[Federal Register Volume 76, Number 176 (Monday, September 12, 2011)]
[Notices]
[Pages 56263-56271]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-23239]
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SOCIAL SECURITY ADMINISTRATION
[Social Security Ruling, SSR 11-2p; Docket No. SSA-2010-0079]
Titles II and XVI: Documenting and Evaluating Disability in Young
Adults
AGENCY: Social Security Administration.
ACTION: Notice of Social Security Ruling (SSR).
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SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of
Social Security gives notice of Social Security Ruling, SSR-11-2p. This
Ruling explains our policy on documenting and evaluating disability in
young adults.
DATES: Effective Date: September 12, 2011.
FOR FURTHER INFORMATION CONTACT: Cheryl A. Williams, Office of
Disability Programs, Social Security Administration, 6401 Security
Boulevard, Baltimore, MD 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.
[[Page 56264]]
Although SSRs do not have the same force and effect as statutes or
regulations, they are binding on all of our components. 20 CFR
402.35(b)(1).
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)
Dated: September 6, 2011.
Michael J. Astrue,
Commissioner of Social Security.
Policy Interpretation Ruling
Titles II and XVI: Documenting and Evaluating Disability in Young
Adults
Purpose: This SSR consolidates information from our regulations on
documenting and evaluating disability in young adults. We also provide
guidance on how we apply our policies when we determine whether a young
adult is disabled under our rules.
Citations (Authority): Sections 216(i), 222(c), 223(a), 223(c),
223(d), 223(f), 225(b), 1614(a)(3), 1614(a)(4), 1619, and 1631(a) of
the Social Security Act, as amended; Regulations No. 4, subpart B,
section 404.130; subpart D, sections 404.316, 404.327-404.330, 404.339-
404.340, 404.348, 404.350, 404.352, and 404.354; subpart P, sections
404.1505, 404.1509-404.1510, 404.1513, 404.1520-404.1521, 404.1525-
404.1527, 404.1545-404.1546, 404.1560-404.1569a, 404.1571-404.1576,
404.1584, 404.1590, 404.1594, appendix 1 and appendix 2; and
Regulations No. 16, subpart I, sections 416.902, 416.905, 416.909-
416.910, 416.913, 416.920-416.921, 416.924a, 416.925-416.927, 416.945-
416.946, 416.960-416.969a, 416.971-416.976, 416.987, 416.990, and
416.994, and subpart M, sections 416.1320, 416.1331, and 416.1338.
Introduction
We consider people between the ages of 18 to approximately 25 to be
young adults. When we make disability determinations or decisions for
young adults, we use the same definition for disability as we do for
other adults.\1\ We also use adult rules to make disability
determinations or decisions in several other situations:
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\1\ Under title II, we sometimes use the adult definition of
disability to make disability determinations or decisions for people
under age 18. In these situations, we will use the guidance in this
SSR when we make our determination or decision.
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When a young adult files a claim for child \2\ benefits on
a parent's record based on a disability that began before he or she
attained age 22;
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\2\ For purposes of title II entitlement, a ``child'' is a
person who has the required relationship to the insured worker. See
20 CFR 404.330, 404.339-404.340, 404.348, 404.350, and 404.354.
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When a child \3\ who is receiving title XVI childhood
disability benefits attains age 18 and must undergo a disability
redetermination; \4\ and
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\3\ For purposes of determining disability under title XVI, a
``child'' is ``a person who has not attained age 18.'' See 20 CFR
416.902.
\4\ See 20 CFR 416.987.
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When a young adult receiving disability benefits under
title II or XVI undergoes a continuing disability review (CDR) to
determine whether he or she is still disabled.\5\
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\5\ See 20 CFR 404.1590 and 416.990.
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Like other adults, a young adult who applies for disability
benefits under title II or XVI \6\ is ``disabled'' if he or she has a
medically determinable physical or mental impairment(s) \7\ that
results in ``an inability to do any substantial gainful activity.'' \8\
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\6\ For simplicity, we refer in this SSR only to initial claims
for benefits. However, the policy interpretations in this SSR also
apply, with some exceptions, to age-18 redeterminations under
section 1614(a)(3)(H)(iii) of the Act and 20 CFR 416.987 and to CDRs
under sections 223(f) and 1614(a)(4) of the Act and 20 CFR 404.1594
and 416.994. When there is a difference in how the policy applies to
age-18 redeterminations or to CDRs, we explain how the policy
differs.
\7\ We use the term ``impairment(s)'' in this SSR to refer to an
``impairment or a combination of impairments.''
\8\ The impairment(s) must also satisfy the duration requirement
in sections 216(i)(1), 223(d)(1)(A), and 1614(a)(3)(A) of the Act;
that is, it must be expected to result in death or must have lasted
or be expected to last for a continuous period of not less than 12
months. See also 20 CFR 404.1505, 404.1509, 416.905, and 416.909.
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We use a five-step sequential evaluation process to determine
disability:
1. Is the person engaging in substantial gainful activity (SGA)?
\9\ If yes, the person is not disabled.
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\9\ For the definition of SGA and the rules for how we determine
whether work shows that a person has the ability to do SGA, see 20
CFR 404.1510, 404.1571-404.1576, 404.1584, and 416.910, and 416.971-
416.976.
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2. Does the person have a medically determinable physical or mental
impairment(s) that is severe? \10\ If no, the person is not disabled.
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\10\ An impairment(s) is not severe if it does not significantly
limit the person's physical or mental ability to do basic work
activities. 20 CFR 404.1521 and 416.921.
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3. Does the person have an impairment(s) that meets or medically
equals a listing in the Listing of Impairments (listings)? \11\ If yes
and the impairment(s) meets the duration requirement, the person is
disabled.
