[Federal Register Volume 62, Number 186 (Thursday, September 25, 1997)]
[Proposed Rules]
[Pages 50270-50280]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-25366]
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SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
[Regulations Nos. 4 and 16]
RIN 0960-AE56
Federal Old-Age, Survivors, and Disability Insurance and
Supplemental Security Income for the Aged, Blind, and Disabled;
Evaluating Opinion Evidence
AGENCY: Social Security Administration.
ACTION: Proposed rules.
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SUMMARY: We propose to revise the Social Security and supplemental
security income (SSI) regulations about the evaluation of medical
opinions to clarify how administrative law judges and the Appeals
Council are to consider opinion evidence from State agency medical and
psychological consultants, other program physicians and psychologists,
and medical experts we consult in claims for disability benefits under
titles II and XVI of the Social Security Act (the Act). We also propose
to define or clarify several terms used in our regulations and to
delete other terms.
DATES: To be sure that your comments are considered, we must receive
them no later than November 24, 1997.
ADDRESSES: Comments should be submitted in writing to the Commissioner
of Social Security, P.O. Box 1585, Baltimore, MD 21235, sent by telefax
to (410) 966-2830, sent by E-mail to ``[email protected],'' or
delivered to the Division of Regulations and Rulings, Social Security
Administration, 3-B-1 Operations Building, 6401 Security Boulevard,
Baltimore, MD 21235, between 8:00 a.m. and 4:30 p.m. on regular
business days. Comments may be inspected during these same hours by
making arrangements with the contact person shown below.
FOR FURTHER INFORMATION CONTACT: Richard M. Bresnick, Legal Assistant,
Division of Regulations and Rulings, Social Security Administration,
6401 Security Boulevard, Baltimore, MD 21235, (410) 965-1758 for
information about these rules. For information on eligibility or filing
for benefits, call our national toll-free number, 1-800-772-1213.
SUPPLEMENTARY INFORMATION: The Act provides, in title II, for the
payment of disability benefits to persons insured under the Act. Title
II also provides, under certain circumstances, for the payment of
child's insurance benefits based on disability and widow's and
widower's insurance benefits for disabled widows, widowers, and
surviving divorced spouses of insured persons. In addition, the Act
provides, in title XVI, for SSI payments to persons who are aged,
blind, or disabled and who have limited income and resources.
For adults under both the title II and title XVI programs
(including persons claiming child's insurance benefits based on
disability under title II), ``disability'' means the inability to
engage in any substantial gainful activity. For an individual under age
18 claiming SSI benefits based on
[[Page 50271]]
disability, ``disability'' means that an impairment(s) causes ``marked
and severe functional limitations.'' Under both title II and title XVI,
disability must be the result of a medically determinable physical or
mental impairment(s) that can be expected to result in death or that
has lasted or can be expected to last for a continuous period of at
least 12 months.
Explanation of Proposed Revisions
Proposals To Simplify and Clarify Terms
The current regulations use several terms to refer to sources of
medical evidence. Regulations Secs. 404.1502 and 416.902, ``General
definitions and terms for this subpart,'' define the terms ``source of
record,'' ``medical sources'' (which include ``consultative
examiners''), and ``treating source.'' These terms are used in various
sections of the regulations in subpart P of part 404 and subpart I of
part 416, chiefly Secs. 404.1527 and 416.927, ``Evaluating medical
opinions about your impairment(s) or disability.'' In addition,
Secs. 404.1519 and 416.919 use the phrase ``a treating physician or
psychologist, another source of record, or an independent source.''
Regulations Secs. 404.1527 and 416.927 also employ the terms
``nontreating source'' and ``nonexamining source.''
In paragraph (a) of Secs. 404.1513 and 416.913 of our regulations,
we say that we need reports about the individual's impairments from
``acceptable medical sources'' and we identify the sources who are
acceptable medical sources. We need various terms for acceptable
medical sources in only three, specific instances: (1) When we explain
the preference we give to obtaining evidence from treating sources, (2)
when we explain the preference we give to treating sources to perform
consultative examinations, and (3) in our rules for weighing opinions
from acceptable medical sources. In the first two cases, the only
definition that is needed is the definition of a ``treating source.''
In the last case, relevant distinctions are needed between treating
sources, nontreating sources (i.e., acceptable medical sources, such as
some consultative examiners, who have examined an individual but not
provided treatment), and nonexamining sources (i.e., acceptable medical
sources who have provided opinion evidence but who have not treated or
examined the individual).
Therefore, we propose to simplify and clarify the terms we use to
describe various acceptable medical sources of evidence, including
medical opinion evidence (i.e., opinions on the nature and severity of
an individual's impairment(s)--see current Secs. 404.1527(a)(2) and
416.927(a)(2)) and other opinions (e.g., opinions on issues reserved to
the Commissioner--see current Secs. 404.1527(e) and 416.927(e)), by
using only four terms: Treating source, nontreating source,
nonexamining source, and an overall term, ``acceptable medical
source,'' which would include all three types of sources. These
proposals would not change our current policy, but are only intended to
clarify our intent.
To do this, we propose to define the term ``acceptable medical
source'' in Secs. 404.1502 and 416.902. This is a term we have used for
many years in Secs. 404.1513(a) and 416.913(a). We also propose to
redefine the term ``medical sources'' to mean acceptable medical
sources, or other health care providers who are not ``acceptable
medical sources,'' to clarify our intent in certain regulations
sections. For instance, under the rules in Secs. 404.1519, 404.1519g,
416.919, and 416.919g, we may select a qualified medical source who is
not an ``acceptable medical source'' to perform a consultative
examination; e.g., an audiologist or speech and language pathologist.
We also propose to add definitions for the terms ``nonexamining
source'' and ``nontreating source,'' now used in Secs. 404.1527 and
416.927, which are not currently defined in regulations. We propose to
clarify the definition of ``treating source'' to include the other
acceptable medical sources identified in Secs. 404.1513(a) and
416.913(a) in addition to licensed physicians or licensed or certified
psychologists, and, consistent with use of the word ``evaluation'' in
the first sentence of the current definition in Secs. 404.1502 and
416.902, to clarify that a source who only examines and evaluates an
individual on an ongoing basis, but who does not provide any treatment,
may also be a ``treating source.''
We propose to delete the term ``source of record'' because sources
previously included in the definition of that term are included in the
definition of the terms ``acceptable medical source'' or ``medical
source'' and the term ``source of record'' is not needed.
Clarification of Secs. 404.1527 and 416.927
We propose to clarify, consistent with our original intent,
paragraph (f) of Secs. 404.1527 and 416.927. As we explained in the
preamble to the current rules published in the Federal Register on
August 1, 1991 (56 FR 36932, 36937), the purpose of paragraph (f) is
to: (1) Explain how we consider evidence from various kinds of
nonexamining sources (e.g., State agency medical and psychological
consultants, other program physicians and psychologists, and medical
advisors--now called ``medical experts''--at the administrative law
judge hearings and Appeals Council levels of administrative review),
(2) clarify the role of the State agency medical and psychological
consultant at the various levels of the administrative review process,
and (3) codify in regulations our longstanding policy that, because
State agency medical and psychological consultants are highly qualified
physicians and psychologists who are also experts in Social Security
disability evaluation, administrative law judges will consider their
findings with regard to the nature and severity of an individual's
impairment as opinions of nonexamining physicians and psychologists.
