SSR 83-10: TITLES II AND XVI: DETERMINING CAPABILITY TO DO OTHER WORK -- THE MEDICAL-VOCATIONAL RULES OF APPENDIX 2
PURPOSE: To clarify the manner in which the medical-vocational rules in Appendix 2 of Subpart P, Regulations No. 4, address the issue of capability to do other work, and to provide definitions of terms and concepts frequently used in evaluating disability under the medical-vocational rules.
CITATIONS (AUTHORITY): Sections 223(d)(2)(A) and 1614(a)(3)(B) of the Social Security Act; Regulations No. 4, Subpart P, sections 404.1505(a), 404.1520(f)(1), 404.1545, 404.1560-404.1561, 404.1563-404.1569, and Appendix 2; and Regulations no. 16, Subpart I, sections 416.905(a), 416.920(f)(1), 416.945, 416..960-416.961, and 416.- 963-416.969.
PERTINENT HISTORY: Under the sequential evaluation process for evaluating disability, if it is determined that an individual is not engaging in substantial gainful activity (SGA) and has one more severe medically determinable impairments which do not meet or equal the Listing of Impairments but prevent him or her from performing past relevant work, evaluation of the individual's capability to do other work becomes necessary (see SSR 82-56, PPS-81, The Sequential Evaluation Process). In this, the fifth and last step in the process, the individual's residual functional capacity (RFC) in conjunction with his or her age, education, and work experience, are considered to determine whether the individual can engage in any other substantial gainful work which exists in the national economy. (See the glossary at the end of the policy statement for definitions of terms and concepts commonly used in medical-vocational evaluation -- e.g., RFC.)
To increase the consistency and promote the uniformity with which disability determinations are made at this step at all levels of adjudication, the regulations for determining disability were expanded in February 1979. Appendix 2 was provided to establish specific numbered table rules for use in medical-vocational evaluation.
Each numbered rule in the appendix resolves the issue of capability to do other work by addressing specific combinations of the factors(i.e., RFC, age, education, and work experience) that determine capability to do work other than that previously performed. The criteria for each factor contained within a rule are defined in the regulations. Resolution of the issue of capability to do other work is indicated in the "Decision" column (i.e., "Disabled" or "Not disabled") for the particular rule.
In using the rules of Appendix 2, we compare an individual's circumstances, as indicated by the findings with respect to RFC, age, education, and work experience, to the pertinent rule(s). Where the findings regarding each factor coincide with the criteria for the corresponding factor in a rule, that rule applies and directs a decision of "Disabled" or "Not disabled." Where one or more of the criteria of a rule are not met, no decision is directed; instead, the rules are used, in conjunction with the definitions and discussions in the text of the regulations, as guidance for decisionmaking.
Specific questions have arisen as to how we determine that the criteria of a rule are met and, where the criteria are not met, how we use the rules as a framework for decisionmaking. This Program Policy Statement (PPS) reviews and clarifies considerations underlying the rules to provide the necessary foundation for other PPS's that address issues about using the rules to adjudicate claims. (See the cross-reference section at the end of the PPS).
POLICY STATEMENT: In making disability determinations and decisions at the last step of the sequential evaluation process, emphasis continues to be given to medical considerations. The rules of Appendix 2 assure that appropriate weight is afforded to the severity of the impairment within the context of medical-vocational evaluation to determine capability to do other work. For that purpose, RFC (i.e., what work-related activities an individual can do despite the impairment(s)) is used to determine the maximum sustained capability for work. RFC is considered a factor affecting ability to adjust to work other than that previously performed. Capability to do other work is determined by considering the interaction of RFC with the other factors affecting vocational adaptability, i.e., age, education, and work experience. Education and work experience may also reflect acquired skills that can be used in skilled or semiskilled work other than that previously performed.
Work Capability as Established by RFC Alone
-- the Occupational Base
In Appendix 2, work in the national economy is classified exertionally as sedentary, light, medium, heavy or very heavy. (Although the tables containing the specific numbered rules, i.e., Tables No. 1, 2, and 3, are limited to the sedentary, light, and medium levels of work, respectively, there is a specific rule pertaining to heavy and very heavy work, rule 204.00.) Each functional level is defined (in accordance with terms used by the United States Department of Labor) by the extent of its requirements in the primary strength activities of sitting, standing, walking, lifting, carrying, pushing, and pulling.
