SSA's latest on Fibro dated 7/25/12

Discussion in 'Financial, Disability and Legal Resources' started by TwoCatDoctors, Jul 31, 2012.

  1. TwoCatDoctors

    TwoCatDoctors New Member

    THIS IS FROM THE GOVERNMENT AND IS NOT COPYRIGHTED.


    NOTE: This SSR will guide the Social Security Administration in determinations involving Fibro. In particular, note:

    (1) "acceptable doctors" are licensed physicians (a medical or osteopathic doctor).
    (2) they may contact neighbors, friends, past employers, the SSA person who took your application, etc. (which probably means to find out how you move, how long you can sit, etc.)
    (3) they will be taking into consideration good and bad days. Interesting because we always use our bad days for paperwork so they may discount some of our bad days to include some good days.

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    [Federal Register Volume 77, Number 143 (Wednesday, July 25, 2012)]
    [Notices]
    [Pages 43640-43644]
    From the Federal Register Online via the Government Printing Office [www.gpo.gov]
    [FR Doc No: 2012-17936]


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    SOCIAL SECURITY ADMINISTRATION

    [Docket No. SSA-2011-0021]


    Social Security Ruling, SSR 12-2p; Titles II and XVI: Evaluation
    of Fibromyalgia

    AGENCY: Social Security Administration.

    ACTION: Notice of Social Security Ruling (SSR).

    -----------------------------------------------------------------------

    SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of
    Social Security gives notice of Social Security Ruling, SSR 12-2p. This
    ruling provides guidance on how we develop evidence to establish that a
    person has a medically determinable impairment of fibromyalgia, and how
    we evaluate fibromyalgia in disability claims and continuing disability
    reviews under titles II and XVI of the Social Security Act.

    DATES: Effective Date: July 25, 2012.

    FOR FURTHER INFORMATION CONTACT: Cheryl Williams, Office of Disability
    Programs, Social Security Administration, 6401 Security Boulevard,
    Baltimore, Maryland 21235-6401, (410) 965-1020.

    SUPPLEMENTARY INFORMATION: Although we are not required to do so
    pursuant to 5 U.S.C. 552(a)(1) and (a)(2), we are publishing this SSR
    in accordance with 20 CFR 402.35(b)(1).

    Through SSRs, we make available to the public precedential
    decisions relating to the Federal old-age, survivors, disability,
    supplemental security income, special veterans benefits, and black lung
    benefits programs. We may base SSRs on determinations or decisions made
    at all levels of administrative adjudication, Federal court decisions,
    Commissioner's decisions, opinions of the Office of the General
    Counsel, or other interpretations of the law and regulations.

    Although SSRs do not have the same force and effect as statutes or
    regulations, they are binding on all components of the Social Security
    Administration. 20 CFR 402.35(b)(1).

    [[Page 43641]]

    This SSR will be in effect until we publish a notice in the Federal
    Register that rescinds it, or publish a new SSR that replaces or
    modifies it.

    (Catalog of Federal Domestic Assistance, Program Nos. 96.001, Social
    Security--Disability Insurance; 96.002, Social Security--Retirement
    Insurance; 96.004--Social Security--Survivors Insurance; 96.006--
    Supplemental Security Income)

    Michael J. Astrue,
    Commissioner of Social Security.

    Policy Interpretation Ruling

    Titles II and XVI: Evaluation of Fibromyalgia

    Purpose: This Social Security Ruling (SSR) provides guidance on how
    we develop evidence to establish that a person has a medically
    determinable impairment (MDI) of fibromyalgia (FM), and how we evaluate
    FM in disability claims and continuing disability reviews under titles
    II and XVI of the Social Security Act (Act).\1\
    ---------------------------------------------------------------------------

    \1\ For simplicity, we refer in this SSR only to initial claims
    for benefits made by adults (individuals who are at least age 18).
    However, the policy interpretations in this SSR also apply to claims
    for benefits made by children (individuals under age 18) under title
    XVI of the Act and to claims above the initial level. FM can affect
    children, and the signs and symptoms are essentially the same in
    children as adults. The policy interpretations in this SSR also
    apply to continuing disability reviews of adults and children under
    sections 223(f) and 1614(a)(4) of the Act, and to redeterminations
    of eligibility for benefits we make in accordance with section
    1614(a)(3)(H) of the Act when a child who is receiving title XVI
    childhood disability benefits attains age 18.
    ---------------------------------------------------------------------------