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\11\ The rules for how we determine whether an impairment(s)
meets or medically equals a listing are in 20 CFR 404.1525,
404.1526, 416.925, and 416.926. The listings are at 20 CFR part 404,
subpart P, appendix 1.
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4. Does the person have the residual functional capacity (RFC) \12\
to do past relevant work? If yes, the person is not disabled.
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\12\ The basic rules for RFC are in 20 CFR 404.1545-404.1546,
404.1569a, 416.945-416.946, and 416.969a. See also SSR 96-8p, 61 FR
34474 (1996), available at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR96-08-di-01.html. (For the complete titles of all
SSRs cited in this footnote and those following, see the CROSS-
REFERENCES section at the end of this SSR).
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5. Does the person have the RFC to adjust to other work that exists
in significant numbers in the national economy, considering his or her
age, education, and previous work experience? \13\ If no, the person is
disabled. If yes, the person is not disabled.\14\
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\13\ The rules for determining whether a person can adjust to
other work are in 20 CFR 404.1560-404.1569a, 20 CFR part 404,
subpart P, appendix 2, and 20 CFR 416.960-416.969a.
\14\ See 20 CFR 404.1520 and 416.920. The sequential evaluation
process for age-18 redeterminations follows the process we use for
initial claims, except that we do not consider whether the person is
engaging in SGA (step 1). See 20 CFR 416.987. Unlike the sequential
evaluation process for initial claims, the sequential evaluation
process for CDRs first considers whether there has been medical
improvement related to the ability to work. See 20 CFR 404.1594 and
416.994.
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This SSR explains the evidence we need to document a young adult's
impairment-related limitations, other considerations for evaluating
limitations, disability insured status, issues related to the
sequential evaluation process, and resolving inconsistencies in the
evidence. We also discuss continued payments for young adults
participating in vocational rehabilitation plans.
Policy Interpretation
The abilities, skills, and behaviors that young adults use to do
basic work activities are essentially the same as those that older
adolescents \15\ use for age-appropriate activities.\16\ Thus, the
evidence we consider when we make disability determinations for young
adults is generally the same as, or similar to, the evidence we
consider for making disability determinations for older adolescents
under title XVI. Because the abilities, skills, and behaviors are
essentially the same, the same considerations for evaluating
[[Page 56265]]
limitations in an older adolescent also apply to young adults.
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\15\ An adolescent is a child ``age 12 to the attainment of age
18.'' See 20 CFR 416.926a. An older adolescent is a child
approximately age 16 to the attainment of age 18.
\16\ See, for example, 20 CFR 416.926a(g)-(k). We include
examples of work and work-related activities in the sections
describing the domains for adolescents.
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I. Sources of Evidence About a Young Adult's Ability To Work
Once we have evidence from an acceptable medical source \17\ that
establishes the existence of at least one medically determinable
impairment (MDI), we consider all relevant evidence in the case record
to determine whether a young adult is disabled. This evidence may come
from acceptable medical sources and from a wide variety of ``other
sources.'' \18\ Although we always need evidence from an acceptable
medical source, we will determine what other evidence we need based on
the facts of the case.
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\17\ See 20 CFR 404.1513(a) and 416.913(a).
\18\ See 20 CFR 404.1513(d) and 416.913(d). For more information
about how we consider opinion evidence from ``other sources,''
including opinions about functional limitations, see SSR 06-03p, 71
FR 45593 (2006), available at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2006-03-di-01.html. For information about how
we consider opinion evidence from acceptable medical sources, see
generally 20 CFR 404.1527 and 416.927.
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A. Medical Sources
1. In addition to providing evidence establishing an MDI,
acceptable medical sources can provide information about how an
impairment(s) affects a young adult's ability to do work-related
activities. For example, a physician might discuss the impact of asthma
on a young adult's participation in physical activities, or a speech-
language pathologist might discuss how a language disorder contributes
to limited attention and problems on a job.
2. We may receive evidence from other medical sources who are not
``acceptable medical sources,'' such as nurse-practitioners,
physicians' assistants, naturopaths, chiropractors, audiologists,
occupational therapists (OTs), physical therapists (PTs), and
psychiatric social workers (PSWs). We cannot use evidence from these
sources to establish that a young adult has an MDI. However, we can use
evidence from these sources to determine the severity of the
impairment(s) and how it affects the young adult's ability to do work-
related activities. This evidence can be very helpful, especially if a
source sees the young adult regularly. For example:
A PSW might comment on the young adult's ability to deal
with changes in a routine work setting.
An OT or PT might evaluate the impact of a neurological
disorder on the young adult's activities and comment on muscle tone and
strength and how it affects his or her ability to stand and walk.
An OT might comment on the young adult's ability to use
fine motor skills to use a computer.
B. Non-Medical Sources
Evidence from other sources who are not medical sources, but who
know and have contact with the young adult, can also help us evaluate
the severity and impact of a young adult's impairment(s). These sources
include family members, educational personnel (for example, teachers
and counselors), public and private social welfare agency personnel,
and others (for example, friends, neighbors, and clergy). Therefore, we
consider evidence in the case record from non-medical sources when we
determine the severity of the young adult's impairment(s) and how the
young adult is able to function.
C. School Programs
Evidence from school programs, including secondary and post-
secondary schools, can also help us evaluate the severity and impact of
a young adult's impairment(s).
1. Many young adults who received special education (including
transition services) or related services \19\ before they attained age
18 continue to receive these services until they are age 22. Other
young adults may participate in postsecondary programs, including
college or vocational training.\20\
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\19\ In this context, special education refers to instructional
services provided to students through age 21 in primary and
secondary education under the Individuals with Disabilities
Education Improvement Act of 2004 (commonly referred to as
``IDEA'').
