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New Ruling 16-03p - Evaluation of Symptoms

Bob Hansen • March 13, 2024

Titles II and XVI: Evaluation of Symptoms in Disability Claims

This SSR supersedes SSR 96-7p: Policy Interpretation Ruling Titles II and XVI: Evaluation of Symptoms in Disability Claims: Assessing the Credibility of an Individual's Statements.


PURPOSE:

We are rescinding SSR 96-7p: Policy Interpretation Ruling Titles II and XVI Evaluation of Symptoms in Disability Claims: Assessing the Credibility of an Individual's Statements and replacing it with this Ruling. We solicited a study and recommendations from the Administrative Conference of the United States (ACUS) on the topic of symptom evaluation. Based on ACUS's recommendations[1] and our adjudicative experience, we are eliminating the use of the term “credibility” from our sub-regulatory policy, as our regulations do not use this term. In doing so, we clarify that subjective symptom evaluation is not an examination of an individual's character. Instead, we will more closely follow our regulatory language regarding symptom evaluation.Consistent with our regulations, we instruct our adjudicators to consider all of the evidence in an individual's record when they evaluate the intensity and persistence of symptoms after they find that the individual has a medically determinable impairment(s) that could reasonably be expected to produce those symptoms. We evaluate the intensity and persistence of an individual's symptoms so we can determine how symptoms limit ability to perform work-related activities for an adult and how symptoms limit ability to function independently, appropriately, and effectively in an age-appropriate manner for a child with a title XVI disability claim.


CITATIONS (AUTHORITY):

Sections 216(i), 223(d), and 1614(a)(3) of the Social Security Act as amended; Regulations no. 4, sections 404.1508, 404.1512(d), 404.1513, 404.1520, 404.1526, 404.1527, 404.1528, 404.1529, 404.1545 and 404.1594; and Regulations No. 16 sections 416.908, 416.912(d), 416.913, 416.920, 416.924(c), 416.924a(b)(9)(ii-iii), 416.926a, 416.927, 416.928, 416.929, 416.930(c), 416.945, 416.994, and 416.994a.


BACKGROUND:

In determining whether an individual is disabled, we consider all of the individual's symptoms, including pain, and the extent to which the symptoms can reasonably be accepted as consistent with the objective medical and other evidence in the individual's record. We define a symptom as the individual's own description or statement of his or her physical or mental impairment(s).[2] Under our regulations, an individual's statements of symptoms alone are not enough to establish the existence of a physical or mental impairment or disability. However, if an individual alleges impairment-related symptoms, we must evaluate those symptoms using a two-step process set forth in our regulations.[3]First, we must consider whether there is an underlying medically determinable physical or mental impairment(s) that could reasonably be expected to produce an individual's symptoms, such as pain. Second, once an underlying physical or mental impairment(s) that could reasonably be expected to produce an individual's symptoms is established, we evaluate the intensity and persistence of those symptoms to determine the extent to which the symptoms limit an individual's ability to perform work-related activities for an adult or to function independently, appropriately, and effectively in an age- appropriate manner for a child with a title XVI disability claim.This ruling clarifies how we consider:


  • The intensity, persistence, and functionally limiting effects of symptoms,
  • Objective medical evidence when evaluating symptoms,
  • Other evidence when evaluating symptoms,
  • The factors set forth in 20 CFR 404.1529(c)(3) and 416.929(c)(3),
  • The extent to which an individual's symptoms affect his or her ability to perform work-related activities or function independently, appropriately, and effectively in an age-appropriate manner for a child with a title XVI disability claim, and
  • Adjudication standards for evaluating symptoms in the sequential evaluation process.


POLICY INTERPRETATION:

We use a two-step process for evaluating an individual's symptoms.