Sections 404.1527(f) and 416.927(f) of the current regulations
state that administrative law judges and the Appeals Council are
required to consider State agency medical and psychological consultant
findings about the existence and severity of an individual's
impairment(s), the existence and severity of an individual's symptoms,
whether an individual's impairment(s) meets or equals the requirements
for any impairment listed in appendix 1 to subpart P of part 404, and
an individual's residual functional capacity. We recently restated and
clarified these provisions of the regulations in Social Security Ruling
(SSR) 96-6p, ``Titles II and XVI: Consideration of Administrative
Findings of Fact by State Agency Medical and Psychological Consultants
and Other Program Physicians and Psychologists at the Administrative
Law Judge and Appeals Council Levels of Administrative Review; Medical
Equivalence.'' (61 FR 34466, July 2, 1996.)
Consistent with our statements in the 1991 preamble to the current
regulations and the clarifications in SSR 96-6p, we propose the
following revisions to paragraph (f) of Secs. 404.1527 and 416.927. We
also propose conforming revisions to paragraphs (d)(6) and (e). None of
these proposed revisions is intended to change our current policies.
Because paragraph (f) refers to the rules in paragraphs (a) through
(e) of Secs. 404.1527 and 416.927, which collectively address both
medical opinions (as described in paragraph (a)(2) of Secs. 404.1527
and 416.927) and opinions on issues reserved to the Commissioner of
Social Security (the Commissioner), it is inaccurate to refer
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in paragraph (f) solely to opinions on the ``nature and severity of a
person's impairment(s).'' Therefore, we propose to delete the phrase
``on the nature and severity of your impairments'' from the
introductory text of paragraph (f). We also propose to revise paragraph
(f)(2) to provide more detail on how administrative law judges are to
consider the opinions of State agency medical and psychological
consultants, other program physicians and psychologists, and medical
experts we consult. The proposal would divide paragraph (f)(2) into an
introductory paragraph and new paragraphs (f)(2)(i) through
(f)(2)(iii), which would provide a more detailed explanation of how
opinions from these sources are to be evaluated. The introductory text
of paragraph (f)(2) and, when appropriate, paragraphs (f)(2)(i) through
(f)(2)(iii), include reference to ``other program physicians and
psychologists'' and the term ``medical expert'' for consistency with
the current or proposed language in paragraph (b)(6) of Secs. 404.1512
and 416.912.
We propose to clarify in new paragraph (f)(2)(i) that, because
State agency medical and psychological consultants and other program
physicians and psychologists are highly qualified physicians and
psychologists who are also experts in Social Security disability
evaluation, administrative law judges must consider findings of these
experts, except for the ultimate determination of disability, when they
make their disability decisions. We propose to state in new paragraph
(f)(2)(ii) that when administrative law judges evaluate the findings of
these experts, they will use the relevant factors set forth in
paragraphs (a) through (e) of Secs. 404.1527 and 416.927.
In paragraph (f)(2)(ii) we also propose to provide examples of the
kinds of factors that an administrative law judge must consider when
evaluating the findings of State agency medical and psychological
consultants or other program physicians and psychologists. We also
propose to clarify that administrative law judges are required to
explain in their decisions the weight given to any opinion of a State
agency medical or psychological consultant or other program physician
or psychologist, as they must do for any opinions from treating
sources, nontreating sources, and nonexamining sources who do not work
for us.
In new paragraph (f)(2)(iii), we propose to substitute the term
``medical expert'' for ``medical advisor'' for the reason explained
below about paragraph (b)(6) of Secs. 404.1512 and 416.912. We also
propose to make it clear in new paragraph (f)(2)(iii) that when
administrative law judges consider opinions from medical experts they
consult they will use the rules in paragraphs (a) through (e) of
Secs. 404.1527 and 416.927.
We also propose to amend paragraph (d)(6) of Secs. 404.1527 and
416.927 by adding two examples of other factors that can affect the
weight we give to a medical opinion. The amount of Social Security
disability programs expertise an acceptable medical source has is a
relevant factor that is consistent with the examples we propose to
provide in paragraph (f)(2)(ii). This would include acceptable medical
sources who are currently medical or psychological consultants and
those who had been medical or psychological consultants, or other
program physicians or psychologists, in the past. Another relevant
factor is whether a source reviewed the individual's entire case record
before providing a medical opinion. Both of these are relevant factors
that we will consider in deciding the weight to give to a medical
opinion from any acceptable medical source.
We also propose to amend paragraph (e) of Secs. 404.1527 and
416.927 by adding an introductory paragraph to distinguish opinions on
issues reserved to the Commissioner from medical opinions, and by
designating the last sentence of paragraph (e)(2) as new paragraph
(e)(3) to make it clear that the rule in new paragraph (e)(3) applies
to an opinion about disability described in paragraph (e)(1) as well as
to an opinion on any issue reserved to the Commissioner described in
paragraph (e)(2).
Other Changes
Sections 404.1502 and 416.902 General Definitions and Terms for This
Subpart
In Secs. 404.1502 and 416.902, we propose to clarify, consistent
with current Secs. 404.602 and 416.302, the definition of the term
``you'' to more accurately indicate that the definition includes the
person for whom an application is filed because the person who files an
application may be filing it on behalf of another person.
Also, in keeping with the President's goal of streamlining and
simplifying regulations, we propose to delete the term ``Secretary''
and its definition from Sec. 404.1502 and to delete the terms
``Commissioner'' (see 62 FR 6408, February 11, 1997) and ``Secretary''
from Sec. 416.902 because we define these terms for the entire parts
404 and 416 in Secs. 404.2(b) and 416.120(b).
Sections 404.1512 and 416.912 Evidence of Your Impairment
We propose to amend Secs. 404.1512 and 416.912 by revising
paragraph (b)(6) to delete the word ``certain'' to clarify that every
finding made by State agency medical or psychological consultants and
other program physicians or psychologists and the opinions of medical
experts, other than the ultimate determination about whether an
individual is disabled, is evidence that an administrative law judge
and the Appeals Council must consider at the administrative law judge
and Appeals Council levels of review. We also propose to change the
term ``medical advisor'' to ``medical expert'' because the latter is
the term we currently use to describe these nonexamining sources we
consult at the administrative law judge and Appeals Council levels.
Sections 404.1513 and 416.913 Medical Evidence of Your Impairment
We propose to revise paragraph (c) of Secs. 404.1513 and 416.913 to
codify our policy interpretation that, at the administrative law judge
and Appeals Council levels of review, ``statements about what you can
still do,'' which we also call ``medical source statements,'' include
residual functional capacity assessments made by State agency medical
and psychological consultants and other program physicians and
psychologists. This is because they become opinion evidence of
nonexamining physicians and psychologists at the hearings and appeals
levels. (See SSR 96-6p, 61 FR 34466, 34468.)