Transition services means a coordinated set of special education
services that is designed to facilitate the student's movement from
school to post-school activities, including postsecondary education,
vocational education, integrated employment, independent living, or
community participation. Such services include instruction, related
services, community services, the development of employment and
other post-school adult living objectives, and, if appropriate,
acquisition of daily living skills and provision of a functional
vocational evaluation.
Related services include transportation and developmental,
corrective, and other supportive services (for example, occupational
therapy) as are required to assist a student with a disability to
benefit from special education. A student who does not qualify for
special education may qualify for related services under section 504
of the Rehabilitation Act of 1973 to ensure a free, appropriate
public education.
\20\ The Higher Education Opportunity Act of 2008 authorizes
postsecondary educational services for students with disabilities.
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2. Young adults who receive special education services after age 17
will have an Individualized Education Program (IEP),\21\ including an
IEP transition plan. The IEP transition plan describes a student's
levels of functioning based on reasonable estimates by both the student
and the special education team. It also identifies the kinds of
vocational and living skills the young adult needs to develop in order
to function independently as an adult.
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\21\ We provide an extensive discussion of IEPs in SSR 09-2p, 74
FR 7625 (2009), available at: http://www.socialsecurity.gov/OP_Home/rulings/ssi/02/SSR2009-02-ssi-02.html. The information about
IEPs applies equally to people age 18-22 who are still in special
education. We may also consider IEPs from a period before the person
attained age 18 (for example, senior year of high school) if they
are relevant to the period we are considering in connection with an
application, age-18 redetermination, or CDR. Recent IEPs will
frequently be relevant in age-18 redeterminations.
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3. The IEP transition goals may range from the development of
skills appropriate to supervised and supported work and living settings
to those needed in independent work and living situations. For example,
an IEP transition goal for an 18-year-old might be, ``The student will
independently use public transportation,'' while specific objectives
would identify the skills to be developed (for example, reading a bus
schedule) and the particular instruction methods to be used to develop
the skills (for example, one-to-one tutoring with practice reading a
bus schedule).
4. The goals in an IEP may be set at a level that the young adult
can readily achieve to foster a sense of accomplishment and may be
lower than what would be expected of a young adult without impairments.
In this regard:
A young adult who achieves a goal may or may not have
limitations. The young adult may be developing or acquiring skills at a
slower rate than young adults without impairments and may have achieved
the goal simply because it was set low.
A young adult who does not achieve a goal likely has an
impairment-related limitation(s). A young adult's failure to achieve a
goal, however, does not, by itself, establish that the impairment(s) is
disabling.
II. Considerations Related To Evaluating a Young Adult's Impairment-
Related Limitations
We evaluate a young adult's impairment-related limitations when we:
Determine whether his or her MDI(s) is ``severe''--that
is, significantly limits his or her physical or mental ability to do
basic work activities;
Determine whether his or her MDI(s) meets or medically
equals a listed impairment; and
Assess his or her RFC.
The examples in the sections below do not necessarily establish
that a young
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adult is disabled, only that the person may have limitations that
affect what work he or she may be able to do.
A. Evidence Regarding Functioning From Educational Programs
As we discussed in section I.C above, we may have evidence about a
young adult's functioning from school programs, including IEPs. This
evidence may indicate how well a young adult can use his or her
physical or mental abilities to perform work activities. The following
examples of school-reported difficulties might indicate difficulty with
work activities:
Difficulty in understanding, remembering, and carrying out
simple instructions and work procedures during a school-sponsored work
experience;
Difficulty communicating spontaneously and appropriately
in the classroom;
Difficulty with maintaining attention for extended periods
in a classroom;
Difficulty relating to authority figures and responding
appropriately to correction or criticism during school or a work-study
experience;
Difficulty using motor skills to move from one classroom
to another.
B. Community Experiences, Including Job Placements
1. A young adult may receive services in a community setting(s)
through a school or a community agency, such as a mental health center
or vocational rehabilitation agency. These services may include:
Community-based instruction (CBI), or instruction in a
natural, age-appropriate setting (for example, trips to the grocery
store to develop math, sequencing, travel, and social skills).
On-the-job training (OJT), or placement in various work
sites in the community for vocational training and experience,
frequently in an ``enclave'' (small group) of students with a job coach
(for example, placement in an enclave in a motel to learn housekeeping
tasks such as bed-making and vacuuming).
Work experience, or supervised part-time or full-time
employment to assist a young adult in acquiring job skills and good
work attitudes and habits.
2. A young adult may participate in several--or even many--OJT or
work experience placements that are unpaid, paid at SGA levels, or paid
at less than SGA levels. Some young adults have multiple placements as
part of a transition plan that expose them to a variety of work
settings. Other young adults have multiple placements because of
unsatisfactory performance.
Regardless of whether the work was SGA, information about how well
a young adult performed in these placements can help us assess how the
young adult functions. For example, a young adult who was unable to
sustain OJT placements may have limitations in the ability to
understand and remember instructions or to persist at work-related
tasks. In contrast, a young adult who performed OJT placements
successfully may have a good ability to respond appropriately to
supervision. In addition, information about the degree to which a young
adult needs special supports in order to work (such as in supported or
transitional employment programs) may also help us assess the young
adult's functioning.
C. Psychosocial Supports and Highly Structured or Supportive Settings
As for all adults, psychosocial supports and highly structured or
supportive settings may reduce the demands on a young adult and help
him or her function. However, the young adult's ability to function in
settings that are less demanding, more structured, or more supportive
than those in which people typically work does not necessarily show how
the young adult will be able to function in a work setting. We will
consider the kind and extent of support or assistance and the
characteristics of any structured setting in which the young adult
spends his or her time when we evaluate the effects of his or her
impairment(s) on functioning.
