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

PURPOSE: To clarify policies applicable in using the numbered table rules in Appendix 2 of Subpart P of the regulations as a framework for adjudicating claims in which an individual has only exertional limitations, and no specific rule applies because the individual's residual functional capacity (RFC) does not coincide with any one of the defined exertional ranges of work.

CITATIONS (AUTHORITY): Sections 223(d)(2)(A) and 1614(a)(3)(B) of the Social Security Act; Regulations No, 4, Subpart P, sections 404.1520(f), 404.1545, 404.1561, 404.1566, 404.1567, 404.1569; Appendix 2 of Subpart P, section 200.00(d); Regulations No. 16, Subpart I, sections 416.920(f), 416.945, 416.961, 416.966, 416.967, and 416.969.

PERTINENT HISTORY: If a person has a severe medically determinable impairment which, though not meeting or equaling the criteria in the Listing of Impairments (Regulations No. 4, Subpart P, Appendix 1), prevents the person from performing past relevant work, we must decide whether he or she can do other work. The Medical-Vocational Guidelines which follow Appendix 1 as Appendix 2 contain numbered table rules which direct conclusions of "Disabled" or "Not disabled" where all of the individual findings coincide with those of a numbered rule. The table rules do not direct such conclusions when an individual's exertional RFC does not coincide with the exertional criteria of any one of the external ranges, i.e., sedentary, light, medium, as defined in sections 404.1567 and 416.967 of the regulations (See SSR 83-10, PPS-101, Determining Capability to Do Other Work -- The Medical-Vocational Rules of Appendix 2, for a discussion of exertion and ranges of work.) In some instances, an individual can do a little more or less than the exertion specified for a particular range of work; e.g., the person is considered to be physically capable of meeting the exertional demands of light work except that he or she can lift no more than 15 pounds at a time rather than 20 pounds, or he or she can fully meet the exertional demands of light work and can also perform part of the greater lifting requirement of medium work (such as up to 30 pounds at a time rather than 50 pounds at a time).

This Program Policy Statement (PPS) sets out the process of using the numbered rules in adjudicating those claims in which the exertional components of the RFC are less or greater than those of a specifically defined exertional range of work.

POLICY STATEMENT: Each numbered rule directs a conclusion as to whether an individual in a specific case situation is able to make an adjustment to work other than that previously performed. The decision is based on the person's remaining occupational base, as determined by RFC, in conjunction with his or her age, education, and work experience. (See the text and work experience. (See the text and glossary of SSR 83-10, PPS-101, Determining Capability to Do Other Work -- The Medical-Vocational Rules of Appendix 2.)

Where an individual exertional RFC does not coincide with the definitions of any one of the ranges of work as defined in sections 404.1567 and 416.967 of the regulations, the occupational base is affected and may or may not represent a significant number of jobs in terms of the rules directing a conclusion as to disability. The adjudicator will consider the extent of any erosion of the occupational base and access its significance. In some instances, the restriction will be so slight that it would clearly have little effect on the occupational base. In cases of considerably greater restriction(s), the occupational base will obviously be affected, In still other instances, the restrictions of the occupational base will be less obvious.

Where the extent of erosion of the occupational base is not clear, the adjudicator will need to consult a vocational resource. The publications listed in sections 404.1566 and 416.966 of the regulations will be sufficient for relatively simple issues. In more complex cases, a person or persons with specialized knowledge would be helpful. State agencies may use personnel termed vocational consultants or specialists, or they may purchase the services of vocational evaluation workshops. Vocational experts may testify for this purpose at the hearing and appeals levels. In this PPS, the term vocational specialist (VS) describes all vocational resource personnel.

Adjudicative Guidance

The rules provide a basis for equitable consideration of the remaining occupational base, as follows:

1. If the individual's exertional capacity falls between two rules which direct the same conclusion, a finding of "Disabled" or "Not disabled," as appropriate, will follow.

: a. As an example, where an exertional RFC is between the sedentary and light exertional levels and a finding of "Disabled" is indicated under both relevant rules, a finding of "Disabled" will follow. Even the complete occupational base (light) would not represent significant work for the individual.
: b. As a second example, where an exertional RFC is between medium and light work, and both relevant rules, direct a conclusion of "Not disabled," the occupational base is clearly more than what is required as representing significant numbers of jobs because even the rule for less exertion directs a decision of "Not disabled."

2. If the exertional level falls between two rules which direct opposite conclusions, i.e., "Not disabled" at the higher exertional level and "Disabled" at the lower exertional level, consider as follows:

: a. An exertional capacity that is only slightly reduced in terms of the regulatory criteria could indicate a sufficient remaining occupational base to satisfy the minimal requirements for a finding of "Not disabled."
: b. On the other hand, if the exertional capacity is significantly reduced in terms of the regularity definition, it could indicate little more than the occupational base for the lower rule and could justify finding of "Disabled."
: c. In situations where the rules would direct different conclusions, and the individual's exertional limitations are somewhere "in the middle" in terms of the regulatory criteria for exertional ranges of work, more difficult judgments are involved as to the sufficiency of the remaining occupational base to support a conclusion as to disability. Accordingly, VS assistance is advisable for these types of cases.

3. Another situation where VS assistance is advisable is where an individual's exertional RFC does not coincide with the full range of sedentary work. In such cases, equally difficult judgments are involved. Rather than having two rules which direct either the same or opposite conclusions, the decisionmaker would have only one relevant rule and would have to decide whether the full range of sedentary work is significantly compromised.