Because paragraphs (b) and (c) relate to the reports about an
individual's impairment(s) needed from acceptable medical sources
described in paragraph (a), we propose to clarify paragraphs (b)(6),
(c)(1) and (c)(2) of Sec. 404.1513 and paragraphs (b)(6), (c)(1),
(c)(2), and (c)(3) of Sec. 416.913 to refer to findings and opinions of
the ``acceptable medical source,'' rather than findings and opinions of
the ``medical source.'' We also propose to clarify paragraphs (c)(1)
and (c)(2) of Sec. 416.913 by indicating that they pertain only to
adults, to make the construction of these paragraphs parallel to that
of paragraph (c)(3), which pertains only to children.
Sections 404.1519 and 416.919 The Consultative Examination
We propose to revise Secs. 404.1519 and 416.919 to substitute the
terms ``treating source'' and ``medical source'' for the terms
``treating physician or psychologist,'' ``source of record'' and
[[Page 50273]]
``independent source'' in the first sentence.
Sections 404.1519g and 416.919g Who We Will Select To Perform a
Consultative Examination
We propose to revise paragraph (a) to refer in the last sentence to
Secs. 404.1513 and 416.913, rather than Secs. 404.1513(a) and
416.913(a), for the reasons explained above about the proposed revised
definition of ``medical source'' in Secs. 404.1502 and 416.902. For the
same reason, we would also change the phrase ``physician or
psychologist'' in the first sentence of paragraph (c) to ``medical
source.''
Sections 404.1519h and 416.919h Your Treating Physician or
Psychologist
We propose to revise the heading and text of these sections to
substitute the term ``treating source'' for the term ``treating
physician or psychologist.''
Sections 404.1519i and 416.919i Other Sources for Consultative
Examinations
We propose to revise the text of these sections to substitute the
term ``treating source'' for the term ``treating physician or
psychologist.''
Sections 404.1519j and 416.919j Objections to the Designated Physician
or Psychologist
We propose to revise the heading and text of these sections to use
the term ``medical source,'' rather than the phrase ``physician or
psychologist,'' for the reasons explained above.
Sections 404.1519k and 416.919k Purchase of Medical Examinations,
Laboratory Tests, and Other Services
We propose to revise the introductory paragraph of these sections
to use the term ``medical source,'' rather than the phrase ``licensed
physician or psychologist, hospital or clinic'' for the reasons
explained above.
Sections 404.1519m and 416.919m Diagnostic Tests or Procedures
We propose to revise the first sentence of these sections to
substitute the term ``treating source'' for the term ``treating
physician or psychologist.'' We also propose to revise the last
sentence to use the term ``medical source,'' rather than the phrase
``physician or psychologist,'' for the reasons explained above.
Sections 404.1519n and 416.919n Informing the Examining Physician or
Psychologist of Examination Scheduling, Report Content, and Signature
Requirements
We propose to revise the heading, introductory paragraph, and
paragraphs (a), (b), (c), and (e) to use the term ``medical source,''
rather than the phrase ``physician or psychologist,'' for the reasons
explained above. We would also add a heading to paragraph (a) for
consistency with the other paragraphs in this section. In addition, we
would revise paragraph (c)(6) to insert language that we intended to
include, as explained in our statements in the 1991 preamble (56 FR
36932, 36934, August 1, 1991) to the current regulations, but
inadvertently omitted, to ensure that although medical source
statements about what an individual can still do despite his or her
impairment(s) should ordinarily be requested as part of the
consultative examination process, the absence of such a statement in a
consultative examination report does not make the report incomplete.
Sections 404.1519o and 416.919o When a Properly Signed Consultative
Examination Report Has Not Been Received
We propose to revise paragraphs (a) and (b) to use the term
``medical source,'' rather than the phrase ``physician or
psychologist,'' for the reasons explained above.
Sections 404.1519p and 416.919p Reviewing Reports of Consultative
Examinations
We propose to revise paragraph (b) to use the term ``medical
source,'' rather than the phrase ``physician or psychologist,'' for the
reasons explained above. We would revise paragraph (c) to correct the
grammar in the first sentence by substituting the word ``when'' for the
word ``where.'' We also propose to substitute the term ``treating
source'' for the term ``treating physician or psychologist.''
Sections 404.1519s and 416.919s Authorizing and Monitoring the
Consultative Examination
We propose to revise paragraph (e)(2) to refer to a consultative
examination provider's ``practice,'' rather than to a ``practice of
medicine, osteopathy, or psychology,'' for the reasons explained above
about the definition of ``medical source.'' For the same reasons, we
would also use the term ``medical sources'' in paragraph (f)(6), rather
than the phrase ``physicians and psychologists.''
Sections 404.1527 and 416.927 Evaluating Medical Opinions About Your
Impairment(s) or Disability
We propose to change the heading of Secs. 404.1527 and 416.927 from
``Evaluating medical opinions about your impairment(s) or disability''
to ``Evaluating opinion evidence'' to more accurately identify the
content of these sections. Under current Secs. 404.1527(a)(2) and
416.927(a)(2), the term ``medical opinion'' means statements from
acceptable medical sources that reflect judgments about the nature and
severity of an individual's impairments, but Secs. 404.1527 and 416.927
address other types of opinions, too.
We propose to revise the third sentence of paragraph (d)(2) of
Secs. 404.1527 and 416.927 to clarify that the ``other factors''
referenced in paragraph (d)(6) will be considered along with the
factors in paragraphs (d)(2) (i) and (ii) and paragraphs (d)(3) through
(d)(5) of this section when we do not give a treating source's medical
opinion controlling weight. As indicated by the current introductory
text to Secs. 404.1527(d) and 416.927(d), exclusion of reference to
paragraph (d)(6) was an inadvertent omission when the current rule was
published. (56 FR 36932, August 1, 1991.)
We propose to change the heading of paragraph (e) in Secs. 404.1527
and 416.927 to reflect that the Commissioner, not the Secretary of
Health and Human Services, has the authority on these issues pursuant
to section 702(a)(5) of the Act as amended by section 102 of the Social
Security Independence and Program Improvements Act of 1994, Public Law
103-296, enacted on August 15, 1994. We also propose to change the
second sentence of paragraph (e)(2) to substitute the term ``medical
sources'' for the phrase ``treating and examining sources'' to be
consistent with the use of the term ``medical sources'' in the first
sentence of paragraph (e)(2) and to clarify that we consider opinions
from all medical sources on the issues described in the second
sentence.
We also propose to shorten the heading of paragraph (f) of
Secs. 404.1527 and 416.927 to ``Opinions of nonexamining sources,''
consistent with the proposed definitions in Secs. 404.1502 and 416.902.
For the same reason, we propose to substitute the term ``nonexamining
sources'' for ``nonexamining physicians and psychologists'' in the
first sentence of paragraph (f).
