[Title 20 CFR 404.1529]
[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. 404.1529 - How we evaluate symptoms, including pain.]
[From the U.S. Government Publishing Office]




  20
  EMPLOYEES' BENEFITS
  2
  1996-04-01
  1996-04-01
  false
  
  404.1529
  Sec. 404.1529
  
    EMPLOYEES' BENEFITS
    SOCIAL SECURITY ADMINISTRATION
    FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- )
    Determining Disability and Blindness
  


Sec. 404.1529  How we evaluate symptoms, including pain.

    (a) General. In determining whether you are disabled, we consider 
all your symptoms, including pain, and the extent to which your symptoms 
can reasonably be accepted as consistent with the objective medical 
evidence and other evidence. By objective medical evidence, we mean 
medical signs and laboratory findings as defined in Sec. 404.1528 (b) 
and (c). By other evidence, we mean the kinds of evidence described in 
Secs. 404.1512(b) (2) through (6) and 404.1513(b) (1), (4), and (5) and 
(e). These include statements or reports from you, your treating or 
examining physician or psychologist, and others about your medical 
history, diagnosis, prescribed treatment, daily activities, efforts to 
work, and any other evidence showing how your impairment(s) and any 
related symptoms affect your ability to work. We will consider all of 
your statements about your symptoms, such as pain, and any description 
you, your physician, your psychologist, or other persons may provide 
about how the symptoms affect your activities of daily living and your 
ability to work. However, statements about your pain or other symptoms 
will not alone establish that you are disabled; there must be medical 
signs and laboratory findings which show that you have a medical 
impairment(s) which could reasonably be expected to produce the pain or 
other symptoms alleged and which, when considered with all of the other 
evidence (including statements about the intensity and persistence of 
your pain or other symptoms which may reasonably be accepted as 
consistent with the medical signs and laboratory findings), would lead 
to a conclusion that you are disabled. In evaluating the intensity and 
persistence of your symptoms, including pain, we will consider all of 
the available evidence, including your medical history, the medical 
signs and laboratory findings and statements about how your symptoms 
affect you. (Section 404.1527 explains how we consider opinions of your 
treating source and other medical opinions on the existence and severity 
of your symptoms, such as pain.) We will then determine the extent to 
which your alleged functional limitations and restrictions due to pain 
or other symptoms can reasonably be accepted as consistent with the 
medical signs and laboratory findings and other evidence to decide how 
your symptoms affect your ability to work.
    (b) Need for medically determinable impairment that could reasonably 
be expected to produce your symptoms, such as pain. Your symptoms, such 
as pain, fatigue, shortness of breath, weakness, or nervousness, will 
not be found to affect your ability to do basic work activities unless 
medical signs or laboratory findings show that a medically determinable 
impairment(s) is present. Medical signs and laboratory findings, 
established by medically acceptable clinical or laboratory diagnostic 
techniques, must show the existence of a medical impairment(s) which 
results from anatomical, physiological, or psychological abnormalities 
and which could reasonably be expected to produce the pain or other 
symptoms alleged. At the