    Citations: Sections 216(i), 223(d), 223(f), 1614(a)(3), and
    1614(a)(4) of the Act, as amended; Regulations No. 4, subpart P,
    sections 404.1505, 404.1508-404.1513, 404.1519a, 404.1520, 404.1520a,
    404.1521, 404.1523, 404.1526, 404.1527-404.1529, 404.1545, 404.1560-
    404.1569a, 404.1593, 404.1594, appendix 1, and appendix 2; and
    Regulations No. 16, subpart I, sections 416.905, 416.906, 416.908-
    416.913, 416.919a, 416.920, 416.920a, 416.921, 416.923, 416.924,
    416.924a, 416.926, 416.926a, 416.927-416.929, 416.945, 416.960-
    416.969a, 416.987, 416.993, 416.994, and 416.994a.

    Introduction

    FM is a complex medical condition characterized primarily by
    widespread pain in the joints, muscles, tendons, or nearby soft tissues
    that has persisted for at least 3 months. FM is a common syndrome.\2\
    When a person seeks disability benefits due in whole or in part to FM,
    we must properly consider the person's symptoms when we decide whether
    the person has an MDI of FM. As with any claim for disability benefits,
    before we find that a person with an MDI of FM is disabled, we must
    ensure there is sufficient objective evidence to support a finding that
    the person's impairment(s) so limits the person's functional abilities
    that it precludes him or her from performing any substantial gainful
    activity. In this Ruling, we describe the evidence we need to establish
    an MDI of FM and explain how we evaluate this impairment when we
    determine whether the person is disabled.
    ---------------------------------------------------------------------------

    \2\ See National Center for Biotechnology Information, U.S.
    National Library of Medicine, Fibromyalgia, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001463.
    ---------------------------------------------------------------------------

    Policy Interpretation

    FM is an MDI when it is established by appropriate medical
    evidence. FM can be the basis for a finding of disability.

    I. What general criteria can establish that a person has an MDI of
    FM? Generally, a person can establish that he or she has an MDI of FM
    by providing evidence from an acceptable medical source.\3\ A licensed
    physician (a medical or osteopathic doctor) is the only acceptable
    medical source who can provide such evidence. We cannot rely upon the
    physician's diagnosis alone. The evidence must document that the
    physician reviewed the person's medical history and conducted a
    physical exam. We will review the physician's treatment notes to see if
    they are consistent with the diagnosis of FM, determine whether the
    person's symptoms have improved, worsened, or remained stable over
    time, and establish the physician's assessment over time of the
    person's physical strength and functional abilities.
    ---------------------------------------------------------------------------

    \3\ See 20 CFR 404.1513(a) and 416.913(a).
    ---------------------------------------------------------------------------

    II. What specific criteria can establish that a person has an MDI
    of FM? We will find that a person has an MDI of FM if the physician
    diagnosed FM and provides the evidence we describe in section II.A. or
    section II. B., and the physician's diagnosis is not inconsistent with
    the other evidence in the person's case record. These sections provide
    two sets of criteria for diagnosing FM, which we generally base on the
    1990 American College of Rheumatology (ACR) Criteria for the
    Classification of Fibromyalgia \4\ (the criteria in section II.A.), or
    the 2010 ACR Preliminary Diagnostic Criteria \5\ (the criteria in
    section II.B.). If we cannot find that the person has an MDI of FM but
    there is evidence of another MDI, we will not evaluate the impairment
    under this Ruling. Instead, we will evaluate it under the rules that
    apply for that impairment.
    ---------------------------------------------------------------------------

