PURPOSE: To clarify policies for determining whether a table rule in Appendix 2 of Subpart P, Regulation No. 4, applies to direct a conclusion as to "Disabled" or "Not disabled."
CITATIONS (AUTHORITY): Section 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: Each table rule addresses the issue of capability to do other work by a consideration of the factors that affect such capability, i.e., residual functional capacity (RFC), age, education, and work experience. The criteria of a rule are met — and the rule directs a decision of "Disabled" or "Not disabled" — where an individual's RFC, age, education, and work experience coincide with the corresponding factors in the rule. This Program Policy Statement (PPS) clarifies the policies applicable to a determination of whether the criteria of a table rule are met.
POLICY STATEMENT: To determine whether an individual's RFC, age, education, and work experience coincide with the corresponding factors of a table rule, the findings of fact pertaining to each factor are compared to the criteria for that factor in the rule. Thus, the determination as to whether the criteria of a rule are met is based on judgments that have previously been made regarding the individual's RFC, age, education, and work experience.
Each rule directs whether a work adjustment is possible based on an administrative evaluation of the interaction between a particular RFC used to determine a remaining occupational base in unskilled work and specified factors as to age, education, and work experience. The criteria of a rule are met only where they are exactly met. Where the criteria of any rule are not met, a decision is not directed because of an evaluation will not have been performed. In these cases, the rules are used, in conjunction with definitions and discussions provided in the test of the regulations, as a framework for decisionmaking. (See the cross-reference section at the end of the PPS.)
The criteria for each of the factors considered in the rules involve judgmental aspects. Therefore, the determination as to whether these criteria are met requires the decisionmaker to carefully exercise judgments.
Tables No, 1, 2, and 3 in Appendix 2, Subpart P, of the regulations are each based on a maximum sustained work capability (RFC) which is limited to i.e., does not substantially exceed, that needed to perform work existing at the level of exertion specified in the table's heading — sedentary, light, medium, respectively. Each rule under a particular table is based on the same RFC.
The RFC is defined by criteria that establish an exertional capability for a full range (all or substantially all) of the work existing at the level of exertion in question (sedentary, light, or medium). The RFC reflects an exertional capability sufficient to allow performance of substantially all of the primary strength activities required in the range of work existing at the specified level and, with some exceptions, at lower levels. However, the exertional capability does not allow performance at greater exertional levels than those under consideration.
The RFC upon which each table rule is based reflects the absence of any nonexertional limitation.
The focus is on the term "substantially all" as it is used to define the minimum exertional capabilities that must be present. For the purposes of determining whether the criteria of a rule are met, we consider "substantially all" to mean essentially all as opposed to "in the main" or "for the most part.'
For an additional discussion of RFC as well as age, education, previous work experience, and other subjects which must be considered when a decision is made that the medical-vocational rules are met, see SSR 83-10, PPS-101, Determining Capability to Do Other Work — The Medical-Vocational Rules of Appendix 2. Note the glossary there.
Determinations or Decisions Where a Numbered Rule is Met
Before a rule in Appendix 2 can be considered for a decision of "Disabled" or "Not disabled," the sequential evaluation process requires decisions that the claimant or beneficiary: (1) is not currently working in substantial gainful activity (SGA); (2) has a severe impairments(s); (3) does not have an impairment(s) which meets or equals an impairment listed in Appendix 1 to Subpart P and meets the duration requirement; (4) does have an impairment which prevents doing past relevant work; and (5) does not have the medical-vocational characteristics of individuals discussed in SSR 82-63, PPS-79, Medical-Vocational Profiles Showing an Inability to Make an Adjustment to Other Work.
With respect to the elements of a numbered rule, findings of fact based on the evidence in the individual claim must be made. Appropriate findings show that:
A disability decision of "Disabled" or "Not disabled" based on a numbered rule being met must specify the rule in Appendix 2 which directs that particular decision.
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 effective as of February 26, 1979.
CROSS-REFERENCES: Program Operations Manual System, Part 4 (Disability Insurance State Manual Procedures) sections DI 2091, 2093, 2101, 2105, 2380E, 2380.1, 2382.2, 2385, 2386, 2387, 2388, 2390, and 3027; SSR 83-10, PPS-101, Determining Capability to Do Other Work — The Medical-Vocational Rules of Appendix 2 (containing a Glossary); SSR 83-12, PPS-103, 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; 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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