The rules of Appendix 2 use exertional capabilities (i.e., those required to perform the primary strength activities) to identify maximum sustained work capability. Under each rule, the capability considered is limited to that necessary to perform sustained work on a regular basis at the particular level of exertion.
The rules within a table are based on the same RFC. In each rule, the remaining exertional capabilities must be sufficient to allow performance of substantially all (nearly all) of the primary strength activities defining the particular level of exertion (i.e., sedentary, light, or medium). Also, the combined exertional capabilities do not allow performance of exertional levels beyond that in question.
Accordingly, the RFC determines a work capability that is exertionally sufficient to allow performance of at least substantially all of the activities of work at a particular level (e.g., sedentary, light, or medium), but is also insufficient to allow substantial performance of work at greater exertional levels. Sedentary exertional demands are less than light, which are, in turn, less than medium. In addition, RFC generally represents an exertional work capability for all work at any functional level(s) below that used in the table under consideration.
The exertional requirements of work at a particular functional level are the same regardless of whether the work is skilled, semi-skilled, or unskilled. Therefore, RFC alone never establishes the capability for skilled or semiskilled work. Ability to perform skilled or semiskilled work depends on the presence of acquired skills which may be transferred to such work from past job experience above the unskilled level or the presence of recently completed education which allows for direct entry into skilled or semiskilled work. However, as noted in SSR 82-41, PPS-67, Work Skills and Their Transferability as Intended by the Expanded Vocational Factors Regulations Effective February 26, 1979, a person's RFC may prevent the transferability of skills.
Unskilled work may be performed by individuals with no work skills or no work experience. However, as shown in the table rules, individuals may not be expected to make a vocational adjustment to unskilled work in certain circumstances. A final requirement in determining an occupational base under the rules within a table is that the RFC reflects no impairment-caused limitation affecting performance of other then exertional activities, i.e., no nonexertional limitation. Thus, the only impairment-caused limitations considered in each rule are exertional limitations. Accordingly, the RFC considered under each rule reflects the presence of nonexertional capabilities sufficient to perform unskilled work at the pertinent exertional levels.
The RFC addressed in a rule establishes the presence of an occupational base that is limited to and includes a full range (all or substantially all) of the unskilled occupations existing at the exertional level in question. The base established by the RFC also ordinarily includes all those occupations at any lower exertional level(s).
When the medical-vocational rules were promulgated, administrative notice was taken of the fact that it was possible to identify at the unskilled level, approximately 200 sedentary occupations; approximately 1,600 sedentary and light occupations; and approximately 2,500 sedentary, light and medium occupations, each representing numerous jobs in the national economy. (By "administration notice" we mean our recognition that various authoritative publications identify occupations which exist in the national economy; these sources are listed in sections 404.1566 and 416.966 of the regulations.) Thus, as related to RFC, the occupational base considered in each rule consists of those unskilled occupations identified at the exertional level in question. (The base may be enhanced by the addition of specific skilled or semiskilled occupations that an individual can perform by reason of his or her education or work experience.
The Issue of Work Adjustment
In the situations considered in the numbered table rules (those indicating decisions of "Disabled" as well as "Not disabled"), an individual has the RFC to perform a full range of the unskilled occupations relevant to the table. Each of these occupations represents numerous jobs in the national economy. However, the individual may not be able to adjust to those jobs because of adverse vocational factors.
The issue of whether a work adjustment is possible involves a determination as to whether the jobs whose requirements can be met provide an opportunity for adjusting to substantial and gainful work other than that previously performed. Accordingly, the issue of work adjustment is determined based on the interaction of the work capability represented by RFC (the remaining occupational base) with the other factors affecting capability for adjustment -- age, education, and work experience.
Each numbered rule in Appendix 2 includes an administrative evaluation which determines whether a work adjustment should be possible. In each instance, the issue is decided based on the interaction between the person's occupational base as determined by RFC with his or her age, education, and work experience.