Electronic Versions
The electronic file of this document is available on the Federal
Bulletin Board (FBB) at 9:00 a.m. on the date of publication in the
Federal Register. To download the file, modem dial (202) 512-1387. The
FBB instructions will explain how to download the file and the fee.
This file is in WordPerfect and
[[Page 50274]]
will remain on the FBB during the comment period.
Regulatory Procedures
Executive Order 12866
We have consulted with the Office of Management and Budget (OMB)
and determined that these proposed rules do not meet the criteria for a
significant regulatory action under Executive Order 12866. Therefore,
they are not subject to OMB review.
Regulatory Flexibility Act
We certify that these proposed regulations will not have a
significant economic impact on a substantial number of small entities
because they affect only individuals. Therefore, a regulatory
flexibility analysis as provided in the Regulatory Flexibility Act, as
amended, is not required.
Paperwork Reduction Act
These proposed regulations impose no additional reporting or
recordkeeping requirements subject to OMB clearance.
(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)
List of Subjects
20 CFR Part 404
Administrative practice and procedure, Blind, Disability benefits,
Old-Age, Survivors, and Disability Insurance, Reporting and
recordkeeping requirements, Social Security.
20 CFR Part 416
Administrative practice and procedure, Aged, Blind, Disability
benefits, Public assistance programs, Supplemental Security Income
(SSI), Reporting and recordkeeping requirements.
Dated: September 12, 1997.
John J. Callahan,
Acting Commissioner of Social Security.
For the reasons set out in the preamble, we propose to amend
subpart P of part 404 and subpart I of part 416 of 20 CFR chapter III
as set forth below:
PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE
(1950- )
Subpart P--[Amended]
1. The authority citation for subpart P of part 404 continues to
read as follows:
Authority: Secs. 202, 205(a), (b), and (d)-(h), 216(i), 221(a)
and (i), 222(c), 223, 225, and 702(a)(5) of the Social Security Act
(42 U.S.C. 402, 405(a), (b), and (d)-(h), 416(i), 421(a) and (i),
422(c), 423, 425, and 902(a)(5)); sec. 211(b), Pub. L. 104-193, 110
Stat. 2105, 2189.
2. Section 404.1502 is amended by removing the term ``Source of
record'' and its definition, revising the definitions of ``Medical
sources'' and ``Treating source,'' changing the term ``You'' to ``You
or your'' and revising its definition, and adding definitions in the
appropriate alphabetical order for the terms ``Acceptable medical
source,'' ``Nonexamining source,'' and ``Nontreating source'' to read
as follows:
Sec. 404.1502 General definitions and terms for this subpart.
As used in the subpart--
Acceptable medical source refers to one of the sources described in
Sec. 404.1513(a) who provides evidence about your impairments. It
includes treating sources, nontreating sources, and nonexamining
sources.
Medical sources refers to acceptable medical sources, or other
health care providers who are not acceptable medical sources.
Nonexamining source means a physician, psychologist, or other
acceptable medical source who has not examined you but provides a
medical or other opinion in your case. At the administrative law judge
hearing and Appeals Council levels of the administrative review
process, it includes State agency medical and psychological
consultants, other program physicians and psychologists, and medical
experts we consult. See Sec. 404.1527.
Nontreating source means a physician, psychologist, or other
acceptable medical source who has examined you but does not have, or
did not have, an ongoing treatment relationship with you. The term
includes an acceptable medical source who is a consultative examiner
for us, when the consultative examiner is not your treating source. See
Sec. 404.1527.
* * * * *
Treating source means your own physician, psychologist, or other
acceptable medical source who provides you, or has provided you, with
medical treatment or evaluation and who has, or has had, an ongoing
treatment relationship with you. Generally, we will consider that you
have an ongoing treatment relationship with an acceptable medical
source when the medical evidence establishes that you see, or have
seen, the source with a frequency consistent with accepted medical
practice for the type of treatment and/or evaluation required for your
medical condition(s). We may consider an acceptable medical source who
has treated or evaluated you only a few times or only after long
intervals (e.g., twice a year) to be your treating source if the nature
and frequency of the treatment or evaluation is typical for your
condition(s). We will not consider an acceptable medical source to be
your treating source if your relationship with the source is not based
on your medical need for treatment or evaluation, but solely on your
need to obtain a report in support of your claim for disability. In
such a case, we will consider the acceptable medical source to be a
nontreating source.
* * * * *
You or your means, as appropriate, the person who applies for
benefits or for a period of disability, the person for whom an
application is filed, or the person who is receiving benefits based on
disability or blindness.
3. Section 404.1512 is amended by revising paragraph (b)(6) to read
as follows:
Sec. 404.1512 Evidence of your impairment.
* * * * *
(b) * * *
(6) At the administrative law judge and Appeals Council levels,
findings, other than the ultimate determination about whether you are
disabled, made by State agency medical or psychological consultants and
other program physicians or psychologists, and opinions expressed by
medical experts we consult based on their review of the evidence in
your case record. See Secs. 404.1527(f)(2) and (f)(3).
* * * * *
4. Section 404.1513 is amended by revising the first sentence of
paragraph (b)(6) and paragraph (c) to read as follows:
Sec. 404.1513 Medical evidence of your impairment.
* * * * *
(b) * * *
(6) A statement about what you can still do despite your
impairment(s) based on the acceptable medical source's findings on the
factors under paragraphs (b)(1) through (b)(5) of this section (except
in statutory blindness claims). * * *
(c) Statements about what you can still do. At the administrative
law judge and Appeals Council levels, we will consider residual
functional capacity assessments made by State agency medical and
psychological consultants and other program physicians and
psychologists to be ``statements about what you can still do'' made by
nonexamining physicians and
[[Page 50275]]
psychologists based on their review of the evidence in the case record.
Statements about what you can still do (based on the acceptable medical
source's findings on the factors under paragraphs (b)(1) through (b)(5)
of this section) should describe, but are not limited to, the kinds of
physical and mental capabilities listed below. See Secs. 404.1527 and
404.1545(c).
(1) The acceptable medical source's opinion about your ability,
despite your impairment(s), to do work-related activities such as
sitting, standing, walking, lifting, carrying, handling objects,
hearing, speaking, and traveling; and
(2) In cases of mental impairment(s), the acceptable medical
source's opinion about your ability to understand, to carry out and
remember instructions, and to respond appropriately to supervision,
coworkers, and work pressures in a work setting.
* * * * *
5. Section 404.1519 is amended by revising the first sentence to
read as follows:
Sec. 404.1519 The consultative examination.
A consultative examination is a physical or mental examination or
test purchased for you at our request and expense from a treating
source or another medical source, including a pediatrician when
appropriate. * * *
6. Section 404.1519g is amended by revising the last sentence of
paragraph (a) and the first sentence of paragraph (c) to read as
follows:
Sec. 404.1519g Who we will select to perform a consultative
examination.
(a) * * * For a more complete list of medical sources, see
Sec. 404.1513.
