaluate those criteria.  If Social Security does not find a person disabled on this basis alone but finds marked limitation in physical function and any one of four areas of mental function, it will find no residual functional capacity for work.

Some of the highlights of the changes are: epilepsy is combined into revised and expanded Listing 11.03, the IQ factor for cerebral palsy in Listing 11.07 is removed, listing 11.09 for Multiple Sclerosis now includes marked limitation in physical functioning in addition to mental functioning, listing 11.20 for coma or persistent vegetative state persisting for at least one month is added, and listing 11.22 for motor neuron disorders other than ALS is added.

The children’s listings are rearranged to more closely parallel the adult listings. Listing 111.06 for motor dysfunction is removed.

Revised Medical Criteria for Evaluating Neurological Disorders, 81 Fed. Reg. 43048 (July 1, 2016).

Social Security has substantially changed the mental impairment listings effective January 17, 2017.  The revisions add three new listed impairments: neurodevelopmental disorders (includes learning disabilities) (new Listing 12.11), eating disorders (new listing 12.13), and trauma- and stressor-related disorders (including PTSD) (new listing 12.15).  The revisions also substantially rewrite the listing for Intellectual Disability (listing 12.05).  Revisions to the children’s listings mirror changes to the adult listings.

The revisions change the “B” criteria.  The new “B” criteria are: Understand, Remember or Apply Information; Interact with Others; Concentrate, Persist or Maintain Pace and Adapt or Manage Oneself.  The revisions add multiple factors to consider for each of the new “B” criteria.

The revisions also require considering homelessness as a factor in difficulty to produce medical evidence.

Revised Medical Criteria for Evaluating Mental Disorders, 81 Fed. Reg. 66138 (September 26, 2016).

Social Security has finalized new regulations that change its hearing process.  These are important changes because they change the deadlines and time frames for Social Security hearings.  Three key changes in the process are:

1. Social Security will now give at least 75 days notice of the hearing date.

2. Claimants and claimant’s representatives must now submit evidence, hearing briefs and objections to issues at least five business days prior to the hearing. For evidence that the Claimant has not yet received, the Claimant or claimant’s representative must inform about that evidence.  Exceptions to the five business day rule include disability that prevents the Claimant from submitting evidence and “other unusual, unexpected or unavoidable circumstances” which expressly includes actively and diligently seeking evidence but the evidence was not received 5 business days before the hearing.

3. When seeking Appeals Council review, any new evidence must be submitted to the Appeal Council with the Request for Review. The Appeals Council will only consider new evidence under limited circumstances, including disability that prevents the Claimant from submitting evidence and “other unusual, unexpected or unavoidable circumstances” which expressly includes actively and diligently seeking evidence but the evidence was not received 5 business days before the hearing.

Ensuring Program Uniformity at the Hearing and Appeals Council Levels of the Administrative Review Process, 81 Fed. Reg. 90987 (December 16, 2016).