The ultimate question in the medical-vocational evaluation of the capability to do other work is whether work that an individual can do functionally and vocationally exists in the national economy. Whether work exists in the national economy for any particular individual depends on whether there is a significant number of jobs (in one or more occupations) with requirements that the individual is able to meet, considering his or her remaining physical and mental abilities and vocational qualifications.
The occupational base that is determined to be available based on RFC alone consists of a full range of occupations, each of which represents numerous jobs in the national economy. Where a rule indicates that a work adjustment is expected, a reasonable opportunity exists for adjusting to work other than that previously performed. (Rules which include the transferability of a person's work skills to skilled or semiskilled occupations within his or her RFC (or use of recent education for direct entry into such work) impose specific skilled or semiskilled occupations upon the unskilled occupational base.) Conversely, where the rules determine that a work adjustment is not expected, no reasonable opportunity exists for adjusting to substantial work. Thus, where the criteria of a rule are met, the issue as to the existence of work in the national economy for that individual is resolved. While there is no requirement to cite unskilled occupations where the criteria of a rule are met, specific examples of skilled or semiskilled occupations will be cited where a rule determines that a work adjustment above the unskilled level is expected.
The definitions of terms and related concepts provided in this glossary are to be used when an individual's capability to do other work is determined under the provisions of Appendix 2 of the regulations. The definitions are based on the regulations, the vocational reference material noted in section 200.00(b) of Appendix 2, and the adjudicative experience of the Social Security Administration.
Broad World of Work. Work which exists at all exertional levels. It may include skilled and semiskilled work as well as unskilled work.
Environmental Conditions. Extremes of temperature, humidity, noise, vibration, fumes, odors, toxic conditions, dust, poor ventilation, hazards, etc.
Exertional Activity. One of the primary strength activities (sitting, standing, walking, lifting, carrying, pushing, and pulling) defining a level of work.
Exertional Capability. A capability required to perform an exertional activity.
Exertional Limitation. An impairment-caused limitation which affects capability to perform an exertional activity.
Exertional Level (Level of Exertion) A work classification defining the functional requirements of work in terms of the range of the primary strength activities required. The primary strength activities specifically associated with the sedentary, light, and medium levels of exertion are set forth in sections 404.1567 and 416.967 of the regulations.
The following elaborations of the activities needed to carry out the requirements of sedentary, light, and medium work are based on the same resource materials noted in section 200.00(b) of Appendix 2. They may be used by decisionmakers to determine if an individual has the ability to perform the full range of sedentary, light, or medium work from an exertional standpoint.
- 1. Sedentary work. The regulations define sedentary work as involving lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although sitting is involved, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met. By its very nature, work performed primarily in a seated position entails no significant stooping. Most unskilled sedentary jobs require good use of the hands and fingers for repetitive hand-finger actions.
- "Occasionally" means occurring from very little up to one-third of the time. Since being on one's feet is required "occasionally" at the sedentary level of exertion, periods of standing or walking should generally total no more than about 2 hours of an 8-hour workday, and sitting should generally total approximately 6 hours of an 8-hour workday. Work processes in specific jobs will dictate how often and how long a person will need to be on his or her feet to obtain or return small articles.
- 2. Light work. The regulations define light work as lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted in a particular light job may be very little, a job is in this category when it requires a good deal of walking or standing -- the primary difference between sedentary and most light jobs. A job is also in this category when it involves sitting most of the time but with some pushing and pulling of arm-hand or leg-foot controls, which require greater exertion than in sedentary work; e.g., mattress sewing machine operator, motor-grader operator, and road-roller operator (skilled and semiskilled jobs in these particular instances). Relatively few unskilled light jobs are performed in a seated position.
- "Frequent" means occurring from one-third to two-thirds of the time. Since frequent lifting or carrying requires being on one's feet up to two-thirds of a workday, the full range of light work requires standing or walking, off and on, for a total of approximately 6 hours of an 8-hour workday. Sitting may occur intermittently during the remaining time. The lifting requirement for the majority of light jobs can be accomplished with occasional, rather than frequent, stooping. Many unskilled light jobs are performed primarily in one location, with the ability to stand being more critical than the ability to walk. They require use of arms and hands to grasp and to hold and turn objects, and they generally do not require use of the fingers for fine activities to the extent required in much sedentary work.