D. Extra Help and Accommodations
Working requires a person to be able to do the tasks of a job
independently, appropriately, effectively, and on a sustained basis. In
this regard, the analysis for adult disability determination purposes
is similar to our ``extra help'' rules for children.\22\ If an adult
with an impairment(s) needs or would need greater supervision or
assistance, or some other type of accommodation, because of the
impairment(s) than an employee who does not have an impairment, the
adult has a work-related limitation.
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\22\ See, 20 CFR 416.924a(b)(5)(ii).
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We consider how independently a young adult is able to function,
including whether the young adult needs help from other people or
special equipment, devices, or medications to perform day-to-day
activities. If a young adult can function only if he or she receives
more help than would generally be provided to people without medical
impairments, we consider how well the young adult would function
without the extra help. The more extra help or support of any kind that
a young adult receives because of his or her impairment(s), the less
independent he or she is in functioning, and the more severe we will
find the limitation to be.
1. Accommodations
a. Accommodations are practices and procedures that allow a person
to complete the same activity or task as other people. Accommodations
can include a change in setting, timing, or scheduling, or an assistive
or adaptive device.
b. Some young adults with impairments need accommodations in their
educational program in order to participate in the general curriculum
or in a transitional program.\23\ The fact that a young adult receives
or has received accommodations as a part of his or her IEP or Section
504 plan,\24\ may be an indication that he or she has a work-related
limitation. For example, evidence showing that a student requires an
audiotape recording of oral directions for replay at school because he
cannot remember more than a one-step instruction might indicate that
the student will have the same inability to remember more than a one-
step instruction without special assistance in a work setting.
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\23\ We provide more detail about accommodations in IEPs in SSR
09-2p.
\24\ Section 504 of the Rehabilitation Act of 1973 prohibits
discrimination on the basis of disability in programs and activities
that receive Federal financial assistance. P.L. 93-112, section 504;
29 U.S.C. 794(a), as amended. Under this section, schools must
provide a free, appropriate public education to each student with a
disability. See 34 CFR 104.33(a). When a student has a disability
that limits his or her access to the educational setting, the school
will conduct an evaluation of specific areas of educational need
and, if necessary, have a written plan for the aids and services
that will be provided.
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c. Some accommodations may indicate an impairment(s) that meets or
medically equals a listing. For example, the need for an augmentative
or alternative communication or AAC device (for example, an electronic
picture board or an electrolarynx) might indicate a speech impairment
that meets listing 2.09 or an impairment that meets one of the
neurological listings in section 11.00 of the listings.
d. When we determine whether a person can perform his or her past
relevant work, we do not consider potential accommodations unless his
or her employer actually made the accommodation. This means that we
cannot find that a young adult can do past relevant work with
accommodations unless the young adult
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actually performed that work with those same accommodations and is
still able to do so now.
e. When we determine whether a person can do other work that exists
in significant numbers in the national economy, we do not consider
whether he or she could do so with accommodations, even if an employer
would be required to provide reasonable accommodations under the
Americans with Disabilities Act of 1990.\25\
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\25\ The Americans with Disabilities Act of 1990 requires an
employer to provide ``reasonable accommodations'' to a qualified
person with a disability. See Sec. 101, 104 Stat. 331, 42 U.S.C.
12111(9); and SSR 00-1c, 65 FR 1215 (2000), available at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2000-01-di-01.html.
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2. Effects of Treatment, Including Medications
Treatment, including medications, can have a positive effect on a
person's ability to function in a work setting. For example, a young
adult who takes an antidepressant medication may be able to interact
appropriately with supervisors and co-workers. Treatment, however, may
not resolve all of the functional limitations that result from an
impairment(s). Medications or other treatment may cause side effects
that affect the mental or physical ability to work. For example, an
anti-epileptic medication may cause drowsiness that affects the ability
to concentrate; daily chest percussion therapy for cystic fibrosis may
cause fatigue because of the physical effort involved in the therapy.
The frequency of a young adult's treatment may preclude him or her from
maintaining a full-time work schedule; that is, 8 hours a day, 5 days a
week on a sustained basis.
E. Work-Related Stress
1. Working involves many factors and demands that can be stressful.
For example, some people may experience stress related to the demands
of getting to work regularly, having work performance supervised, or
remaining in the workplace for a full day, 5 days a week on a sustained
basis. Moreover, one person's reaction to stress associated with the
demands of work may be different from another's, even among people with
the same impairments.
2. Sources familiar with the young adult may provide insight about
the effect of stress on his or her physical or mental functioning and
what, if any, psychosocial supports or structure he or she would need
when experiencing work-related stress.\26\ We consider impairment-
related limitations created by a person's response to the demands of
work when we assess RFC.
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\26\ See SSR 85-15 for further discussion of mental disorders
and stress. SSR 85-15 is available at: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR85-15-di-02.html.
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III. Insured Status for Young Adults
A. When a young adult has worked, we consider whether he or she is
insured for purposes of establishing a period of disability or becoming
entitled to disability insurance benefits. While the Social Security
Act provides the standard for determining insured status for young
adults aged 21 up to age 24, there is no similar statutory standard for
young adults under the age of 21. We use the same rule for both
groups--a young adult meets the disability insured status requirements
if he or she has 6 quarters of coverage in the 12-quarter period ending
with the quarter in which the disability began.\27\
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\27\ Claimants age 24 to the attainment of age 31 meet the
disability insured status requirement when they have quarters of
coverage in at least one-half of the quarters beginning with the
quarter after the quarter they attained age 21 and ending with the
quarter in which disability began. For example, a claimant who
becomes disabled in the quarter in which he or she attains age 25
needs 8 quarters of coverage during the 16 quarters ending in the
quarter in which he or she became disabled. If the number of
quarters in the period we are considering is an odd number, we
reduce it by one to determine how many quarters of coverage the
young adult needs. See 20 CFR 404.130(c).