The two-step process:

Step 1: We determine whether the individual has a medically determinable impairment (MDI) that could reasonably be expected to produce the individual's alleged symptoms. An individual's symptoms, such as pain, fatigue, shortness of breath, weakness, nervousness, or periods of poor concentration will not be found to affect the ability to perform work-related activities for an adult or to function independently, appropriately, and effectively in an age-appropriate manner for a child with a title XVI disability claim unless medical signs or laboratory findings show a medically determinable impairment is present. Signs are anatomical, physiological, or psychological abnormalities established by medically acceptable clinical diagnostic techniques that can be observed apart from an individual's symptoms.[4] Laboratory findings are anatomical, physiological, or psychological phenomena, which can be shown by the use of medically acceptable laboratory diagnostic techniques.[5] We call the medical evidence that provides signs or laboratory findings objective medical evidence. We must have objective medical evidence from an acceptable medical source[6] to establish the existence of a medically determinable impairment that could reasonably be expected to produce an individual's alleged symptoms.[7]In determining whether there is an underlying medically determinable impairment that could reasonably be expected to produce an individual's symptoms, we do not consider whether the severity of an individual's alleged symptoms is supported by the objective medical evidence. For example, if an individual has a medically determinable impairment established by a knee x-ray showing mild degenerative changes and he or she alleges extreme pain that limits his or her ability to stand and walk, we will find that individual has a medically determinable impairment that could reasonably be expected to produce the symptom of pain. We will proceed to step two of the two-step process, even though the level of pain an individual alleges may seem out of proportion with the objective medical evidence.In some instances, the objective medical evidence clearly establishes that an individual's symptoms are due to a medically determinable impairment. At other times, we may have insufficient evidence to determine whether an individual has a medically determinable impairment that could potentially account for his or her alleged symptoms. In those instances, we develop evidence regarding a potential medically determinable impairment using a variety of means set forth in our regulations. For example, we may obtain additional information from the individual about the nature of his or her symptoms and their effect on functioning. We may request additional information from the individual about other testing or treatment he or she may have undergone for the symptoms. We may request clarifying information from an individual's medical sources, or we may send an individual to a consultative examination that may include diagnostic testing. We may use our agency experts to help us determine whether an individual's medically determinable impairment could reasonably be expected to produce his or her symptoms. At the administrative law judge hearing level or the Appeals Council level of the administrative review process, we may ask for and consider evidence from a medical or psychological expert to help us determine whether an individual's medically determinable impairment could reasonably be expected to produce his or her symptoms. If an individual alleges symptoms, but the medical signs and laboratory findings do not substantiate any medically determinable impairment capable of producing the individual's alleged symptoms, we will not evaluate the individual's symptoms at step two of our two- step evaluation process. We will not find an individual disabled based on alleged symptoms alone. If there is no medically determinable impairment, or if there is a medically determinable impairment, but the impairment(s) could not reasonably be expected to produce the individual's symptoms, we will not find those symptoms affect the ability to perform work-related activities for an adult or ability to function independently, appropriately, and effectively in an age-appropriate manner for a child with a title XVI disability claim. Step 2: We evaluate the intensity and persistence of an individual's symptoms such as pain and determine the extent to which an individual's symptoms limit his or her ability to perform work-related activities for an adult or to function independently, appropriately, and effectively in an age- appropriate manner for a child with a title XVI disability claim. Once the existence of a medically determinable impairment that could reasonably be expected to produce pain or other symptoms is established, we recognize that some individuals may experience symptoms differently and may be limited by symptoms to a greater or lesser extent than other individuals with the same medical impairments, the same objective medical evidence, and the same non-medical evidence. In considering the intensity, persistence, and limiting effects of an individual's symptoms, we examine the entire case record, including the objective medical evidence; an individual's statements about the intensity, persistence, and limiting effects of symptoms; statements and other information provided by medical sources and other persons; and any other relevant evidence in the individual's case record. We will not evaluate an individual's symptoms without making every reasonable effort to obtain a complete medical history[8] unless the evidence supports a finding that the individual is disabled. We will not evaluate an individual's symptoms based solely on objective medical evidence unless that objective medical evidence supports a finding that the individual is disabled. We will evaluate an individual's symptoms based on the evidence in an individual's record as described below; however, not all of the types of evidence described below will be available or relevant in every case.