* * * * *
(c) The medical source we choose may use support staff to help
perform the consultative examination. * * *
7. Section 404.1519h is revised to read as follows:
Sec. 404.1519h Your treating source.
When in our judgment your treating source is qualified, equipped,
and willing to perform the additional examination or tests for the fee
schedule payment, and generally furnishes complete and timely reports,
your treating source will be the preferred source to do the purchased
examination. Even if only a supplemental test is required, your
treating source is ordinarily the preferred source.
8. Section 404.1519i is revised to read as follows:
Sec. 404.1519i Other sources for consultative examinations.
We will use a source other than your treating source for a
purchased examination or test in situations including, but not limited
to, the following situations:
(a) Your treating source prefers not to perform such an examination
or does not have the equipment to provide the specific data needed;
(b) There are conflicts or inconsistencies in your file that cannot
be resolved by going back to your treating source;
(c) You prefer a source other than your treating source and have a
good reason for your preference;
(d) We know from prior experience that your treating source may not
be a productive source, e.g., he or she has consistently failed to
provide complete or timely reports.
9. Section 404.1519j is revised to read as follows:
Sec. 404.1519j Objections to the medical source designated to perform
the consultative examination.
You or your representative may object to your being examined by a
medical source we have designated to perform a consultative
examination. If there is a good reason for the objection, we will
schedule the examination with another medical source. A good reason may
be that the medical source we designated had previously represented an
interest adverse to you. For example, the medical source may have
represented your employer in a workers' compensation case or may have
been involved in an insurance claim or legal action adverse to you.
Other things we will consider include: The presence of a language
barrier, the medical source's office location (e.g., 2nd floor, no
elevator), travel restrictions, and whether the medical source had
examined you in connection with a previous disability determination or
decision that was unfavorable to you. If your objection is that a
medical source allegedly ``lacks objectivity'' in general, but not in
relation to you personally, we will review the allegations. See
Sec. 404.1519s. To avoid a delay in processing your claim, the
consultative examination in your case will be changed to another
medical source while a review is being conducted. We will handle any
objection to use of the substitute medical source in the same manner.
However, if we had previously conducted such a review and found that
the reports of the medical source in question conformed to our
guidelines, we will not change your examination.
10. Section 404.1519k is amended by revising the introductory
paragraph to read as follows:
Sec. 404.1519k Purchase of medical examinations, laboratory tests, and
other services.
We may purchase medical examinations, including psychiatric and
psychological examinations, X-rays and laboratory tests (including
specialized tests, such as pulmonary function studies,
electrocardiograms, and stress tests) from a medical source.
* * * * *
11. Section 404.1519m is amended by revising the first and last
sentences to read as follows:
Sec. 404.1519m Diagnostic tests or procedures.
We will request the results of any diagnostic tests or procedures
that have been performed as part of a workup by your treating source or
other medical source and will use the results to help us evaluate
impairment severity or prognosis. * * * The responsibility for deciding
whether to perform the examination rests with the consultative
examining medical source.
12. Section 404.1519n is amended by revising the heading and the
first and last sentences of the introductory paragraph, adding a
heading to and revising the first sentence of paragraph (a), revising
the last two sentences of paragraph (b), revising the second sentence
of and adding third and fourth sentences to paragraph (c)(6), and
revising paragraphs (c)(7) and (e) to read as follows:
Sec. 404.1519n Informing the medical source of examination scheduling,
report content, and signature requirements.
The medical sources who perform consultative examinations will have
a good understanding of our disability programs and their evidentiary
requirements. * * * We will fully inform medical sources who perform
consultative examinations at the time we first contact them, and at
subsequent appropriate intervals, of the following obligations:
(a) Scheduling. In scheduling full consultative examinations,
sufficient time should be allowed to permit the medical source to take
a case history and perform the examination, including any needed tests.
* * *
(b) Report content. * * * The report should reflect your statement
of your symptoms, not simply the medical source's statements or
conclusions. The examining medical source's report of the consultative
examination should include the objective medical facts as well as
observations and opinions.
[[Page 50276]]
(c) * * *
(6) * * * This statement should describe the opinion of the medical
source about your ability, despite your impairment(s), to do work-
related activities, such as sitting, standing, walking, lifting,
carrying, handling objects, hearing, speaking, and traveling; and, in
cases of mental impairment(s), the opinion of the medical source about
your ability to understand, to carry out and remember instructions, and
to respond appropriately to supervision, coworkers and work pressures
in a work setting. Although we will ordinarily request, as part of the
consultative examination process, a medical source statement about what
you can still do despite your impairment(s), the absence of such a
statement in a consultative examination report will not make the report
incomplete. See Sec. 404.1527; and
(7) In addition, the medical source will consider, and provide some
explanation or comment on, your major complaint(s) and any other
abnormalities found during the history and examination or reported from
the laboratory tests. The history, examination, evaluation of
laboratory test results, and the conclusions will represent the
information provided by the medical source who signs the report.
* * * * *
(e) Signature requirements. All consultative examination reports
will be personally reviewed and signed by the medical source who
actually performed the examination. This attests to the fact that the
medical source doing the examination or testing is solely responsible
for the report contents and for the conclusions, explanations or
comments provided with respect to the history, examination and
evaluation of laboratory test results. The signature of the medical
source on a report annotated ``not proofed'' or ``dictated but not
read'' is not acceptable. A rubber stamp signature of a medical source
or the medical source's signature entered by any other person is not
acceptable.
13. Section 404.1519o is amended by revising the second sentence of
paragraph (a) and the third sentence of paragraph (b) to read as
follows:
Sec. 404.1519o When a properly signed consultative examination report
has not been received.
* * * * *
(a) When we will make determinations and decisions without a
properly signed report. * * * After we have made the determination or
decision, we will obtain a properly signed report and include it in the
file unless the medical source who performed the original consultative
examination has died.
* * * * *
(b) When we will not make determinations and decisions without a
properly signed report. * * * If the signature of the medical source
who performed the original examination cannot be obtained because the
medical source is out of the country for an extended period of time, or
on an extended vacation, seriously ill, deceased, or for any other
reason, the consultative examination will be rescheduled with another
medical source.
* * * * *
14. Section 404.1519p is amended by revising paragraphs (b) and (c)
to read as follows:
Sec. 404.1519p Reviewing reports of consultative examinations.
* * * * *
(b) If the report is inadequate or incomplete, we will contact the
medical source who performed the consultative examination, give an
explanation of our evidentiary needs, and ask that the medical source
furnish the missing information or prepare a revised report.
(c) With your permission, or when the examination discloses new
diagnostic information or test results that reveal potentially life-
threatening situations, we will refer the consultative examination
report to your treating source. When we refer the consultative
examination report to your treating source without your permission, we
will notify you that we have done so.
* * * * *
15. Section 404.1519s is amended by revising paragraph (e)(2) and
the first sentence of paragraph (f)(6) to read as follows:
Sec. 404.1519s Authorizing and monitoring the consultative
examination.
