DI 25025: Medical-Vocational Guidelines
TN 8 (05-18)
Citations:
Social Security Act (the Act) §§: 223(d)(2)(A) and 1614(a)(3)(B);
20 CFR §§: Part 404, Subpart P, Appendix 2, 404.1520(f), 404.1560 thru 404.1569(a), 416.920(f), and 416.960 thru 416.969(a);
Social Security Rulings (SSR): 96-9p, 86-8, 85-15, 83-14, 83-12, 83-11, and 83-10;
Acquiescence Rulings (AR): 14–01(8) and 01-1(3)
A. Adjustment to other work with a significant number of jobs
We only make a step five finding of not disabled, if we determine the claimant can adjust to work that exists in significant numbers in the national economy (either in the region where the claimant lives or in several regions in the country). Work exists in the national economy when there is a significant number of jobs (in one or more occupations) having requirements which the claimant is able to meet given his or her physical or mental abilities and vocational qualifications.
B. How we use the medical-vocational rules to support the conclusion that a claimant can adjust to other work
1. Claimant has exertional limitations only and meets a medical-vocational rule
The determination is directed by the appropriate medical-vocational rule number. No further citations are required.
2. Claimant has exertional and nonexertional limitations or medical-vocational rule used as a framework
We support the conclusion that a person can adjust to other work by citing:
occupations to which the claimant can adjust – within which there are a significant number of jobs; or
a Social Security Ruling (SSR) that indicates the claimant’s nonexertional limitations do not substantially erode the unskilled occupational base represented by the medical-vocational rule that applies as a framework for a determination.
3. Nonexertional limitations only – Rule 204.00 as a framework
An impairment that does not preclude heavy work (or very heavy work) would not ordinarily be the primary reason for unemployment, and generally is sufficient for a finding of not disabled; even though the age, education, and skill level of prior work experience may be considered adverse.
Use Rule 204.00 as a framework when finding a claimant:
“not disabled” based an impairment that results in nonexertional limitations only; or
“disabled” based on a consideration of his or her impairment-related nonexertional limitations only.
C. How to cite occupations
1. How many occupations
Cite three occupations that are examples of work the claimant could do given his or her impairment-related limitations and restrictions. We base our medical-vocational rules on the existence of unskilled work at all levels of exertion – from very heavy to sedentary.
Cite occupations within the claimant’s RFC that contain jobs that exist in significant numbers in the national economy if:
a medical-vocational rule is not met; and
no SSR provides support for a finding that the claimant’s limitations do not significantly erode the occupational base of the framework rule.
EXCEPTION:You may cite fewer than three occupations when it is clear that jobs exist in significant numbers within fewer than three occupation(s). Make this determination using vocational specialist advice supported by information contained in the publications listed in regulations sections 404.1566(d) and 416.966(d) or other reliable sources of occupational information.
2. Selecting the exertional level of cited occupations
a. The claimant has exertional or exertional and nonexertional limitations
Cited occupations must be within the claimant’s residual functional capacity. The claimant may be capable of performing occupations at several exertional levels. For example, we would generally expect a claimant with a medium RFC to be capable of performing medium, light, and sedentary unskilled occupations that did not exceed the requirements of his RFC.
While it is acceptable to cite occupations from the entire unskilled pool of work that the claimant can perform, in some cases citing occupations at the heaviest exertional levels the claimant can perform may more clearly support our determination of not disabled than citing occupations from the lighter levels of work. This is especially important when given the claimant’s age and education level an RFC for lighter levels of work would be consistent with a medical-vocational allowance.
EXAMPLE: A 55-year-old claimant with a high school education has an RFC for medium work. Although the claimant would have an occupational base of medium, light, and sedentary unskilled work, citing sedentary or light occupations may not support a medical-vocational denial as clearly as citing medium occupations—since a light or sedentary RFC would likely be consistent with a finding of disabled.
b. Claimant has nonexertional limitations only
We base our medical-vocational rules on the existence of unskilled work at all levels of exertion. Rule 204.00 in Appendix 2, is defined as a maximum sustained work capability limited to heavy or very heavy work. If someone can perform very heavy work, we presume that a claimant would generally be capable of adjusting to other levels of work below it such as: heavy, medium, light and sedentary unless additional limiting factors exist.
If the claimant has nonexertional limitations only, his or her occupational base is for all unskilled occupations, from very heavy down to sedentary. However, the claimant or an advocate for the claimant may find our citing of heavy or very heavy occupations to be overly harsh. For most claimants with nonexertional limitations only, you may cite some heavy, some very heavy and some medium unskilled occupations. However, when the claimant is age 60 or above with a marginal education, unskilled or no previous work experience--a profile consistent with some medical-vocational allowances—we recommend citing heavy or very heavy occupations only.