- 3. Medium work. The regulations define medium work as lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. A full range of medium work requires standing or walking, off and on, for a total of approximately 6 hours in an 8-hour workday in order to meet the requirements of frequent lifting or carrying objects weighing up to 25 pounds. As in light work, sitting may occur intermittently during the remaining time. Use of the arms and hands is necessary to grasp, hold, and turn objects, as opposed to the finer activities in much sedentary work, which require precision use of the fingers as well as use of the hands and arms.
- The considerable lifting required for the full range of medium work usually requires frequent bending-stooping. (Stooping is a type of bending in which a person bends his or her body downward and forward by bending the spine at the waist.) Flexibility of the knees as well as the torso is important for this activity. (Crouching is bending both the legs and spine in order to bend the body downward and forward.) However, there are relatively few occupations in the national economy which require exertion in terms of weights that must be lifted at time (or involve equivalent exertion in pushing and pulling), but are performed primarily in a sitting position, e.g., taxi driver, bus driver, and tank-truck driver (semi-skilled jobs). In most medium jobs, being on one's feet for most of the workday is critical. Being able to do frequent lifting or carrying of objects weighing up to 25 pounds is often more critical than being able to lift up to 50 pounds at a time.
Full Range of Work. All or substantially all occupations existing at an exertional level.
> Limited to. Does not exceed.
Maximum Sustained Work Capability. The highest functional level a person can perform on a regular work basis -- sedentary, light, medium, heavy, or very heavy work.
Nonexertional Impairment. Any impairment which does not directly affect the ability to sit, stand, walk, lift, carry, push, or pull. This includes impairments which affect the mind, vision, hearing, speech, and use of the body to climb, balance, stoop, kneel, crouch, crawl, reach, handle, and use of the fingers for fine activities.
Nonexertional Limitation. An impairment-caused limitation of function which directly affects capability to perform work activities other than the primary strength activities.
Nonexertional Restriction (Environmental Restriction). An impairment-caused need to avoid one or more environmental conditions in a workplace.
Occupational Base. The number of occupations as represented by RFC, that an individual is capable of performing. These "base" occupations are unskilled in terms of complexity. The regulations take notice of approximately 2,500 medium. light, and sedentary occupations; 1,600 light and sedentary occupations; and 200 sedentary occupations. Each occupation represents numerous jobs in the national economy. (In individual situations, specific skilled or semi-skilled occupations may be added to the base.)
Range of Work. Occupations existing at an exertional level.
Residual Functional Capacity. A medical assessment of what an individual can do in a work setting in spite of the functional limitations and environmental restrictions imposed by all of his or her medically determinable impairment(s). RFC is the maximum degree to which the individual retains the capacity for sustained performance of the physical-mental requirements of jobs.
Skilled Level. A work classification whereby work is defined according to skill requirements. The requirements of the different skill levels are set forth in section 404.1568 and 416.968 of the regulations as follows:
- 1. Unskilled work. Unskilled work is work which needs little or no judgment to do simple duties that can be learned on the job in a short period of time. The job may or may not require considerable strength. For example, we consider jobs unskilled if the primary work duties are handling, feeding, and offbearing (that is, placing or removing materials from machines which are automatic or operated by others), or machine tending, and a person can usually learn to do the job in 30 days, and little specific vocational preparation and judgment are needed. A person does not gain work skills by doing unskilled work.
- 2. Semiskilled work. Semiskilled work is work which needs some skills but does not require doing the more complex work duties. Semiskilled jobs may require alertness and close attention to watching machine processes; or inspecting, testing or otherwise looking for irregularities; or tending or guarding equipment, property, material, or persons against loss, damage or injury; or other types of activities which are similarly less complex than skilled work, but more complex than unskilled work. A job may be classified as semiskilled where coordination and dexterity are necessary, as when hands or feet must be moved quickly to do repetitive tasks.
- 3. Skilled work. Skilled work requires qualifications in which a person uses judgment to determine the machine and manual operations to be performed in order to obtain the proper form, quality, or quantity of material to be produced. Skilled work may require laying out work, estimating qualify, determining the suitability and needed quantities, of materials, making precise measurements, reading blueprints or other specifications, or making necessary computations or mechanical adjustments to control or regulate the work. Other skilled jobs may require dealing with people, facts, or figures or abstract ideas at a high level of complexity.