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B. When our records do not establish disability insured status but
the claimant alleges sufficient work and earnings for that purpose, we
will look to see if there are any covered earnings that are not yet
shown in our records. Covered earnings from an unsuccessful work
attempt may also provide work credits that can establish disability
insured status.
IV. Determining Disability
A. Determining Whether a Young Adult's Work Activity is SGA \28\
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\28\ The SGA step of the sequential evaluation process applies
only to applications under titles II and XVI and to CDRs under title
II. We do not consider the SGA step in age-18 redeterminations or in
title XVI CDRs. See 20 CFR 416.987(b) for the rules on determining
disability in age-18 redeterminations. See 20 CFR 416.994(b)(5) for
the sequential evaluation process for title XVI CDRs for adults.
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When we determine a young adult's earnings for SGA purposes, we
count only those earnings that are attributable to his or her own
productivity. We assume that a young adult's reported earnings are
attributable to his or her own productivity unless there is evidence
indicating that those earnings are greater than would be attributable
to his or her productivity.
1. Work Activity
Many young adults with disabilities have worked. The work
experience may have been (or may be, if the person is still working)
subsidized, in a sheltered setting, or performed under special
conditions. As for any adult, we exclude subsidized earnings.\29\ In
addition:
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\29\ See 20 CFR 404.1574 and 416.974 for evaluating work as an
employee and 20 CFR 404.1575 and 416.975 for work in self-
employment. See also SSR 83-33, and SSR 83-34. SSR 83-33 is
available at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR83-33-di-03.html; SSR 83-34 is available at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR83-34-di-03.html.
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Some young adults whose impairments arose during military
service continue on active duty and receive full pay while they are in
treatment for their impairments. They may also receive payments while
working in a designated therapy program or on limited duty. Active duty
status or receipt of pay (for example, sick pay) by a member of the
military does not indicate by itself that the service person has
demonstrated the ability to do SGA. We will consider the actual work
activity, not the amount of pay the service person receives or the duty
status of the service person, when we determine whether the work is
SGA.\30\
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\30\ See 20 CFR 404.1574(a)(3) and 416.974(a)(3) and SSR 84-24:
Titles II and XVI. SSR 84-24 is available at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR84-24-di-03.html.
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Young adults may have impairment-related work expenses;
that is, expenses for an item or service that directly enables a person
to work and that the person necessarily incurs because of an
impairment(s). We deduct impairment-related work expenses from a
person's wages or self-employment income before we determine whether
the wages or self-employment income constitute SGA.\31\
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\31\ See 20 CFR 404.1576 and 416.976 and SSR 84-26. SSR 84-26 is
available at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR84-26-di-03.html.
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2. Volunteer Service
Young adults with disabilities may participate in government-
sponsored programs for volunteer activity, such as AmeriCorps VISTA. We
do not count as earnings payments a person receives from some of these
programs.\32\
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\32\ See 20 CFR 404.1574(d), 416.974(d), and SSR 84-24.
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3. Unsuccessful Work Attempts
Some people have brief periods of work with earnings at the SGA
level. We will consider the possibility that a brief period of work was
an unsuccessful work attempt when we are determining whether the work
was SGA. If a period
[[Page 56268]]
of work is an unsuccessful work attempt, we will not consider that work
to be SGA when we determine if the young adult is under a
disability.\33\ However, as we noted in section III.A, covered wages or
self-employment income from an unsuccessful work attempt may provide
work credits that establish disability insured status under title II.
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\33\ See 20 CFR 404.1574(c) and 416.974(c) for employees and
404.1575(d) and 416.975(d) for self-employed; see also SSR 84-25 and
SSR 05-2, 70 FR 9692 (2005). SSR 84-25 is available at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR84-25-di-03.html; SSR 05-02 is
at: http://www.ssa.gov/OP_Home/rulings/di/03/SSR2005-02-di-03.html.
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B. Determining Whether the Young Adult Has an MDI(s)
Young adults often have the same kinds of impairments as children;
for example, attention deficit/hyperactivity disorder, language
disorders, or learning disorders. Sometimes, the impairment may be
evident before age 18; at other times, the impairment may not be
identified until later. We will consider all MDIs the young adult has,
including MDIs that are usually found in children.
C. Determining Whether a Young Adult Can Do Past Relevant Work
Many young adults have performed work that was SGA for at least
brief periods. This work will usually meet the 15-year recency test for
past relevant work. If the work also lasted long enough for the young
adult to learn to do it, it will be past relevant work.\34\ We do not
consider work done during a period of entitlement to disability
benefits under title II or title XVI to be past relevant work; \35\
however, we may consider the young adult's job performance when we
assess his or her RFC.
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\34\ 20 CFR 404.1560 and 416.960; see also SSR 82-61 and SSR 82-
62. SSR 82-61 is available at: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR82-61-di-02.html; SSR 82-62, at: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR82-62-di-02.html.
\35\ 20 CFR 404.1594(i) and 416.994(b)(8)
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D. Determining Whether a Young Adult Can Adjust to Other Work
1. As for any adult, we consider a young adult's RFC, age,
education, and work experience to determine if he or she can make an
adjustment to other work. A young adult does not need to have an
impairment(s) that meets or medically equals a listing to qualify for
disability benefits. We may find that a young adult is disabled because
of an inability to adjust to other work.
2. When a young adult has only exertional (strength) limitations
and has an RFC and vocational factors that match the criteria of a rule
in the Medical-Vocational Guidelines in appendix 2 of subpart P of the
Regulations No. 4 (grid rules), the grid rules always direct a decision
of ``not disabled'' for young adults.