* * * * *
(e) * * *
(2) Any consultative examination provider with a practice directed
primarily towards evaluation examinations rather than the treatment of
patients; or
* * * * *
(f) * * *
(6) Procedures for providing medical or supervisory approval for
the authorization or purchase of consultative examinations and for
additional tests or studies requested by consulting medical sources. *
* *
* * * * *
16. Section 404.1527 is amended by revising the section heading,
the third sentence of paragraph (d)(2), the heading of paragraph (e),
paragraph (e)(2), the heading and introductory text of paragraph (f),
and paragraph (f)(2), by adding a sentence to paragraph (d)(6), by
adding introductory text to paragraph (e), and by adding paragraph
(e)(3) to read as follows:
Sec. 404.1527 Evaluating opinion evidence.
* * * * *
(d) * * *
(2) Treatment relationship. * * * 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 (d)(6) of this
section in determining the weight to give the opinion. * * *
* * * * *
(6) Other factors. * * * For example, the amount of Social Security
disability programs expertise an acceptable medical source has and
whether an acceptable medical source reviewed the individual's entire
case record before providing a medical opinion are relevant factors
that we will consider in deciding the weight to give to a medical
opinion.
(e) Medical source opinions on issues reserved to the Commissioner.
Opinions on some issues, such as the examples that follow, are not
medical opinions, as described in paragraph (a)(2) of this section, but
are, instead, opinions on issues reserved to the Commissioner because
they are administrative findings that are dispositive of a case; i.e.,
that would direct the determination or decision of disability.
* * * * *
(2) Other opinions on issues reserved to the Commissioner. 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 medical 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 to 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
Commissioner.
(3) We will not give any special significance to the source of an
opinion on issues reserved to the Commissioner described in paragraphs
(e)(1) and (e)(2) of this section.
(f) Opinions of nonexamining sources. We consider all evidence from
nonexamining sources to be opinion evidence. When we consider the
opinions of nonexamining sources, we
[[Page 50277]]
apply the rules in paragraphs (a) through (e) of this section. In
addition, the following rules apply to State agency medical and
psychological consultants, other program physicians and psychologists,
and medical experts we consult in connection with administrative law
judge hearings and Appeals Council review.
* * * * *
(2) Administrative law judges are responsible for reviewing the
evidence and making findings of fact and conclusions of law. They will
consider opinions of State agency medical or psychological consultants,
other program physicians and psychologists, and medical experts as
follows:
(i) Administrative law judges are not bound by any findings made by
State agency medical or psychological consultants, or other program
physicians or psychologists. However, State agency medical and
psychological consultants and other program physicians and
psychologists are highly qualified physicians and psychologists who are
also experts in Social Security disability evaluation. Therefore,
administrative law judges must consider findings of State agency
medical and psychological consultants or other program physicians or
psychologists, except for the ultimate determination about whether you
are disabled. See Sec. 404.1512(b)(6).
(ii) When administrative law judges consider findings of State
agency medical or psychological consultants or other program physicians
or psychologists, they will evaluate the findings using relevant
factors in paragraphs (a) through (e) of this section, such as the
medical or psychological consultants', or other program physicians' or
psychologists', medical specialty and expertise in our rules, the
evidence reviewed by the consultants or other program physicians or
psychologists, supporting explanations provided by the consultants or
other program physicians or psychologists, and any other factors
relevant to the weighing of the opinions. he administrative law judge
must explain in the decision the weight given to the opinions of a
State agency medical or psychological consultant or other program
physician or psychologist, as the administrative law judge must do for
any opinions from treating sources, nontreating sources, and
nonexamining sources who do not work for us.
(iii) Administrative law judges may also ask for and consider
opinions from medical experts on the nature and severity of your
impairment(s) and on whether your impairment(s) equals the requirements
of any impairment listed in appendix 1 to this subpart. When
administrative law judges consider these opinions, they will evaluate
them using the rules in paragraphs (a) through (e) of this section.
* * * * *
PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND
DISABLED
Subpart I--[Amended]
17. The authority citation for subpart I of part 416 continues to
read as follows:
Authority: Secs. 702(a)(5), 1611, 1614, 1619, 1631(a), (c), and
(d)(1), and 1633 of the Social Security Act (42 U.S.C. 902(a)(5),
1382, 1382c, 1382h, 1383(a), (c), and (d)(1), and 1383b); secs. 4(c)
and 5, 6(c)-(e), 14(a) and 15, Pub. L. 98-460, 98 Stat. 1794, 1801,
1802, and 1808 (42 U.S.C. 421 note, 423 note, 1382h note).
18. Section 416.902 is amended by removing the terms
``Commissioner,'' ``Secretary,'' and ``Source of record'' and their
definitions, revising the definitions of ``Medical sources'' and
``Treating source,'' changing the term ``You'' to ``You or your'' and
revising its definition, and adding definitions in the appropriate
alphabetical order for the terms ``Acceptable medical source,''
``Nonexamining source,'' and ``Nontreating source'' to read as follows:
Sec. 416.902 General definitions and terms for this subpart.
As used in the subpart--
Acceptable medical source refers to one of the sources described in
Sec. 416.913(a) who provides evidence about your impairments. It
includes treating sources, nontreating sources, and nonexamining
sources.
* * * * *
Medical sources refers to acceptable medical sources, or other
health care providers who are not acceptable medical sources.
Nonexamining source means a physician, psychologist, or other
acceptable medical source who has not examined you but provides a
medical or other opinion in your case. At the administrative law judge
hearing and Appeals Council levels of the administrative review
process, it includes State agency medical and psychological
consultants, other program physicians and psychologists, and medical
experts we consult. See Sec. 416.927.
Nontreating source means a physician, psychologist, or other
acceptable medical source who has examined you but does not have, or
did not have, an ongoing treatment relationship with you. The term
includes an acceptable medical source who is a consultative examiner
for us, when the consultative examiner is not your treating source. See
Sec. 416.927.
* * * * *
Treating source means your own physician, psychologist, or other
acceptable medical source who provides you, or has provided you, with
medical treatment or evaluation and who has, or has had, an ongoing
treatment relationship with you. Generally, we will consider that you
have an ongoing treatment relationship with an acceptable medical
source when the medical evidence establishes that you see, or have
seen, the source with a frequency consistent with accepted medical
practice for the type of treatment and/or evaluation required for your
medical condition(s). We may consider an acceptable medical source who
has treated or evaluated you only a few times or only after long
intervals (e.g., twice a year) to be your treating source if the nature
and frequency of the treatment or evaluation is typical for your
condition(s). We will not consider an acceptable medical source to be
your treating source if your relationship with the source is not based
on your medical need for treatment or evaluation, but solely on your
need to obtain a report in support of your claim for disability. In
such a case, we will consider the acceptable medical source to be a
nontreating source.
* * * * *
You or your means, as appropriate, the person who applies for
benefits, the person for whom an application is filed, or the person
who is receiving benefits based on disability or blindness.
19. Section 416.912 is amended by revising paragraph (b)(6) to read
as follows:
Sec. 416.912 Evidence of your impairment.