    \4\ See Frederick Wolfe et al., The American College of
    Rheumatology 1990 Criteria for the Classification of Fibromyalgia:
    Report of the Multicenter Criteria Committee, 33 Arthritis and
    Rheumatism 160 (1990), available at http://www.rheumatology.org/practice/clinical/classification/fibromyalgia/1990_Criteria_for_Classification_Fibro.pdf.
    \5\ See Frederick Wolfe et al., The American College of
    Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and
    Measurement of Symptom Severity, 62 Arthritis Care & Research 600
    (2010), available at http://www.rheumatology.org/practice/clinical/classification/fibromyalgia/2010_Preliminary_Diagnostic_Criteria.pdf.
    ---------------------------------------------------------------------------

    A. The 1990 ACR Criteria for the Classification of Fibromyalgia.
    Based on these criteria, we may find that a person has an MDI of FM if
    he or she has all three of the following:
    1. A history of widespread pain--that is, pain in all quadrants of
    the body (the right and left sides of the body, both above and below
    the waist) and axial skeletal pain (the cervical spine, anterior chest,
    thoracic spine, or low back)--that has persisted (or that persisted)
    for at least 3 months. The pain may fluctuate in intensity and may not
    always be present.
    2. At least 11 positive tender points on physical examination (see
    diagram below). The positive tender points must be found bilaterally
    (on the left and right sides of the body) and both above and below the
    waist.
    a. The 18 tender point sites are located on each side of the body
    at the:
    Occiput (base of the skull);
    Low cervical spine (back and side of the neck);
    Trapezius muscle (shoulder);
    Supraspinatus muscle (near the shoulder blade);
    Second rib (top of the rib cage near the sternum or breast
    bone);
    Lateral epicondyle (outer aspect of the elbow);
    Gluteal (top of the buttock);
    Greater trochanter (below the hip); and
    Inner aspect of the knee.
    b. In testing the tender-point sites,\6\ the physician should
    perform digital palpation with an approximate force of 9 pounds
    (approximately the amount of pressure needed to blanch the thumbnail of
    the examiner). The physician considers a tender point to be positive if
    the person experiences any pain when applying this amount of pressure
    to the site.
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    \6\ We may use the criteria in section II.B. of this SSR to
    determine an MDI of FM if the case record does not include a report
    of the results of tender-point testing, or the report does not
    describe the number and location on the body of the positive tender
    points.
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    3. Evidence that other disorders that could cause the symptoms or
    signs were excluded. Other physical and mental disorders may have
    symptoms or signs that are the same or similar to those

    [[Page 43642]]

    resulting from FM.\7\ Therefore, it is common in cases involving FM to
    find evidence of examinations and testing that rule out other disorders
    that could account for the person's symptoms and signs. Laboratory
    testing may include imaging and other laboratory tests (for example,
    complete blood counts, erythrocyte sedimentation rate, anti-nuclear
    antibody, thyroid function, and rheumatoid factor).
    ---------------------------------------------------------------------------

    \7\ Some examples of other disorders that may have symptoms or
    signs that are the same or similar to those resulting from FM
    include rheumatologic disorders, myofacial pain syndrome,
    polymyalgia rheumatica, chronic Lyme disease, and cervical
    hyperextension-associated or hyperflexion-associated disorders.
    [GRAPHIC] [TIFF OMITTED] TN25JY12.000