3. In many young adult cases, however, the grid rules will not
direct a conclusion of ``disabled'' or ``not disabled.'' For example,
many young adults who qualify for disability benefits have impairments
(such as mental and neurological disorders) that cause non-exertional
limitations. These limitations may erode the occupational base at some,
or even all, levels of exertion.\36\ Other young adults have solely
exertional limitations but are unable to do a full range of work in one
of the exertional categories in appendix 2. Some young adults have
limitations that prevent them from performing even the full range of
sedentary work. In these cases, we consider the type and extent of the
young adult's limitations and the extent of the erosion of the
occupational base and other relevant factors. The following guidelines
apply:
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\36\ See 20 CFR 404.1545(c) and 416.945(c).
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a. If the young adult has solely exertional limitations but is able
to do somewhat more than the full range of sedentary work, the young
adult will not be disabled based on a framework of a grid rule. In this
case, the exertional capacity will always fall between two rules (that
is, a sedentary and a light rule) that direct a conclusion of ``not
disabled.'' \37\
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\37\ See 20 CFR 404.1569 and 416.969 and SSR 83-14. SSR 83-14 is
available at: http://www.ssa.gov/OP_Home/rulings/di/02/SSR83-14-di-02.html.
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b. If a young adult has solely nonexertional limitations or both
exertional and nonexertional limitations, we follow the guidance in the
regulations and the relevant SSRs to determine any erosion of the
occupational base.\38\ If the occupational base is significantly
eroded, we will find the young adult disabled despite his or her young
age.\39\
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\38\ See, for example, SSRs 83-12; 83-14; 85-15; and 96-9p, 61
FR 34478 (1996). SSR 83-12 is available at: http://www.socialsecurity.gov/OP_Home/rulings/di/02/SSR83-12-di-02.html;
SSR 96-9p, at: http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR96-09-di-01.html.
\39\ See 20 CFR part 404, subpart P, appendix 2, Sec.
201.00(h)(3) and SSR 96-9p.
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c. If a young adult has a substantial loss of one or more of the
basic mental demands of competitive, remunerative, unskilled work, the
occupational base will be significantly eroded, despite vocational
factors that we would ordinarily consider favorable (for example, young
age, college education, and skilled work experience).\40\ The basic
mental demands of competitive, remunerative, unskilled work include the
abilities to:
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\40\ See SSR 85-15 and SSR 96-9p.
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Understand, remember, and carry out instructions;
Make simple work-related judgments typically required for
unskilled work;
Respond appropriately to supervision, coworkers, and work
situations; and
Deal with changes in a routine work setting.
d. Adjudicators must remember that young adults are more likely to
have recent educational experience that provides for direct entry into
skilled work; some will also have vocational experiences (see section
C. above) that provide them with skills they can use in skilled or
semiskilled work.
4. A young adult needs only basic communication abilities to do
unskilled work.\41\ Basic communication abilities include the ability
to hear and understand simple oral messages, including instructions,
and to communicate simple messages orally. If the person has these
basic communication abilities, there will not be a significant impact
on the unskilled occupational base.
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\41\ See SSR 96-9p.
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a. Nevertheless, when a person has a physical or mental
impairment(s) that affects communication, it is important to consider
the nature of the impairment and whether the person has other
associated limitations. Many disorders that cause limitations in basic
communication may cause other limitations as well. For example, a
physical disorder like cerebral palsy that can affect a person's facial
muscles and limit the ability to communicate simple messages orally may
also affect the arm muscles and limit the ability to lift and carry.
Language disorders, as well as mental and neurological impairments
commonly found in young adults who allege disability, may also cause
limitations in abilities such as the ability to concentrate, persist,
or maintain pace in job tasks, and the ability to adapt to changes in a
work setting.
b. Language disorders are not the only kinds of impairments that
can affect communication. Some physical impairments may also affect
communication, particularly speech. For example, congenital or acquired
facial deformities may affect speech because a person cannot use his or
her facial muscles for articulation; cerebral palsy may affect speech
because of muscle spasms that make it difficult to speak clearly.
[[Page 56269]]
5. Under the grid rules, we find younger individuals not disabled
even if we determine that their vocational factor of education is
``illiterate.''
a. However, a young adult's educational level can be an indication
of an underlying impairment(s) that affects our assessment of RFC.\42\
For example, if a young adult, despite having attended high school, is
illiterate or has a limited reading ability, he or she may have an MDI,
such as a learning disability or language disorder. Any such underlying
MDI may affect a young adult's RFC. As we noted in Section III.F.4.b,
these types of disorders can cause limitations in many areas.
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\42\
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b. When illiteracy or limited reading ability is related to an MDI,
we consider how the underlying MDI affects the person's ability to meet
the requirements of work when we assess RFC. For example, a person who
has borderline intellectual functioning (BIF) may be limited in her
ability to understand and remember instructions, which results in an
inability to read and write. The BIF also affects her ability to
maintain attention on tasks that she has difficulty remembering. When
we assess her RFC, we assess limitations in maintaining attention as
well as in understanding and remembering instructions. When we
determine whether she can do other work, we consider the vocational
factor of illiteracy.\43\
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\43\ The impairment need not be mental. The same principles
apply to adults as in the 2009 SSRs for children. Those SSRs provide
examples of how physical impairments, especially neurological
impairments and their associated medical treatments, can affect
various functional abilities.
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E. Additional considerations for age-18 redeterminations
1. Young Adult Previously Found Disabled as a Child Under a Listing
\44\
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\44\ See 20 CFR 404.1525(b) and 416.925(b). When we are making a
disability determination or decision under title II for a person
under age 18, we consider part B of the listings until the person
attains age 18. We may also consider part A for the period before
the person attains age 18 if there is no appropriate part B listing
and the disease processes have a similar effect on adults and
children. As for all adults, we use only part A of the Listing of
Impairments when we determine whether a young adult's impairment(s)
meets or medically equals a listing. We never use part B listings
for people who are at least 18 years old.