* * * * *
(b) * * *
(6) At the administrative law judge and Appeals Council levels,
findings, other than the ultimate determination about whether you are
disabled, made by State agency medical or psychological consultants and
other program physicians or psychologists, and opinions expressed by
medical experts we consult based on their review of the evidence in
your case record. See Secs. 416.927(f)(2) and (f)(3).
* * * * *
20. Section 416.913 is amended by revising the first sentence of
paragraph
[[Page 50278]]
(b)(6) and paragraph (c) to read as follows:
Sec. 416.913 Medical evidence of your impairment.
* * * * *
(b) * * *
(6) A statement about what you can still do despite your
impairment(s) based on the acceptable medical source's findings on the
factors under paragraphs (b)(1) through (b)(5) of this section (except
in statutory blindness claims). * * *
(c) Statements about what you can still do. At the administrative
law judge and Appeals Council levels, we will consider residual
functional capacity assessments made by State agency medical and
psychological consultants and other program physicians and
psychologists to be ``statements about what you can still do'' made by
nonexamining physicians and psychologists based on their review of the
evidence in the case record. Statements about what you can still do
(based on the acceptable medical source's findings on the factors under
paragraphs (b)(1) through (b)(5) of this section) should describe, but
are not limited to, the kinds of physical and mental capabilities
listed below. See Secs. 416.927 and 416.945(c).
(1) If you are an adult, the acceptable medical source's opinion
about your ability, despite your impairment(s), to do work-related
activities such as sitting, standing, walking, lifting, carrying,
handling objects, hearing, speaking, and traveling; and
(2) If you are an adult, in cases of mental impairment(s), the
acceptable medical source's opinion about your ability to understand,
to carry out and remember instructions, and to respond appropriately to
supervision, coworkers, and work pressures in a work setting.
(3) If you are a child, the acceptable medical source's opinion
about your functional limitations in learning, motor functioning,
performing self-care activities, communicating, socializing, and
completing tasks (and, if you are a newborn or young infant from birth
to age 1, responsiveness to stimuli).
* * * * *
21. Section 416.919 is amended by revising the first sentence to
read as follows:
Sec. 416.919 The consultative examination.
A consultative examination is a physical or mental examination or
test purchased for you at our request and expense from a treating
source or another medical source, including a pediatrician when
appropriate. * * *
22. Section 416.919g is amended by revising the last sentence of
paragraph (a) and the first sentence of paragraph (c) to read as
follows:
Sec. 416.919g Who we will select to perform a consultative
examination.
(a) * * * For a more complete list of medical sources, see
Sec. 416.913.
* * * * *
(c) The medical source we choose may use support staff to help
perform the consultative examination. * * *
23. Section 416.919h is revised to read as follows:
Sec. 416.919h Your treating source.
When in our judgment your treating source is qualified, equipped,
and willing to perform the additional examination or tests for the fee
schedule payment, and generally furnishes complete and timely reports,
your treating source will be the preferred source to do the purchased
examination. Even if only a supplemental test is required, your
treating source is ordinarily the preferred source.
24. Section 416.919i is revised to read as follows:
Sec. 416.919i Other sources for consultative examinations.
We will use a source other than your treating source for a
purchased examination or test in situations including, but not limited
to, the following situations:
(a) Your treating source prefers not to perform such an examination
or does not have the equipment to provide the specific data needed;
(b) There are conflicts or inconsistencies in your file that cannot
be resolved by going back to your treating source;
(c) You prefer a source other than your treating source and have a
good reason for your preference;
(d) We know from prior experience that your treating source may not
be a productive source, e.g., he or she has consistently failed to
provide complete or timely reports.
25. Section 416.919j is revised to read as follows:
Sec. 416.919j Objections to the medical source designated to perform a
consultative examination.
You or your representative may object to your being examined by a
medical source we have designated to perform a consultative
examination. If there is a good reason for the objection, we will
schedule the examination with another medical source. A good reason may
be that the medical source we designated had previously represented an
interest adverse to you. For example, the medical source may have
represented your employer in a workers' compensation case or may have
been involved in an insurance claim or legal action adverse to you.
Other things we will consider include: The presence of a language
barrier, the medical source's office location (e.g., 2nd floor, no
elevator), travel restrictions, and whether the medical source had
examined you in connection with a previous disability determination or
decision that was unfavorable to you. If your objection is that a
medical source allegedly ``lacks objectivity'' in general, but not in
relation to you personally, we will review the allegations. See
Sec. 416.919s. To avoid a delay in processing your claim, the
consultative examination in your case will be changed to another
medical source while a review is being conducted. We will handle any
objection to use of the substitute medical source in the same manner.
However, if we had previously conducted such a review and found that
the reports of the medical source in question conformed to our
guidelines, we will not change your examination.
26. Section 416.919k is amended by revising the introductory
paragraph to read as follows:
Sec. 416.919k Purchase of medical examinations, laboratory tests, and
other services.
We may purchase medical examinations, including psychiatric and
psychological examinations, X-rays and laboratory tests (including
specialized tests, such as pulmonary function studies,
electrocardiograms, and stress tests) from a medical source.
* * * * *
27. Section 416.919m is amended by revising the first and last
sentences to read as follows:
Sec. 416.919m Diagnostic tests or procedures.
We will request the results of any diagnostic tests or procedures
that have been performed as part of a workup by your treating source or
other medical source and will use the results to help us evaluate
impairment severity or prognosis. * * * The responsibility for deciding
whether to perform the examination rests with the consultative
examining medical source.
28. Section 416.919n is amended by revising the heading and the
first and last sentences of the introductory paragraph, adding a
heading to and revising the first sentence of paragraph (a), revising
the last two sentences of paragraph (b), revising the second and third
sentences of and adding fourth and fifth sentences to paragraph (c)(6),
[[Page 50279]]
and revising paragraphs (c)(7) and (e) to read as follows:
Sec. 416.919n Informing the medical source of examination scheduling,
report content, and signature requirements.
The medical sources who perform consultative examinations will have
a good understanding of our disability programs and their evidentiary
requirements. * * * We will fully inform medical sources who perform
consultative examinations at the time we first contact them, and at
subsequent appropriate intervals, of the following obligations:
(a) Scheduling. In scheduling full consultative examinations,
sufficient time should be allowed to permit the medical source to take
a case history and perform the examination, including any needed tests.
* * *
* * * * *
(b) Report content. * * * The report should reflect your statement
of your symptoms, not simply the medical source's statements or
conclusions. The examining medical source's report of the consultative
examination should include the objective medical facts as well as
observations and opinions.