    B. The 2010 ACR Preliminary Diagnostic Criteria. Based on these
    criteria, we may find that a person has an MDI of FM if he or she has
    all three of the following criteria \8\:
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    \8\ We adapted the criteria from the 2010 ACR Preliminary
    Diagnostic Criteria because the Act and our regulations require a
    claimant for disability benefits to establish by objective medical
    evidence that he or she has a medically determinable impairment. See
    sections 223(d)(5)(A) and 1614(a)(3)(D) of the Act; 20 CFR 404.1508
    and 416.908; SSR 96-4p: Titles II and XVI: Symptoms, Medically
    Determinable Physical and Mental Impairments, and Exertional and
    Nonexertional Limitations, 61 FR 34488 (July 2, 1996) (also
    available at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR96-04-di-01.html).
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    1. A history of widespread pain (see section II.A.1.);
    2. Repeated manifestations of six or more FM symptoms, signs,\9\ or
    co-occurring conditions,\10\ especially manifestations of fatigue,
    cognitive or memory problems (``fibro fog''), waking unrefreshed,\11\
    depression, anxiety disorder, or irritable bowel syndrome; and
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    \9\ Symptoms and signs that may be considered include the
    ``(s)omatic symptoms'' referred to in Table No. 4, ``Fibromyalgia
    diagnostic criteria,'' in the 2010 ACR Preliminary Diagnostic
    Criteria. We consider some of the ``somatic symptoms'' listed in
    Table No. 4 to be ``signs'' under 20 CFR 404.1528(b) and 416.928(b).
    These ``somatic symptoms'' include muscle pain, irritable bowel
    syndrome, fatigue or tiredness, thinking or remembering problems,
    muscle weakness, headache, pain or cramps in the abdomen, numbness
    or tingling, dizziness, insomnia, depression, constipation, pain in
    the upper abdomen, nausea, nervousness, chest pain, blurred vision,
    fever, diarrhea, dry mouth, itching, wheezing, Raynaud's phenomenon,
    hives or welts, ringing in the ears, vomiting, heartburn, oral
    ulcers, loss of taste, change in taste, seizures, dry eyes,
    shortness of breath, loss of appetite, rash, sun sensitivity,
    hearing difficulties, easy bruising, hair loss, frequent urination,
    or bladder spasms.
    \10\ Some co-occurring conditions that may be considered are
    referred to in Table No. 4, ``Fibromyalgia diagnostic criteria,'' in
    the 2010 ACR Preliminary Diagnostic Criteria as ``somatic
    symptoms,'' such as irritable bowel syndrome or depression. Other
    co-occurring conditions, which are not listed in Table No. 4, may
    also be considered, such as anxiety disorder, chronic fatigue
    syndrome, irritable bladder syndrome, interstitial cystitis,
    temporomandibular joint disorder, gastroesophageal reflux disorder,
    migraine, or restless leg syndrome.
    \11\ ``Waking unrefreshed'' may be indicated in the case record
    by the person's statements describing a history of non-restorative
    sleep, such as statements about waking up tired or having difficulty
    remaining awake during the day, or other statements or evidence in
    the record reflecting that the person has a history of non-
    restorative sleep.
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    3. Evidence that other disorders that could cause these repeated
    manifestations of symptoms, signs, or co-occurring conditions were
    excluded (see section II.A.3.).

    III. What documentation do we need?

    A. General

    1. As in all claims for disability benefits, we need objective
    medical evidence to establish the presence of an MDI. When a person
    alleges FM, longitudinal records reflecting ongoing medical evaluation
    and treatment from acceptable medical sources are especially helpful in
    establishing both the existence and severity of the impairment. In
    cases involving FM, as in any case, we will make every reasonable
    effort to obtain all available, relevant evidence to ensure appropriate
    and thorough evaluation.
    2. We will generally request evidence for the 12-month period
    before the date of application unless we have reason to believe that we
    need evidence from an

    [[Page 43643]]

    earlier period, or unless the alleged onset of disability is less than
    12 months before the date of application.\12\ In the latter case, we
    may still request evidence from before the alleged onset date if we
    have reason to believe that it could be relevant to a finding about the
    existence, severity, or duration of the disorder, or to establish the
    onset of disability.
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    \12\ See 20 CFR 404.1512(d) and 416.912(d).
    ---------------------------------------------------------------------------

    B. Other Sources of Evidence

    1. In addition to obtaining evidence from a physician, we may
    request evidence from other acceptable medical sources, such as
    psychologists, both to determine whether the person has another MDI(s)
    and to evaluate the severity and functional effects of FM or any of the
    person's other impairments. We also may consider evidence from medical
    sources who are not ``acceptable medical sources'' to evaluate the
    severity and functional effects of the impairment(s).
    2. Under our regulations and SSR 06-3p,\13\ information from
    nonmedical sources can also help us evaluate the severity and
    functional effects of a person's FM. This information may help us to
    assess the person's ability to function day-to-day and over time. It
    may also help us when we make findings about the credibility of the
    person's allegations about symptoms and their effects.\14\ Examples of
    nonmedical sources include:
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    \13\ See 20 CFR 404.1513(d)(4), 416.913(d)(4); SSR 06-3p: Titles
    II and XVI: Considering Opinions and Other Evidence from Sources Who
    Are Not ``Acceptable Medical Sources'' in Disability Claims, 71 FR
    45593 (August 9, 2006), (also available at: http://www.ssa.gov/OP_Home/rulings/di/01/SSR2006-03-di-01.html).
    \14\ See section IV below.
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    a. Neighbors, friends, relatives, and clergy; and
    b. Past employers, rehabilitation counselors, and teachers; and
    c. Statements from SSA personnel who interviewed the person.