D. How to cite a supporting Social Security Ruling (SSR)
After you have determined the medical-vocational rule that comes closest to approximating the claimant’s remaining occupational base, you may cite an SSR(s) that supports the use of the rule you are using as a framework for a determination, in lieu of citing occupations. Cite the framework rule and the SSR that explains why the claimant’s impairment-related limitations do not significantly erode the occupational base represented by the rule you are using as a framework for a determination. Include this information in the rationale for your determination.
EXCEPTION: If a claimant with a severe mental impairment resides in Arkansas, Iowa, Minnesota, Missouri, Nebraska, North Dakota, or South Dakota, you may not cite SSR 85-15 in lieu of occupations. For detailed information, see AR 14–01(8) Requiring Vocational Specialist or Vocational Expert Evidence When an Individual has a Severe Mental Impairment(s).
E. Selected SSR citations — the impact of exertional and nonexertional limitations on the unskilled occupational base
1. Standing/Walking
|
SSR |
Issue |
Statement from SSR |
|---|---|---|
|
83-10 |
Lifting and carrying—light work Standing/walking—sedentary and light work |
“Even though the weight lifted in a particular light job may be very little, a job is in this category when it requires a good deal of walking or standing—the primary difference between sedentary and most light jobs.” |
|
83-10 |
Standing/walking—light work |
“Many unskilled light jobs are performed primarily in one location, with the ability to stand being more critical than the ability to walk.” |
|
96-9p |
Standing/walking—sedentary work |
“If an individual can stand and walk for a total of slightly less than 2 hours per 8-hour workday, this, by itself, would not cause the occupational base to be significantly eroded.” |
|
96-9p |
Alternate sitting and standing |
“An individual may need to alternate the required sitting of sedentary work by standing (and, possibly, walking) periodically. Where this need cannot be accommodated by scheduled breaks and a lunch period, the occupational base for a full range of unskilled sedentary work will be eroded.” (This suggests that if scheduled breaks and a lunch can accommodate the need to alternate positions, the full range of unskilled sedentary work is intact.) |
|
96-9p |
Medically required hand-held assistive device—sedentary work |
“For example, if a medically required hand-held assistive device is needed only for prolonged ambulation, walking on uneven terrain, or ascending or descending slopes, the unskilled sedentary occupational base will not ordinarily be significantly eroded.” “Since most unskilled sedentary work requires only occasional lifting and carrying of light objects such as ledgers and files and a maximum lifting capacity for only 10 pounds, an individual who uses a medically required hand-held assistive device in one hand may still have the ability to perform the minimal lifting and carrying requirements of many sedentary unskilled occupations with the other hand.” |
2. Lifting/carrying/pushing/pulling
|
SSR |
Issue |
Statement from SSR |
|---|---|---|
|
83-10 |
Lifting/carrying—medium work |
“Being able to do frequent lifting or carrying of objects weighing up to 25 pounds is often more critical than being able to lift up to 50 pounds at a time.” |
|
96-9p |
Lifting/carrying—sedentary work |
“For example, if it can be determined that the individual has an ability to lift or carry slightly less than 10 pounds, with no other limitations or restrictions in the ability to perform the requirements of sedentary work, the unskilled sedentary occupational base would not be significantly eroded.” |
|
96-9p |
Pushing/pulling—sedentary work |
“Limitations or restrictions on the ability to push or pull will generally have little effect on the unskilled sedentary occupational base.” |
3. Postural limitations
|
SSR |
Issue |
Statement from SSR |
|---|---|---|
|
83-10 |
Stooping—sedentary work |
“By its very nature, work performed primarily in a seated position entails no significant stooping.” |
|
83-10 |
Stooping—light work |
“The lifting requirement for the majority of light jobs can be accomplished with occasional, rather than frequent, stooping.” |
|
83-14 |
Stooping and crouching—light and sedentary work |
“However, to perform substantially all of the exertional requirements of most sedentary and light jobs, a person would not need to crouch and would need to stoop only occasionally.” |
|
83-14 |
Climbing, kneeling and crawling—medium work |
“In jobs at the medium level of exertion, there is more likelihood than in light work that such factors as the ability to ascend or descend ladders and scaffolding, kneel, and crawl will be a part of the work requirement. However, limitations of these activities would not significantly affect the medium occupational base.” |
|
83-14 |
Climbing, kneeling, and crawling—light work |
“On the other hand, there are nonexertional limitations or restrictions which have very little or no effect on the unskilled light occupational base. Examples are inability to ascend or descend scaffolding, poles, and ropes, inability to crawl on hands and knees; and inability to use the fingertips to sense the temperature or texture of an object.” |
|
85-15 |
Climbing and balancing |
“Where a person has some limitation in climbing and balancing and it is the only limitation, it would not ordinarily have a significant impact on the broad world of work.” |
|
85-15 |
Stooping and crouching— sedentary and light work |
“If a person can stoop occasionally (from very little up to one-third of the time) in order to lift objects, the sedentary and light occupational base is virtually intact.” “This is also true for crouching.” |
|
85-15 |
Crawling and kneeling |