(c) * * *
* * * * *
(6) * * * If you are an adult, this statement should describe the
opinion of the medical source about your ability, despite your
impairment(s), to do work-related activities, such as sitting,
standing, walking, lifting, carrying, handling objects, hearing,
speaking, and traveling; and, in cases of mental impairment(s), the
opinion of the medical source about your ability to understand, to
carry out and remember instructions, and to respond appropriately to
supervision, coworkers and work pressures in a work setting. If you are
a child, this statement should describe the opinion of the medical
source about your functional limitations in learning, motor
functioning, performing self-care activities, communicating,
socializing, and completing tasks (and, if you are a newborn or young
infant from birth to age 1, responsiveness to stimuli). Although we
will ordinarily request, as part of the consultative examination
process, a medical source statement about what you can still do despite
your impairment(s), the absence of such a statement in a consultative
examination report will not make the report incomplete. See
Sec. 416.927; and
(7) In addition, the medical source will consider, and provide some
explanation or comment on, your major complaint(s) and any other
abnormalities found during the history and examination or reported from
the laboratory tests. The history, examination, evaluation of
laboratory test results, and the conclusions will represent the
information provided by the medical source who signs the report.
* * * * *
(e) Signature requirements. All consultative examination reports
will be personally reviewed and signed by the medical source who
actually performed the examination. This attests to the fact that the
medical source doing the examination or testing is solely responsible
for the report contents and for the conclusions, explanations or
comments provided with respect to the history, examination and
evaluation of laboratory test results. The signature of the medical
source on a report annotated ``not proofed'' or ``dictated but not
read'' is not acceptable. A rubber stamp signature of a medical source
or the medical source's signature entered by any other person is not
acceptable.
29. Section 416.919o is amended by revising the second sentence of
paragraph (a) and the third sentence of paragraph (b) to read as
follows:
Sec. 416.919o When a properly signed consultative examination report
has not been received.
* * * * *
(a) When we will make determinations and decisions without a
properly signed report. * * * After we have made the determination or
decision, we will obtain a properly signed report and include it in the
file unless the medical source who performed the original consultative
examination has died.
* * * * *
(b) When we will not make determinations and decisions without a
properly signed report. * * * If the signature of the medical source
who performed the original examination cannot be obtained because the
medical source is out of the country for an extended period of time, or
on an extended vacation, seriously ill, deceased, or for any other
reason, the consultative examination will be rescheduled with another
medical source.
* * * * *
30. Section 416.919p is amended by revising paragraphs (b) and (c)
to read as follows:
Sec. 416.919p Reviewing reports of consultative examinations.
* * * * *
(b) If the report is inadequate or incomplete, we will contact the
medical source who performed the consultative examination, give an
explanation of our evidentiary needs, and ask that the medical source
furnish the missing information or prepare a revised report.
(c) With your permission, or when the examination discloses new
diagnostic information or test results that reveal potentially life-
threatening situations, we will refer the consultative examination
report to your treating source. When we refer the consultative
examination report to your treating source without your permission, we
will notify you that we have done so.
* * * * *
31. Section 416.919s is amended by revising paragraph (e)(2) and
the first sentence of paragraph (f)(6) to read as follows:
Sec. 416.919s Authorizing and monitoring the consultative examination.
* * * * *
(e) * * *
(2) Any consultative examination provider with a practice directed
primarily towards evaluation examinations rather than the treatment of
patients; or
* * * * *
(f) * * *
(6) Procedures for providing medical or supervisory approval for
the authorization or purchase of consultative examinations and for
additional tests or studies requested by consulting medical sources. *
* *
* * * * *
32. Section 416.927 is amended by revising the section heading, the
third sentence of paragraph (d)(2), the heading of paragraph (e),
paragraph (e)(2), the heading and introductory text of paragraph (f),
and paragraph (f)(2), by adding a sentence to paragraph (d)(6), by
adding introductory text to paragraph (e), and by adding paragraph
(e)(3) to read as follows:
Sec. 416.927 Evaluating opinion evidence.
* * * * *
(d) * * *
(2) Treatment relationship. * * * 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 (d)(6) of this
section in determining the weight to give the opinion. * * *
* * * * *
(6) Other factors. * * * For example, the amount of Social Security
disability programs expertise an acceptable medical source has and
whether an acceptable medical source reviewed the individual's entire
case record before providing a medical opinion are relevant factors
that we will consider in deciding the weight to give to a medical
opinion.
[[Page 50280]]
(e) Medical source opinions on issues reserved to the Commissioner.
Opinions on some issues, such as the examples that follow, are not
medical opinions, as described in paragraph (a)(2) of this section, but
are, instead, opinions on issues reserved to the Commissioner because
they are administrative findings that are dispositive of a case; i.e.,
that would direct the determination or decision of disability.
* * * * *
(2) Other opinions on issues reserved to the Commissioner. 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 medical 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 to subpart P
of part 404 of this chapter, your residual functional capacity (see
Secs. 416.945 and 416.946), or the application of vocational factors,
the final responsibility for deciding these issues is reserved to the
Commissioner.
(3) We will not give any special significance to the source of an
opinion on issues reserved to the Commissioner described in paragraphs
(e)(1) and (e)(2) of this section.
(f) Opinions of nonexamining sources. We consider all evidence from
nonexamining sources to be opinion evidence. When we consider the
opinions of nonexamining sources, we apply the rules in paragraphs (a)
through (e) of this section. In addition, the following rules apply to
State agency medical and psychological consultants, other program
physicians and psychologists, and medical experts we consult in
connection with administrative law judge hearings and Appeals Council
review.
* * * * *
(2) Administrative law judges are responsible for reviewing the
evidence and making findings of fact and conclusions of law. They will
consider opinions of State agency medical or psychological consultants,
other program physicians and psychologists, and medical experts as
follows:
(i) Administrative law judges are not bound by any findings made by
State agency medical or psychological consultants, or other program
physicians or psychologists. However, State agency medical and
psychological consultants and other program physicians and
psychologists are highly qualified physicians and psychologists who are
also experts in Social Security disability evaluation. Therefore,
administrative law judges must consider findings of State agency
medical and psychological consultants or other program physicians or
psychologists, except for the ultimate determination about whether you
are disabled. See Sec. 416.912(b)(6).
(ii) When administrative law judges consider findings of State
agency medical or psychological consultants or other program physicians
or psychologists, they will evaluate the findings using relevant
factors in paragraphs (a) through (e) of this section, such as the
medical or psychological consultants', or other program physicians' or
psychologists', medical specialty and expertise in our rules, the
evidence reviewed by the consultants or other program physicians or
psychologists, supporting explanations provided by the consultants or
other program physicians or psychologists, and any other factors
relevant to the weighing of the opinions. The administrative law judge
must explain in the decision the weight given to the opinions of a
State agency medical or psychological consultant or other program
physician or psychologist, as the administrative law judge must do for
any opinions from treating sources, nontreating sources, and
nonexamining sources who do not work for us.
(iii) Administrative law judges may also ask for and consider
opinions from medical experts on the nature and severity of your
impairment(s) and on whether your impairment(s) equals the requirements
of any impairment listed in appendix 1 to subpart P of part 404 of this
chapter. When administrative law judges consider these opinions, they
will evaluate them using the rules in paragraphs (a) through (e) of
this section.
* * * * *
[FR Doc. 97-25366 Filed 9-24-97; 8:45 am]
BILLING CODE 4190-29-U