    C. When There Is Insufficient Evidence for Us To Determine Whether the
    Person Has an MDI of FM or Is Disabled

    1. We may take one or more actions to try to resolve the
    insufficiency: \15\
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    \15\ See 20 CFR 404.1520b(c) and 416.920b(c).
    ---------------------------------------------------------------------------

    a. We may recontact the person's treating or other source(s) to see
    if the information we need is available;
    b. We may request additional existing records;
    c. We may ask the person or others for more information; or
    d. If the evidence is still insufficient to determine whether the
    person has an MDI of FM or is disabled despite our efforts to obtain
    additional evidence, we may make a determination or decision based on
    the evidence we have.
    2. We may purchase a consultative examination (CE) at our expense
    to determine if a person has an MDI of FM or is disabled when we need
    this information to adjudicate the case.\16\
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    \16\ See 20 CFR 404.1520b(c)(3), and 416.920b(c)(3). We may
    purchase a CE without recontacting a person's treating or other
    sources if the source cannot provide the necessary information, or
    the information is not available from the source. See 20 CFR
    404.1519a(b), and 416.919a(b).
    ---------------------------------------------------------------------------

    a. We will not purchase a CE solely to determine if a person has FM
    in addition to another MDI that could account for his or her symptoms.
    b. We may purchase a CE to help us assess the severity and
    functional effects of medically determined FM or any other
    impairment(s). If necessary, we may purchase a CE to help us determine
    whether the impairment(s) meets the duration requirement.
    c. Because the symptoms and signs of FM may vary in severity over
    time and may even be absent on some days, it is important that the
    medical source who conducts the CE has access to longitudinal
    information about the person. However, we may rely on the CE report
    even if the person who conducts the CE did not have access to
    longitudinal evidence if we determine that the CE is the most probative
    evidence in the case record.
    IV. How do we evaluate a person's statements about his or her
    symptoms and functional limitations? We follow the two-step process set
    forth in our regulations and in SSR 96-7p.\17\
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    \17\ See 20 CFR 404.1529(b) and (c) and 416.929(b) and (c); SSR
    96-7p: Titles II and XVI: Evaluation of Symptoms in Disability
    Claims: Assessing the Credibility of an Individual's Statements, 61
    FR 34483 (July 2, 1996) (also available at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR96-07-di-01.html).
    ---------------------------------------------------------------------------

