[Title 20 CFR 404.1527]
[Code of Federal Regulations (annual edition) - April 1, 1996 Edition]
[Title 20 - EMPLOYEES' BENEFITS]
[Chapter III - SOCIAL SECURITY ADMINISTRATION]
[Part 404 - FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- )]
[Subpart P - Determining Disability and Blindness]
[Sec. 404.1527 - Evaluating medical opinions about your impairment(s) or disability.]
[From the U.S. Government Publishing Office]




  20
  EMPLOYEES' BENEFITS
  2
  1996-04-01
  1996-04-01
  false
  
  404.1527
  Sec. 404.1527
  
    EMPLOYEES' BENEFITS
    SOCIAL SECURITY ADMINISTRATION
    FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- )
    Determining Disability and Blindness
  


Sec. 404.1527  Evaluating medical opinions about your impairment(s) or disability.

    (a) General. (1) You can only be found disabled if you are unable to 
do any substantial gainful activity by reason of any medically 
determinable physical or mental impairment which can be expected to 
result in death or which has lasted or can be expected to last for a 
continuous period of not less than 12 months. See Sec. 404.1505. Your 
impairment must result from anatomical, physiological, or psychological 
abnormalities which are demonstrable by medically acceptable clinical 
and laboratory diagnostic techniques. See Sec. 404.1508.
    (2) Evidence that you submit or that we obtain may contain medical 
opinions. Medical opinions are statements from physicians and 
psychologists or other acceptable medical sources that reflect judgments 
about the nature and severity of your impairment(s), including your 
symptoms, diagnosis and prognosis, what you can still do despite 
impairment(s), and your physical or mental restrictions.
    (b) How we consider medical opinions. In deciding whether you are 
disabled, we will always consider the medical opinions in your case 
record together with the rest of the relevant evidence we receive.
    (c) Making disability determinations. After we review all of the 
evidence relevant to your claim, including medical opinions, we make 
findings about what the evidence shows.
    (1) If all of the evidence we receive, including all medical 
opinion(s), is consistent, and there is sufficient evidence for us to 
decide whether you are disabled, we will make our determination or 
decision based on that evidence.
    (2) If any of the evidence in your case record, including any 
medical opinion(s), is inconsistent with other evidence or is internally 
inconsistent, we will weigh all of the evidence and see whether we can 
decide whether you are disabled based on the evidence we have.
    (3) If the evidence is consistent but we do not have sufficient 
evidence to decide whether you are disabled, or if after weighing the 
evidence we decide

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we cannot reach a conclusion about whether you are disabled, we will try 
to obtain additional evidence under the provisions of Secs. 404.1512 and 
404.1519 through 404.1519h. We will request additional existing records, 
recontact your treating sources or any other examining sources, ask you 
to undergo a consultative examination at our expense, or ask you or 
others for more information. We will consider any additional evidence we 
receive together with the evidence we already have.
    (4) When there are inconsistencies in the evidence that cannot be 
resolved, or when despite efforts to obtain additional evidence the 
evidence is not complete, we will make a determination or decision based 
on the evidence we have.
    (d) How we weigh medical opinions. Regardless of its source, we will 
evaluate every medical opinion we receive. Unless we give a treating 
source's opinion controlling weight under paragraph (d)(2) of this 
section, we consider all of the following factors in deciding the weight 
we give to any medical opinion.
    (1) Examining relationship. Generally, we give more weight to the 
opinion of a source who has examined you than to the opinion of a source 
who has not examined you.
    (2) Treatment relationship. Generally, we give more weight to 
opinions from your treating sources, since these sources are likely to 
be the medical professionals most able to provide a detailed, 
longitudinal picture of your medical impairment(s) and may bring a 
unique perspective to the medical evidence that cannot be obtained from 
the objective medical findings alone or from reports of individual 
examinations, such as consultative examinations or brief 
hospitalizations. If we find that a treating source's opinion on the 
issue(s) of the nature and severity of your impairment(s) is well-
supported by medically acceptable clinical and laboratory diagnostic 
techniques and is not inconsistent with the other substantial evidence 
in your case record, we will give it controlling weight. When we do not 
give the treating source's opinion controlling weight, we apply the 
factors listed below, as well as the factors in paragraphs (d) (3) 
through (5) of this section in determining the weight to give the 
opinion. We will always give good reasons in our notice of determination 
or decision for the weight we give your treating source's opinion.
    (i) Length of the treatment relationship and the frequency of 
examination. Generally, the longer a treating source has treated you and 
the more times you have been seen by a treating source, the more weight 
we will give to the source's medical opinion. When the treating source 
has seen you a number of times and long enough to have obtained a 
longitudinal picture of your impairment, we will give the source's 
opinion more weight than we would give it if it were from a nontreating 
source.
    (ii) Nature and extent of the treatment relationship. Generally, the 
more knowledge a treating source has about your impairment(s) the more 
weight we will give to the source's medical opinion. We will look at the 
treatment the source has provided and at the kinds and extent of 
examinations and testing the source has performed or ordered from 
specialists and independent laboratories. For example, if your 
ophthalmologist notices that you have complained of neck pain during 
your eye examinations, we will consider his or her opinion with respect 
to your neck pain, but we will give it less weight than that of another 
physician who has treated you for the neck pain. When the treating 
source has reasonable knowledge of your impairment(s), we will give the 
source's opinion more weight than we would give it if it were from a 
nontreating source.
    (3) Supportability. The more a medical source presents relevant 
evidence to support an opinion, particularly medical signs and 
laboratory findings, the more weight we will give that opinion. The 
better an explanation a source provides for an opinion, the more weight 
we will give that opinion. Furthermore, because nonexamining sources 
have no examining or treating relationship with you, the weight we will 
give their opinions will depend on the degree to which they provide 
supporting explanations for their opinions. We will evaluate the degree 
to which these opinions consider all of the pertinent evidence in your 
claim, including