- For a further discussion of skills see SSR 82-41, PPS-67, Work Skills and Their Transferability as Intended by the Expanded Vocational Factors Regulations Effective February 26, 1979.
Substantially All Activities. Nearly all (essentially all) of the activities required in an exertional range of work.
Vocational Factors: An Individual's Age, Education, and Work Experience
- 1. Age. The regulations provide the older age is an increasingly adverse vocational factor for persons with severe impairments. The chronological ages, 45, 50, 55, and 60 may be critical to a decision. However, the regulations also provide that age categories are not applied mechanically in borderline situations. For example, a rule for an individual of advanced age (55 or older) could be found applicable, in some circumstances, to an individual whose chronological age is 54 years and 11 months (closely approaching advanced age). No fixed guidelines as to when a borderline situation exists are provided since such guidelines would themselves reflect a mechanical approach.
- Under Title II, a period of disability cannot begin after a worker's disability insured status has expired. When the person last met the insured status requirement before the date of adjudication, the oldest age to be considered is the person's age at the date last insured. In these situations, the person's age at the time of decisionmaking is immaterial.
- 2. Education. Unless there is evidence to contradict a persons's statement as to the numerical grade level completed in school, the statement will be used to determine the persons's educational abilities. The person's present level of reasoning, communication, and arithmetical ability may be higher or lower than the level of formal education. Evidence of this includes the kinds of responsibilities the person had when working, any acquired work skills, daily activities, and hobbies, as well as the results of testing. Therefore, a person will meet the criteria for the different education levels specified in the regulations, not solely on the basis of his or her statements, but based upon all evidence pertinent to evaluating that person's educational capacities.
- The criterion of "high school graduate or more -- provides for direct entry into skilled work" is met when there is little time lapse between the completion of formal education and the date of adjudication, and where the content of the education would enable individuals, with a minimal degree of job orientation, to begin performing the skilled job duties of certain identifiable occupations within their RFC.
- 3. Previous Work Experience. A person's work experience may be none, not vocationally relevant, unskilled, semiskilled, or skilled. To meet the criterion of "skilled or semiskilled -- skills transferable," a person must have performed work which is above the unskilled level of complexity, must have identifiable skills, and must be able to use these skills in specific skilled or semiskilled occupations within his or her RFC. (For additional guidance related to work experience, see SSR 82-41, PPS-67, Work Skills and Their Transferability as Intended by the Expanded Vocational Factors Regulations Effective February 26, 1979; SSR 82-61, PPS-72, Past Relevant Work: The Particular Job or the Occupation as Generally Performed; SSR 82-62, PPS-80, A Disability Claimant's Capacity to Do Past Relevant Work, in General; and SSR 82-63, PPS-79, Medical-Vocational Profiles Showing an Incapability to Make an Adjustment to Other Work.
EFFECTIVE DATE: Final regulations providing the Medical-Vocational Guidelines were published in the Federal Register on November 28, 1978, at 43 FR 55349, effective February 26, 1979. They were rewritten to make them easier to understand and were published on August 20, 1980, at 45 FR 55566. The policies in this PPS are also effective as of February 26, 1979.
CROSS-REFERENCES: Program Operations Manual System, Part 4 (Disability Insurance State Manual Procedures), sections DI 2380E, 2382.1, 2382.2, 2384, and 2388A through E; SSR 83-11, PPS-102, Capability to Do Other Work -- The Exertionally Based Medical-Vocational Rules Met; SSR 83-12, PPS-103, Capability to Do Other Work -- The Medical-Vocational Rules as a Framework for Evaluating Exertional Limitation Within a Range of Work or Between Ranges of Work; SSR 83-13, PPS-104, Capability to Do Other Work -- The Medical-Vocational Rules as a Framework for Evaluating Solely Nonexertional Impairments; and SSR 83-14, PPS-105, Capability to Do Other Work -- The Medical-Vocational Rules as Framework for Evaluating a Combination of Exertional and Nonexertional Impairments.