“However, crawling on hands and knees and feet is a relatively rare activity even in arduous work, and limitations on the ability to crawl would be of little significance in the broad world of work.” “This is also true of kneeling.” |
|
96-9p |
Postural limitations—sedentary work |
“Postural limitations or restrictions related to such activities as climbing ladders, ropes, or scaffolds, balancing, kneeling, crouching, or crawling would not usually erode the occupational base for a full range of unskilled sedentary work significantly because those activities are not usually required in sedentary work.” |
|
96-9p |
Stooping—sedentary work |
“A complete inability to stoop would significantly erode the unskilled sedentary occupational base and a finding that the individual is disabled would usually apply, but restriction to occasional stooping should, by itself, only minimally erode the unskilled occupational base of sedentary work.” |
4. Manipulative limitations
|
SSR |
Issue |
Statement from SSR |
|---|---|---|
|
83-10 |
Reaching, Handling, Fingering—light work |
“They require use of arms and hands to grasp and to hold and to turn objects, and they generally do not require use of the fingers for fine activities to the extent required in much sedentary work.” (“They” refers to many unskilled light jobs.) |
|
83-10 |
Reaching, Handling, Fingering—medium and sedentary work |
(The quote refers to manipulative activities common in medium work as opposed to sedentary.) “Use of the arms and hands is necessary to grasp, hold, and turn objects, as opposed to the finer activities in much sedentary work, which require precision use of the fingers as well as use of the hands and arms.” |
|
85-15 |
Fingering |
“As a general rule, limitations of fine manual dexterity have greater adjudicative significance—in terms of relative number of jobs in which the function is required—as the person’s exertional RFC decreases.” |
|
85-15 |
Feeling |
“However, a VS would not ordinarily be required where a person has a loss of ability to feel the size, shape temperature, or texture of an object by the fingertips, since this is a function required in very few jobs.” |
|
96-9p |
Feeling—sedentary work |
“The ability to feel the size, shape, temperature, or texture of an object by the fingertips is a function required in very few jobs and impairment of this ability would not, by itself, significantly erode the unskilled sedentary occupational base.” |
5. Special senses limitations
|
SSR |
Issue |
Statement from SSR |
|---|---|---|
|
85-15 |
Vision |
“As a general rule, even if a person’s visual impairment(s) were to eliminate all jobs that involve very good vision (such as working with small objects or reading small print), as long as he or she retains sufficient visual acuity to be able to handle and work with rather large objects (and has the visual fields to avoid ordinary hazards in the workplace), there would be a substantial number of jobs remaining across all exertional levels.” |
|
96-9p |
Hearing and speaking |
“Basic communication is all that is needed to do unskilled work. The ability to hear and understand simple oral instructions or to communicate simple information is sufficient. If the individual retains these basic communication abilities, the unskilled sedentary occupational base would not be significantly eroded in these areas.” |
6. Environmental limitations
|
85-15 |
Hazards |
“A person with a seizure disorder who is restricted only from being on unprotected elevations and near dangerous moving machinery is an example of someone whose environmental restriction does not have a significant effect on work that exists at all exertional levels.” |
|
96-9p |
Cold, heat, wetness, humidity, vibration, unusual hazards—sedentary work |
“In general, few occupations in the unskilled sedentary occupational base require work in environments with extreme cold, extreme heat, wetness, humidity, vibration, or unusual hazards…. Even a need to avoid all exposure to these conditions would not, by itself, result in a significant erosion of the occupational base.” |
7. Mental limitations
|
SSR |
Issue |
Statement from SSR |
|---|---|---|
|
85-15 |
Mental |
“Where there is no exertional impairment, unskilled jobs at all levels of exertion constitute the potential occupational base for persons who can meet the mental demands of unskilled work. These jobs ordinarily involve dealing primarily with objects, rather than with data or people, and they generally provide substantial vocational opportunity for persons with solely mental impairments who retain the capacity to meet the intellectual and emotional demand of such jobs on a sustained basis.”1 |
F. Exceptions to the requirement to cite occupations or SSR to support a framework “not disabled” determination
You are not required to cite jobs or an SSR in the following situations when a “not disabled” determination is appropriate.
1. RFC falls between two “not disabled” rules
If the claimant’s RFC falls between two rules that both direct a determination of not disabled (see DI 25025.015).
2. No applicable rule reflects the claimant’s unskilled, semiskilled, or skilled PRW
If there is no guideline regarding “unskilled” work, use “no transferable skills.” If there is no guideline for “no transferable skills”, use “unskilled.” If the claimant has transferable skills use the closest “transferable skills” guidelines (see DI 25025.025C).
3. Transferability of skills not material
If the claimant has past relevant skilled or semi-skilled work and the decision rules for skills transferable and skills not transferable both direct a finding of not disabled (see DI 25025.022).
Footnotes:
. Per AR 14-1 adjudicators may not use this citation in lieu of citing occupations for claimants residing in Arkansas, Iowa, Minnesota, Missouri, Nebraska, North Dakota, or South Dakota.