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a. Although our rules use different words to describe the concept,
``listing-level severity'' is generally the same for both parts A and B
of the listings. Most of the part B listings have an equivalent listing
in part A, and many contain identical criteria. Listings that include
functioning among their criteria are generally based on a standard of
``extreme'' limitation in a specific function (such as walking) or in a
broad area (domain) of functioning (such as concentration, persistence,
or pace), or on ``marked'' limitations in two areas of functioning.
b. While the areas of functioning may differ between analogous
listings in parts A and B, we intend for these criteria to be equally
severe. Therefore, a child's impairment(s) that met or medically
equaled a part B listing will often meet or medically equal a part A
listing at age 18 unless the impairment(s) has medically improved. Note
though that we do not use the medical improvement review standard for
CDRs in age-18 redeterminations.\45\
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\45\ A young adult who was eligible for disability benefits
under title XVI may also file an application under title II; for
example, for Child's Insurance Benefits based on disability. The
same principle applies in such claims.
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2. Young Adult Previously Found Disabled as a Child Based on Functional
Equivalence
a. To functionally equal the listings under title XVI, a child's
impairment(s) must result in ``marked'' limitations in two of the
childhood domains or an ``extreme'' limitation in one.\46\ Although we
do not use these domains for adults, they describe aspects of
functioning that are relevant to our evaluation of a young adult's
work-related limitations. We use similar domains when we evaluate a
child's mental impairments and some physical impairments, such as
immune disorders. We may find that the young adult has the same
severity rating for a domain under a part A listing as he or she had as
a child under a similar functional equivalence domain. For example,
absent medical improvement or new evidence demonstrating that the prior
finding was in error, a young adult who had an extreme limitation in
the ability to interact and relate with others as a child will probably
have extreme limitation in social functioning as an adult. Similarly,
unless the impairment(s) has improved or there is new evidence
indicating that the prior finding was in error, a finding of marked
limitation in the ability to attend and complete tasks as a child is
likely to translate to a marked limitation in the ability to
concentrate, persist, or maintain pace in work-related task completion
as an adult.
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\46\ See 20 CFR 416.926a for the rules on functional
equivalence, including a description of the six domains we use.
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b. The broad domains of functioning we used to evaluate a child's
impairment-related limitations may also provide guidance for findings
about a young adult's RFC on redetermination. Accordingly, it is
important to remember that the descriptions of the childhood functional
equivalence domains in the regulations include work-related functions
for adolescents, defined as children age 12-18.\47\
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\47\ See generally 20 CFR 416.926a(g)-(l). See also the examples
of typical functioning and limitations in SSRs 09-3 through 09-7 and
the examples of limitations in SSR 09-8 (citations at the end of
this SSR). These rulings are available at: http://www.ssa.gov/OP_Home/rulings/rulfind1.html#YRT2009.
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V. Continued Payments for Young Adults Participating in a Vocational
Rehabilitation or Similar Program \48\ (``Section 301'') \49\
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\48\ See 20 CFR 404.316(c), 404.352(d), 416.1320(d), and
416.1331(a)-(b).
\49\ We commonly refer to this provision as ``Section 301''
because the initial legislative authority for continued payment of
benefits was provided in Section 301 of the Social Security
Disability Amendments of 1980 (Pub. L. 96-265).
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A. When we determine that a young adult is no longer disabled due
to medical improvement, we will continue payments if:
(1) He or she is participating in the Ticket to Work and Self-
Sufficiency program or another appropriate program of vocational
rehabilitation (VR), employment, or other support services \50\; and
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\50\ See 20 CFR 404.327(a) and 416.1338(c).
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(2) Completion of the program or continued participation for a
specified period will increase the likelihood that he or she will not
return to the disability or blindness benefit rolls.\51\
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\51\ See 20 CFR 404.328 and 416.1338(e).
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The title XVI provision for Section 301 payments also applies to a
person age 18 or older whose disability has ended as a result of a
title XVI age-18 redetermination.\52\
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\52\ See 20 CFR 416.1338(a).
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B. Likelihood Determination
1. When a young adult is a student age 18 through 21 participating
in an IEP under the provisions of the IDEA, we will find that
completion of or continuation in the IEP will increase the likelihood
that he or she will not return to the disability or blindness benefit
rolls.\53\ In this circumstance, we will continue benefit payments
until the IEP is completed or the person stops participating in the IEP
for any reason.
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\53\ See 20 CFR 404.328(b) and 416.1338(e)(2).
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2. When a young adult is participating in another appropriate
program, we will find that completion of or continuation in that
program will increase the likelihood that the person will not return to
the disability or blindness benefit rolls if the program provides the
person with:
[[Page 56270]]
a. Work experience that will increase the likelihood of doing past
relevant work; or,
b. Education or skilled or semi-skilled work experience that will
increase the likelihood of adjusting to other work.\54\
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\54\ See 20 CFR 404.328(a) and 416.1338(e)(1).
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For example, the young adult is in a VR-sponsored training program
to become a certified computer technician. She is acquiring computer
skills that will permit direct entry into semiskilled or skilled
occupations, thus increasing her overall ability to adjust to other
work. We would determine that the training program would increase the
likelihood that she will not return to the disability or blindness
benefit rolls.
VI. Resolving Inconsistencies in the Evidence
We evaluate relevant evidence for consistency and resolve any
inconsistencies that need to be resolved.
