TN 2 (02-01)

Introduction

1. Usefulness of Lay Evidence

   Information concerning activities given by the individual, particularly during a consultative examination, may be scant or generalized and may be in conflict with the clinical picture observed during the examination or described in other examinations or reports. Resolve any inconsistencies to obtain a proper understanding of the individual's activities. Third party nonmedical information may be useful in obtaining a better description of the individual's daily activities, interests, and interpersonal relationships. This lay information can best be provided by community health centers or day care centers, if the individual has participated in these programs. Also consider information provided by others, including family members, who have had close contact with the individual and have knowledge of his/her living conditions.

2. Significance of Daily Activities, Including Work Attempts

   The individual's level of functioning may vary considerably over a period of time. The level of functioning at any specific point in time may seem relatively efficient or may be very poor. Proper evaluation of the impairment requires the adjudicator to take these variations into account in determining the severity of the individual's impairment over time. Thus, it is vital to obtain the necessary medical evidence from treating sources and to obtain information about the activities of daily living over a sufficiently long period of time prior to the date of adjudication to establish the individual's baseline level of function. Even clinic records with brief entries are often valuable, when combined with other evidence, in determining a baseline level of function. Mere participation in an activity does not, of itself, reflect upon the degree of impairment of severity. This can only be measured by considering the quality, independence, frequency and appropriateness of the activities. More specifically, the information that an individual watches television, attends occupational therapy, or participates in planned recreational activities cannot represent the basis for determining that the individual retains the capacity to do basic work-related activities. The adjudicator must determine to what extent the individual decides to carry out or participate in these activities, instead of being placed in a position in front of the television set or led onto a bus with a group, and determine to what extent the individual understands what is going on in connection with these activities and can make the decision to participate.

   Some individuals may have attempted to work or may actually have worked, during a period of time relevant to the current determination of disability. This may have been an independent attempt at work or may have been in connection with a community health or other sheltered program. These work efforts will typically have been of short duration. The information concerning the individual's behavior during the attempt at work and the circumstances surrounding the termination of the work effort may be particularly informative as to the individual's ability or inability to function in a work setting.

   With this kind of evidence, it is then important to resolve whether a reported current period of poor functioning represents a relatively short period of relapse that may be expected to respond to therapy or situational changes, and to resolve whether a period of satisfactory functioning represents a stable, improved remission that can be expected to be sustained.