A VS can assess the effect of any limitation on the range of work at issue (e.g., the potential occupational base); advise whether the impaired person's RFC permits him or her to perform substantial numbers of occupations within the range of work at issue; identify jobs which are within the RFC, if they exist; and provide a statement of the incidence of such jobs in the region in which the person lives or in several regions of the country.

: a. Where an individual's impairment has not met or equal the criteria of the Listing of Impairments at an earlier step in the sequence of adjudication, but the full range of sedentary work is significantly compromised, section 201.00(h) of Appendix 2 provides that a finding of "Disabled" is not precluded for even younger individuals. (The example in that section are of significantly restricted occupational bases.)
: b. Where a person can perform all of the requirements of sedentary work except, for example, a restriction to avoid frequent contact with petroleum based solvents, there is an insignificant compromise of the full range of sedentary work. Technically, because of the restriction, this person cannot perform the full range of sedentary work. However, this slight compromise within the full range of sedentary work (i.e., eliminating only the very few sedentary jobs in which frequent exposure to petroleum based solvents would be required) leaves the sedentary occupational base substantially intact. Using the rules as a framework, a finding of "Not disabled" would be appropriate.

Consideration of restrictions less clear in their effect than in the examples cited will require a more detailed review of the impact of the particular limitations on the performance of the full range of sedentary work. The assistance of a VS will usually be required in assessing the extent of the reduced work capabilities caused by the limitations. The particular examples set out above illustrate cases in which nonexertional impairments impinge upon the full range of sedentary work. Using the rules as a framework, the same principals may be applied to determine whether there has been a significant compromise in those instances where additional exertional limitations impinge on the full range of sedentary work.

SPECIAL SITUATIONS

: 1. Alternate Sitting and Standing
: In some disability claims, the medical facts lead to an assessment of RFC which compatible with the performance of either sedentary or light work except that the person must alternate periods of sitting and standing. The individual may be able to sit for time, but must then get up and stand or walk for awhile before returning to sitting. Such an individual is not functionally capable of doing either the prolonged sitting contemplated in the definition of sedentary work (and for the relatively few light jobs which are performed primarily in a seated position) or the prolonged standing or walking contemplated for most light work. (Persons who can adjust to any need to vary sitting and standing by doing so at breaks, lunch periods, etc., would still be able to perform a defined range of work.)
: There are some jobs in the national economy -- typically professional and managerial ones -- in which a person can sit or stand with a degree of choice. If an individual had such a job and is still capable of performing it, or is capable of transferring work skills to such jobs, he or she would not be found disabled. However, must jobs have ongoing work processes which demand that a worker be in a certain place or posture for at least a certain length of time to accomplish a certain task. Unskilled types of jobs are particularly structured so that a person cannot ordinarily sit or stand at will. In cases of unusual limitation of ability to sit or stand, a VS should be consulted to clarify the implications for the occupational base.
: 2. Loss of Use of an Upper Extremity
: A person who has lost the use of an arm or hand because of amputation, paralysis, etc., obviously cannot perform jobs which require use of both arms or both hands. Loss of major use of an upper extremity is rather definitive in that there is a considerable absence of functional ability. As stated in SSR 82-51, PPS-85, Guidelines for Residual Functional Capacity Assessment in Musculoskeletal and Cardiovascular Impairments, an amputation above the elbow would limit a person to light work activity with additional limitations because of loss of bimanual manipulation and difficulty or inability to handle bulky objects; effective use of the remaining hand may also be affected. An amputation below the elbow -- or partial loss of use of the extremity -- will require a more detailed evaluation of functional ability, including the condition of the remaining stump and the person's ability to use a prosthesis -- or the person's remaining ability for fine and gross manipulating.
: Experience with persons who have lost the use of an upper extremity has shown that their potential occupational base is between the occupational bases for Table No. (sedentary work) and Table No.2 (light work). While individuals with this impairment have been known to perform selected occupations at nearly all exertional levels, the total number of occupations within their RFC's is less than the number represented by a full or wide range of light work. These individuals would generally not be expected to perform sedentary work because most unskilled sedentary jobs require good use of both hands. Persons who have the least remaining function would have only the lower occupational base, while those who have the most remaining function would have some of the higher occupational base added in terms of numbers of jobs which can be performed with this type of impairment. Given an individual's particular RFC, a VS will be able to determine the size of the remaining occupational base, cite specific jobs within the individual's RFC, and provide a statement of the incidence of those jobs in the region of the individual's residence or in several regions of the country.

The Disability Determination or Decision Where a Claimant or
Beneficiary Has Exertional Limitations Within A Range of Work or
Between Ranges of Work

The usual requirements apply for a clear, persuasive, orderly rationale, reflecting the sequential evaluation process, with recitations of the evidence and specific findings of fact. (See SSR 82-56, PPS-81, The Sequential Evaluation Process.) Whenever vocational resources are used, and an individual is found to be not disabled, the determination or decision will include (1) citations of examples of occupation/jobs the person can do functionally and vocationally and (2) a statement of the incidence of such work in the region in which the individual resides or in several regions of the country.

EFFECTIVE DATE: Final regulations providing the Medical-Vocational Guidelines were published in the Federal Register 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 effective as of February 26, 1979.

CROSS-REFERENCE: Program Operations Manual System, Part 4 (Disability Insurance State Manual Procedure), sections DI 2380E, 2382.2, 2384, and 2388A-E; SSR 83-10, PPS-101, Determining Capability to Do Other Work -- The Medical-Vocational Rules of Appendix 2; SSR 83-11, PPS-102, Capability to Do Other Work -- The Exertionally Based Medical-Vocational Rules Met; 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 a Framework for Evaluating a Combination of Exertional and Nonexertional Impairments.

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