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initial or reconsideration step in the administrative review process 
(except in disability hearings), a State agency medical or psychological 
consultant (or other medical or psychological consultant designated by 
the Secretary) directly participates in determining whether your 
medically determinable impairment(s) could reasonably be expected to 
produce your alleged symptoms. In the disability hearing process, a 
medical or psychological consultant may provide an advisory assessment 
to assist a disability hearing officer in determining whether your 
impairment(s) could reasonably be expected to produce your alleged 
symptoms. At the administrative law judge hearing or Appeals Council 
level, the administrative law judge or the Appeals Council may ask for 
and consider the opinion of a medical advisor concerning whether your 
impairment(s) could reasonably be expected to produce your alleged 
symptoms. The finding that your impairment(s) could reasonably be 
expected to produce your pain or other symptoms does not involve a 
determination as to the intensity, persistence, or functionally limiting 
effects of your symptoms. We will develop evidence regarding the 
possibility of a medically determinable mental impairment when we have 
information to suggest that such an impairment exists, and you allege 
pain or other symptoms but the medical signs and laboratory findings do 
not substantiate any physical impairment(s) capable of producing the 
pain or other symptoms.
    (c) Evaluating the intensity and persistence of your symptoms, such 
as pain, and determining the extent to which your symptoms limit your 
capacity for work--(1) General. When the medical signs or laboratory 
findings show that you have a medically determinable impairment(s) that 
could reasonably be expected to produce your symptoms, such as pain, we 
must then evaluate the intensity and persistence of your symptoms so 
that we can determine how your symptoms limit your capacity for work. In 
evaluating the intensity and persistence of your symptoms, we consider 
all of the available evidence, including your medical history, the 
medical signs and laboratory findings, and statements from you, your 
treating or examining physician or psychologist, or other persons about 
how your symptoms affect you. We also consider the medical opinions of 
your treating source and other medical opinions as explained in 
Sec. 404.1527. Paragraphs (c)(2) through (c)(4) of this section explain 
further how we evaluate the intensity and persistence of your symptoms 
and how we determine the extent to which your symptoms limit your 
capacity for work, when the medical signs or laboratory findings show 
that you have a medically determinable impairment(s) that could 
reasonably be expected to produce your symptoms, such as pain.
    (2) Consideration of objective medical evidence. Objective medical 
evidence is evidence obtained from the application of medically 
acceptable clinical and laboratory diagnostic techniques, such as 
evidence of reduced joint motion, muscle spasm, sensory deficit or motor 
disruption. Objective medical evidence of this type is a useful 
indicator to assist us in making reasonable conclusions about the 
intensity and persistence of your symptoms and the effect those 
symptoms, such as pain, may have on your ability to work. We must always 
attempt to obtain objective medical evidence and, when it is obtained, 
we will consider it in reaching a conclusion as to whether you are 
disabled. However, we will not reject your statements about the 
intensity and persistence of your pain or other symptoms or about the 
effect your symptoms have on your ability to work solely because the 
available objective medical evidence does not substantiate your 
statements.
    (3) Consideration of other evidence. Since symptoms sometimes 
suggest a greater severity of impairment than can be shown by objective 
medical evidence alone, we will carefully consider any other information 
you may submit about your symptoms. The information that you, your 
treating or examining physician or psychologist, or other persons 
provide about your pain or other symptoms (e.g., what may precipitate or 
aggravate your symptoms, what medications, treatments or other methods 
you use to alleviate them, and how the symptoms may affect your

[[Page 334]]