    A. First step of the symptom evaluation process. There must be
    medical signs and findings that show the person has an MDI(s) which
    could reasonably be expected to produce the pain or other symptoms
    alleged. FM which we determined to be an MDI satisfies the first step
    of our two-step process for evaluating symptoms.
    B. Second step of the symptom evaluation process. Once an MDI is
    established, we then evaluate the intensity and persistence of the
    person's pain or any other symptoms and determine the extent to which
    the symptoms limit the person's capacity for work. If objective medical
    evidence does not substantiate the person's statements about the
    intensity, persistence, and functionally limiting effects of symptoms,
    we consider all of the evidence in the case record, including the
    person's daily activities, medications or other treatments the person
    uses, or has used, to alleviate symptoms; the nature and frequency of
    the person's attempts to obtain medical treatment for symptoms; and
    statements by other people about the person's symptoms. As we explain
    in SSR 96-7p, we will make a finding about the credibility of the
    person's statements regarding the effects of his or her symptoms on
    functioning. We will make every reasonable effort to obtain available
    information that could help us assess the credibility of the person's
    statements.
    V. How do we find a person disabled based on an MDI of FM? Once we
    establish that a person has an MDI of FM, we will consider it in the
    sequential evaluation process to determine whether the person is
    disabled. As we explain in section VI. below, we consider the severity
    of the impairment, whether the impairment medically equals the
    requirements of a listed impairment, and whether the impairment
    prevents the person from doing his or her past relevant work or other
    work that exists in significant numbers in the national economy.
    VI. How do we consider FM in the sequential evaluation process?
    \18\ As with any adult claim for disability benefits, we use a 5-step
    sequential evaluation process to determine whether an adult with an MDI
    of FM is disabled.\19\
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    \18\ As we have already noted, we refer in this SSR only to
    adult disability claims, but the guidance in the SSR applies to all
    disability cases under titles II and XVI involving FM. We use
    different sequential evaluation processes for claims of children
    under title XVI and in continuing disability reviews of adults and
    children under titles II and XVI. See 20 CFR 404.1594, 416.924,
    416.994, and 416.994a. We also use a modification of the 5-step
    sequential evaluation process for adults in 20 CFR 416.920 when we
    do age-18 redeterminations under title XVI. See 20 CFR 416.987.
    \19\ See 20 CFR 404.1520 and 416.920.
    ---------------------------------------------------------------------------

    A. At step 1, we consider the person's work activity. If a person
    with FM is doing substantial gainful activity, we find that he or she
    is not disabled.
    B. At step 2, we consider whether the person has a ``severe''
    MDI(s). If we find that the person has an MDI that could reasonably be
    expected to produce the pain or other symptoms the person alleges, we
    will consider those symptom(s) in deciding whether the person's
    impairment(s) is severe. If the person's pain or other symptoms cause a
    limitation or restriction that has more than a minimal effect on the
    ability to perform basic work activities, we will

    [[Page 43644]]

    find that the person has a severe impairment(s).\20\
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    \20\ See SSR 96-3p: Titles II and XVI: Considering Allegations
    of Pain and Other Symptoms in Determining Whether a Medically
    Determinable Impairment is Severe, 61 FR 34468 (July 2, 1996) (also
    available at: http://www.ssa.gov/OP_Home/rulings/di/01/SSR96-03-di-01.html).
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    C. At step 3, we consider whether the person's impairment(s) meets
    or medically equals the criteria of any of the listings in the Listing
    of Impairments in appendix 1, subpart P of 20 CFR part 404 (appendix
    1). FM cannot meet a listing in appendix 1 because FM is not a listed
    impairment. At step 3, therefore, we determine whether FM medically
    equals a listing (for example, listing 14.09D in the listing for
    inflammatory arthritis), or whether it medically equals a listing in
    combination with at least one other medically determinable impairment.
    D. Residual Functional Capacity (RFC) assessment: In our
    regulations and SSR 96-8p,\21\ we explain that we assess a person's RFC
    when the person's impairment(s) does not meet or equal a listed
    impairment. We base our RFC assessment on all relevant evidence in the
    case record. We consider the effects of all of the person's medically
    determinable impairments, including impairments that are ``not
    severe.'' For a person with FM, we will consider a longitudinal record
    whenever possible because the symptoms of FM can wax and wane so that a
    person may have ``bad days and good days.''
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    \21\ See 20 CFR 404.1520(e), 416.920(e); SSR 96-8p: Titles II
    and XVI: Assessing Residual Functional Capacity in Initial Claims,
    61 FR 34474 (July 2, 1996) (also available at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR96-08-di-01.html).
    ---------------------------------------------------------------------------

    E. At steps 4 and 5, we use our RFC assessment to determine whether
    the person is capable of doing any past relevant work (step 4) or any
    other work that exists in significant numbers in the national economy
    (step 5). If the person is able to do any past relevant work, we find
    that he or she is not disabled. If the person is not able to do any
    past relevant work or does not have such work experience, we determine
    whether he or she can do any other work. The usual vocational
    considerations apply.\22\
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    \22\ See 20 CFR 404.1560-404.1569a and 416.960-416.969a.
    ---------------------------------------------------------------------------