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opinions of treating and other examining sources.
    (4) Consistency. Generally, the more consistent an opinion is with 
the record as a whole, the more weight we will give to that opinion.
    (5) Specialization. We generally give more weight to the opinion of 
a specialist about medical issues related to his or her area of 
specialty than to the opinion of a source who is not a specialist.
    (6) Other factors. When we consider how much weight to give to a 
medical opinion, we will also consider any factors you or others bring 
to our attention, or of which we are aware, which tend to support or 
contradict the opinion.
    (e) Medical source opinions on issues reserved to the Secretary.
    (1) Opinions that you are disabled. We are responsible for making 
the determination or decision about whether you meet the statutory 
definition of disability. In so doing, we review all of the medical 
findings and other evidence that support a medical source's statement 
that you are disabled. A statement by a medical source that you are 
``disabled'' or ``unable to work'' does not mean that we will determine 
that you are disabled.
    (2) Other opinions on issues reserved to the Secretary. We use 
medical sources, including your treating source, to provide evidence, 
including opinions, on the nature and severity of your impairment(s). 
Although we consider opinions from treating and examining sources on 
issues such as whether your impairment(s) meets or equals the 
requirements of any impairment(s) in the Listing of Impairments in 
appendix 1 of this subpart, your residual functional capacity (see 
Secs. 404.1545 and 404.1546), or the application of vocational factors, 
the final responsibility for deciding these issues is reserved to the 
Secretary. We will not give any special significance to the source of 
the opinion on these issues.
    (f) Opinions of nonexamining medical and psychological consultants 
and other nonexamining physicians and psychologists. We consider all 
evidence from nonexamining physicians and psychologists to be opinion 
evidence. When we consider the opinions of nonexamining sources on the 
nature and severity of your impairments, we apply the rules set forth in 
paragraphs (a) through (e) of this section. In addition, the following 
rules apply to State agency medical and psychological consultants, and 
to medical advisors we consult in connection with administrative law 
judge hearings and Appeals Council review.
    (1) At the initial and reconsideration steps in the administrative 
review process, except in disability hearings, State agency medical and 
psychological consultants are members of the teams that make the 
determinations of disability. A State agency medical or psychological 
consultant will consider the evidence in your case record and make 
findings of fact about the medical issues, including, but not limited 
to, the existence and severity of your impairment(s), the existence and 
severity of your symptoms, whether your impairment(s) meets or equals 
the requirements for any impairment listed in Appendix 1 to this 
subpart, and your residual functional capacity. These administrative 
findings of fact are based on the evidence in your case record but are 
not themselves evidence at these steps.
    (2) Administrative law judges are responsible for reviewing the 
evidence and making findings of fact and conclusions of law. 
Administrative law judges are not bound by any findings made by State 
agency medical or psychological consultants. However, these findings are 
considered at the hearing level. See Sec. 404.1512(b)(6). When 
administrative law judges consider these findings, they will evaluate 
them using the rules set forth in paragraphs (a) through (e) of this 
section. Also, administrative law judges may ask for and consider the 
opinions of medical advisors on the nature and severity of your 
impairment(s) and whether your impairment(s) equals the requirements of 
any listed impairment in appendix 1 to this subpart.
    (3) When the Appeals Council makes a decision, it will follow the 
same rules for considering opinion evidence as administrative law judges 
follow.

[56 FR 36960, Aug. 1, 1991]

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