pattern of daily living) is also an important indicator of the intensity 
and persistence of your symptoms. Because symptoms, such as pain, are 
subjective and difficult to quantify, any symptom-related functional 
limitations and restrictions which you, your treating or examining 
physician or psychologist, or other persons report, which can reasonably 
be accepted as consistent with the objective medical evidence and other 
evidence, will be taken into account as explained in paragraph (c)(4) of 
this section in reaching a conclusion as to whether you are disabled. We 
will consider all of the evidence presented, including information about 
your prior work record, your statements about your symptoms, evidence 
submitted by your treating, examining or consulting physician or 
psychologist, and observations by our employees and other persons. 
Section 404.1527 explains in detail how we consider and weigh treating 
source and other medical opinions about the nature and severity of your 
impairment(s) and any related symptoms, such as pain. Factors relevant 
to your symptoms, such as pain, which we will consider include:
    (i) Your daily activities;
    (ii) The location, duration, frequency, and intensity of your pain 
or other symptoms;
    (iii) Precipitating and aggravating factors;
    (iv) The type, dosage, effectiveness, and side effects of any 
medication you take or have taken to alleviate your pain or other 
symptoms;
    (v) Treatment, other than medication, you receive or have received 
for relief of your pain or other symptoms;
    (vi) Any measures you use or have used to relieve your pain or other 
symptoms (e.g., lying flat on your back, standing for 15 to 20 minutes 
every hour, sleeping on a board, etc.); and
    (vii) Other factors concerning your functional limitations and 
restrictions due to pain or other symptoms.
    (4) How we determine the extent to which symptoms, such as pain, 
affect your capacity to perform basic work activities. In determining 
the extent to which your symptoms, such as pain, affect your capacity to 
perform basic work activities, we consider all of the available evidence 
described in paragraphs (c)(1) through (c)(3) of this section. We will 
consider your statements about the intensity, persistence, and limiting 
effects of your symptoms, and we will evaluate your statements in 
relation to the objective medical evidence and other evidence, in 
reaching a conclusion as to whether you are disabled. We will consider 
whether there are any inconsistencies in the evidence and the extent to 
which there are any conflicts between your statements and the rest of 
the evidence, including your medical history, the medical signs and 
laboratory findings, and statements by your treating or examining 
physician or psychologist or other persons about how your symptoms 
affect you. Your symptoms, including pain, will be determined to 
diminish your capacity for basic work activities to the extent that your 
alleged functional limitations and restrictions due to symptoms, such as 
pain, can reasonably be accepted as consistent with the objective 
medical evidence and other evidence.
    (d) Consideration of symptoms in the disability determination 
process. We follow a set order of steps to determine whether you are 
disabled. If you are not doing substantial gainful activity, we consider 
your symptoms, such as pain, to evaluate whether you have a severe 
physical or mental impairment(s), and at each of the remaining steps in 
the process. Sections 404.1520 and 404.1520a explain this process in 
detail. We also consider your symptoms, such as pain, at the appropriate 
steps in our review when we consider whether your disability continues. 
Sections 404.1579 and 404.1594 explain the procedure we follow in 
reviewing whether your disability continues.
    (1) Need to establish a severe medically determinable impairment(s). 
Your symptoms, such as pain, fatigue, shortness of breath, weakness, or 
nervousness, are considered in making a determination as to whether your 
impairment or combination of impairment(s) is severe. (See 
Sec. 404.1520(c).)
    (2) Decision whether the Listing of Impairments is met. Some listed 
impairment(s) include symptoms, such as pain, as criteria. Section 
404.1525(f)

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explains how we consider your symptoms when your symptoms are included 
as criteria for a listed impairment.
    (3) Decision whether the Listing of Impairments is equaled. If your 
impairment is not the same as a listed impairment, we must determine 
whether your impairment(s) is medically equivalent to a listed 
impairment. Section 404.1526 explains how we make this determination. 
Under Sec. 404.1526(b), we will consider equivalence based on medical 
evidence only. In considering whether your symptoms, signs, and 
laboratory findings are medically equal to the symptoms, signs, and 
laboratory findings of a listed impairment, we will look to see whether 
your symptoms, signs, and laboratory findings are at least equal in 
severity to the listed criteria. However, we will not substitute your 
allegations of pain or other symptoms for a missing or deficient sign or 
laboratory finding to raise the severity of your impairment(s) to that 
of a listed impairment. If the symptoms, signs, and laboratory findings 
of your impairment(s) are equivalent in severity to those of a listed 
impairment, we will find you disabled. If it does not, we will consider 
the impact of your symptoms on your residual functional capacity. (See 
paragraph (d)(4) of this section.)
    (4) Impact of symptoms (including pain) on residual functional 
capacity. If you have a medically determinable severe physical or mental 
impairment(s), but your impairment(s) does not meet or equal an 
impairment listed in Appendix 1 of this subpart, we will consider the 
impact of your impairment(s) and any related symptoms, including pain, 
on your residual functional capacity. (See Sec. 404.1545.)

[56 FR 57941, Nov. 14, 1991]