1. After reviewing all of the relevant evidence, we determine
whether there is sufficient evidence to make a finding about
disability. ``All of the relevant evidence'' means:
The relevant objective medical evidence and other relevant
evidence from medical sources;
Relevant information from other sources, such as school
teachers, family members, or friends;
The claimant's statements (including statements from the
young adult's roommates or family members); and
Any other relevant evidence in the case record, including
how the young adult functions over time and across settings.
2. If there is sufficient evidence and there are no inconsistencies
in the case record, we will make a determination or decision. If there
are inconsistencies in the record, we may be able to make a
determination or decision if the majority of the evidence or the most
probative evidence outweighs the inconsistent evidence, and additional
information would not change the determination or decision.
3. An inconsistency is not ``material'' if it would not affect the
outcome of the case or any of the major findings. If we can make a
fully favorable decision despite the inconsistent evidence, that
inconsistency would be immaterial. For example, if a young adult has a
digestive disorder that causes weight loss, and one piece of evidence
shows a Body Mass Index (BMI) of 16.75 and another a BMI of 17.00, the
inconsistency is not material because we would find that the young
adult's impairment(s) meets listing 5.08 based on either BMI.
4. An inconsistency could also be immaterial in an unfavorable
determination or decision when resolution of the inconsistency would
not affect the outcome. This could occur, for example, if there is
inconsistent evidence about a limitation in a specific work-related
activity; for example, whether the person is able to climb ladders. If
the person's overall exertional level was consistent with sedentary
work, the ability (or inability) to climb a ladder would not reduce the
number of sedentary occupations he or she could do.
5. An apparent inconsistency is not always a true inconsistency.
For example, the record for a young adult with attention-deficit/
hyperactivity disorder may include good, longitudinal evidence of
hyperactivity at home, in the classroom, and on work experience
placements in the classroom, but show a lack of hyperactivity during a
consultative examination (CE). The observations during the CE may
represent a ``good'' day, rather than the overall level of functioning
or the effect of an unusual setting.\55\ In this case, there would be
only a normal variation in functioning at the time of the CE.
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\55\ See section 12.00C.3 of the listings. Accepting the
observation of the young adult's behavior or performance in an
unusual setting, like a CE, without considering the rest of the
evidence could lead to an erroneous conclusion about the young
adult's overall functioning.
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6. In all other cases in which the evidence is insufficient,
including when a material inconsistency exists that we cannot resolve
based on an evaluation of all of the relevant evidence in the case
record, we will try to complete the record by requesting additional or
clarifying information.\56\
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\56\ See 20 CFR 404.1527(c) and 416.927(c).
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Effective Date: This SSR is effective on September 12, 2011.
Cross-References: SSR 82-61: Title II and XVI: Past Relevant Work--
The Particular Job or The Occupation As Generally Performed; SSR 82-62:
Titles II and XVI: A Disability Claimant's Capacity To Do Past Relevant
Work, In General; 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; 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 83-33: Titles II and XVI:
Determining Whether Work is Substantial Gainful Activity--Employees;
SSR 83-34: Titles II and XVI: Determining Whether Work Is Substantial
Gainful Activity--Self-Employed Persons; SSR 84-24: Titles II and XVI:
Determination of Substantial Gainful Activity for Persons Working in
Special Circumstances--Work Therapy Programs in Military Service--Work
Activity in Certain Government-Sponsored Programs; SSR 84-25: Titles II
and XVI: Determination of Substantial Gainful Activity If Substantial
Work Activity Is Discontinued or Reduced--Unsuccessful Work Attempt;
SSR 84-26: Titles II and XVI: Deducting Impairment-Related Work
Expenses from Earnings in Determinations as to Substantial Gainful
Activity Under Titles II and XVI and as to Countable Earned Income
Under Title XVI; 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 96-8p: 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 00-1c: Sections 222(c) and 223(a), (d)(2)(a), and (e)(1) of
the Social Security Act (42 U.S.C. 422(c) and 423(a), (d)(2)(A), and
(e)(1)) Disability Insurance Benefits--Claims Filed Under Both the
Social Security Act and the Americans with the Disabilities Act; SSR
05-2: Titles II and XVI: Determination of Substantial Gainful Activity
if Substantial Work Activity is Discontinued or Reduced--Unsuccessful
Work Attempt; SSR 06-03p: 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; SSR 09-2p: Title XVI:
Determining Childhood Disability--Documenting a Child's Impairment-
Related Limitations; SSR 09-3p: Title XVI: Determining Childhood
Disability--The Functional Equivalence Domain of ``Acquiring and Using
Information''; SSR 09-4p: Title XVI: Determining Childhood Disability--
The Functional Equivalence Domain of ``Attending and Completing
Tasks''; SSR 09-5p: Title XVI: Determining Childhood Disability--The
Functional Equivalence Domain of ``Interacting and Relating with
Others''; SSR 09-6p: Title XVI: Determining Childhood Disability--The
Functional Equivalence Domain of ``Moving About and Manipulating
Objects''; SSR 09-7p: Title XVI: Determining Childhood Disability--The
Functional Equivalence
[[Page 56271]]
Domain of ``Caring for Yourself''; SSR 09-8p: Title XVI: Determining
Childhood Disability--The Functional Equivalence Domain of ``Health and
Physical Well-Being''; Program Operations Manual System (POMS) RS
00301.120, RS 00301.140, DI 10501.055, DI 10505.00 ff., DI 10510.000
ff., DI 10520.000 ff., DI 11070.001--DI 11070.010, DI 11070.030, DI
14510.000 ff., DI 22001.001--DI 22001.035, DI 23570.010, DI 23570.020,
DI 24510.000 ff., DI 25015.000 ff., DI 25020.000 ff., and DI
28005.001--DI 28005.017.
[FR Doc. 2011-23239 Filed 9-9-11; 8:45 am]
BILLING CODE 4191-02-P