(Superseded by SSR 96-7p)
EFFECTIVE/PUBLICATION DATE: 10/31/95
SSR 95-5p: POLICY INTERPRETATION RULING
TITLES II AND XVI:
CONSIDERING ALLEGATIONS OF PAIN AND OTHER SYMPTOMS IN RESIDUAL FUNCTIONAL
CAPACITY AND INDIVIDUALIZED FUNCTIONAL ASSESSMENTS AND EXPLAINING
PURPOSE: To restate and clarify that the longstanding policies of the Social Security Administration (SSA) of considering allegations of pain in assessing residual functional capacity (RFC), and of requiring explanations of the conclusions reached about pain, apply to the evaluation of all symptoms, not just pain; that they apply to the preparation of the individualized functional assessment (IFA) in the evaluation of disability for individuals under age 18 claiming benefits under title XVI of the Social Security Act (the Act) as well as to the assessment of RFC for other persons claiming benefits based on disability under title II or title XVI of the Act; and that an explanation of the functional impact of symptoms, such as pain, when applicable, is required.
CITATIONS (AUTHORITY): Sections 216(i), 223(d), and 1614(a) of the Social Security Act, as amended; Regulations No. 4, sections 404.1508, 404.1528, 404.1529, and 404.1545; and Regulations No. 16, sections 416.908, 416.924(b), 416.924d, 416.928, 416.929, and 416.945.
PERTINENT HISTORY: On November 14, 1991, we published final regulations regarding the evaluation of symptoms, including pain, for all disability claims under titles II and XVI (56 FR 57928). These regulations codified the policy interpretations set out in SSR 88-13 and SSR 90-1p, making it unnecessary to retain the statements of policy interpretations in these Rulings. We are publishing this Ruling, which supersedes SSR 88-13 and SSR 90-1p, to replace the section of these earlier Rulings that is entitled "Importance of Considering Allegations of Pain in Assessing RFC and Explaining Conclusions Reached," which provides procedures which we determined were not appropriate for inclusion in the regulations (see 56 FR 57934).
POLICY INTERPRETATION: Symptoms, such as pain, fatigue, shortness of breath, weakness, or nervousness, are the individual's own description of the effects of a physical or mental impairment(s). Under title XVI, in the case of an individual under age 18 who is unable to adequately describe his or her symptoms, the description of the symptom(s) given by the person who is most familiar with the individual, such as a parent, other relative, or guardian, will be accepted as a statement of the individual's symptoms.
Because symptoms sometimes suggest a greater severity of impairment than can be shown by objective medical evidence alone, careful consideration must be given to any available information about symptoms.
The RFC assessment or, in the case of an individual under age 18 claiming benefits based on disability under title XVI, the IFA, must describe the relationship between the medically determinable impairment(s) and the conclusions regarding functioning which have been derived from the evidence, and must include a discussion of why reported daily activity limitations or restrictions are or are not reasonably consistent with the medical and other evidence.
In instances in which the adjudicator has observed the individual, the adjudicator is not free to accept or reject that individual's complaints solely on the basis of such personal observations. Rather, in all cases in which pain or other symptoms are alleged, the determination or decision rationale must contain a thorough discussion and analysis of the objective medical and the other evidence, including the individual's complaints of pain or other symptoms and the adjudicator's personal observations. The rationale must include a resolution of any inconsistencies in the evidence as a whole and set forth a logical explanation of the individual's ability to work or, in the case of an individual under age 18 claiming benefits based on disability under title XVI, the individual's ability to function independently, appropriately, and effectively in an age-appropriate manner.
EFFECTIVE DATE: The policy interpretation and procedures explained herein are effective on publication in the Federal Register.
CROSS-REFERENCES: Program Operations Manual System, sections DI 24515.061, DI 24515.062, DI 24515.064, DI 25225.001 and DI 26516.015.