    1. Widespread pain and other symptoms associated with FM, such as
    fatigue, may result in exertional limitations that prevent a person
    from doing the full range of unskilled work in one or more of the
    exertional categories in appendix 2 of subpart P of part 404 (appendix
    2).\23\ People with FM may also have nonexertional physical or mental
    limitations because of their pain or other symptoms.\24\ Some may have
    environmental restrictions, which are also nonexertional.
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    \23\ See SSR 83-12: Title 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 (available at http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR83-12-di-02.html).
    \24\ See SSR 85-15: Titles II and XVI: Capability To Do Other
    Work--The Medical-Vocational Rules as a Framework for Evaluating
    Solely Nonexertional Impairments (available at: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR85-15-di-02.html);
    and SSR 96-4p.
    ---------------------------------------------------------------------------

    2. Adjudicators must be alert to the possibility that there may be
    exertional or nonexertional (for example, postural or environmental)
    limitations that erode a person's occupational base sufficiently to
    preclude the use of a rule in appendix 2 to direct a decision. In such
    cases, adjudicators must use the rules in appendix 2 as a framework for
    decision-making and may need to consult a vocational resource.\25\
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    \25\ See SSR 83-12; SSR 83-14: Titles II and XVI: Capability To
    Do Other Work--The Medical-Vocational Rules as a Framework for
    Evaluating a Combination of Exertional and Nonexertional Impairments
    (available at http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR83-14-di-02.html); SSR 85-15; and SSR 96-9p, Titles II and XVI:
    Determining Capability to Do Other Work--Implications of a Residual
    Functional Capacity for Less Than a Full Range of Sedentary Work, 61
    FR 34478 (July 2, 1996) (also available at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR96-09-di-01.html).

    DATES: Effective Date: This SSR is effective on July 25, 2012.
    Cross-References: SSR 82-63: Titles II and XVI: Medical-Vocational
    Profiles Showing an Inability To Make an Adjustment to Other Work; SSR
    83-12: Title 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; SSR 83-14: Titles II
    and XVI: Capability To Do Other Work--The Medical-Vocational Rules as a
    Framework for Evaluating a Combination of Exertional and Nonexertional
    Impairments; SSR 85-15: Titles II and XVI: Capability To Do Other
    Work--The Medical-Vocational Rules as a Framework for Evaluating Solely
    Nonexertional Impairments; SSR 96-3p: Titles II and XVI: Considering
    Allegations of Pain and Other Symptoms in Determining Whether a
    Medically Determinable Impairment is Severe; SSR 96-4p: Policy
    Interpretation Ruling Titles II and XVI: Symptoms, Medically
    Determinable Physical and Mental Impairments, and Exertional and
    Nonexertional Limitations; SSR 96-7p: Titles II and XVI: Evaluation of
    Symptoms in Disability Claims: Assessing the Credibility of an
    Individual's Statements; SSR 96-8p: Titles II and XVI: Assessing
    Residual Functional Capacity in Initial Claims; SSR 96-9p, Titles II
    and XVI: Determining Capability to Do Other Work--Implications of a
    Residual Functional Capacity for Less Than a Full Range of Sedentary
    Work; SSR 99-2p: Titles II and XVI: Evaluating Cases Involving Chronic
    Fatigue Syndrome (CFS); SSR 02-2p: Titles II and XVI: Evaluation of
    Interstitial Cystitis; and SSR 06-3p: Titles II and XVI: Considering
    Opinions and Other Evidence from Sources Who Are Not ``Acceptable
    Medical Sources'' in Disability Claims; Considering Decisions on
    Disability by Other Governmental and Nongovernmental Agencies; and
    Program Operations Manual System (POMS) DI 22505.001, DI 22505.003, DI
    24510.057, DI 24515.012, DI 24515.061-DI 24515.063, DI 24515.075, DI
    24555.001, DI 25010.001, and DI 25025.001.

    [FR Doc. 2012-17936 Filed 7-24-12; 8:45 am]
    BILLING CODE 4191-02-P




    http://www.gpo.gov/fdsys/pkg/FR-2012-07-25/html/2012-17936.htm[This Message was Edited on 07/31/2012]