1. Consideration of Objective Medical Evidence

Symptoms cannot always be measured objectively through clinical or laboratory diagnostic techniques. However, objective medical evidence is a useful indicator to help make reasonable conclusions about the intensity and persistence of symptoms, including the effects those symptoms may have on the ability to perform work-related activities for an adult or to function independently, appropriately, and effectively in an age-appropriate manner for a child with a title XVI claim.[9] We must consider whether an individual's statements about the intensity, persistence, and limiting effects of his or her symptoms are consistent with the medical signs and laboratory findings of record.The intensity, persistence, and limiting effects of many symptoms can be clinically observed and recorded in the medical evidence. Examples such as reduced joint motion, muscle spasm, sensory deficit, and motor disruption illustrate findings that may result from, or be associated with, the symptom of pain.[10] These findings may be consistent with an individual's statements about symptoms and their functional effects. However, when the results of tests are not consistent with other evidence in the record, they may be less supportive of an individual's statements about pain or other symptoms than test results and statements that are consistent with other evidence in the record.For example, an individual with reduced muscle strength testing who indicates that for the last year pain has limited his or her standing and walking to no more than a few minutes a day would be expected to have some signs of muscle wasting as a result. If no muscle wasting were present, we might not, depending on the other evidence in the record, find the individual's reduced muscle strength on clinical testing to be consistent with the individual's alleged impairment-related symptoms.However, we will not disregard an individual's statements about the intensity, persistence, and limiting effects of symptoms solely because the objective medical evidence does not substantiate the degree of impairment-related symptoms alleged by the individual.[11] A report of minimal or negative findings or inconsistencies in the objective medical evidence is one of the many factors we must consider in evaluating the intensity, persistence, and limiting effects of an individual's symptoms.


2. Consideration of Other Evidence

If we cannot make a disability determination or decision that is fully favorable based solely on objective medical evidence, then we carefully consider other evidence in the record in reaching a conclusion about the intensity, persistence, and limiting effects of an individual's symptoms. Other evidence that we will consider includes statements from the individual, medical sources, and any other sources that might have information about the individual's symptoms, including agency personnel, as well as the factors set forth in our regulations.[12] For example, for a child with a title XVI disability claim, we will consider evidence submitted from educational agencies and personnel, statements from parents and other relatives, and evidence submitted by social welfare agencies, therapists, and other practitioners.[13]


a. The Individual

An individual may make statements about the intensity, persistence, and limiting effects of his or her symptoms. If a child with a title XVI disability claim is unable to describe his or her symptoms adequately, we will accept a description of his or her symptoms from the person most familiar with the child, such as a parent, another relative, or a guardian.[14] For an adult whose impairment prevents him or her from describing symptoms adequately, we may also consider a description of his or her symptoms from a person who is familiar with the individual.An individual may make statements about symptoms directly to medical sources, other sources, or he or she may make them directly to us. An individual may have made statements about symptoms in connection with claims for other types of disability benefits such as workers' compensation, benefits under programs of the Department of Veterans Affairs, or private insurance benefits.An individual's statements may address the frequency and duration of the symptoms, the location of the symptoms, and the impact of the symptoms on the ability to perform daily living activities. An individual's statements may also include activities that precipitate or aggravate the symptoms, medications and treatments used, and other methods used to alleviate the symptoms. We will consider an individual's statements about the intensity, persistence, and limiting effects of symptoms, and we will evaluate whether the statements are consistent with objective medical evidence and the other evidence.


b. Medical Sources

Medical sources may offer diagnoses, prognoses, and opinions as well as statements and medical reports about an individual's history, treatment, responses to treatment, prior work record, efforts to work, daily activities, and other information concerning the intensity, persistence, and limiting effects of an individual's symptoms. Important information about symptoms recorded by medical sources and reported in the medical evidence may include, but is not limited to, the following:


  • Onset, description of the character and location of the symptoms, precipitating and aggravating factors, frequency and duration, change over a period of time (e.g., whether worsening, improving, or static), and daily activities. Very often, the individual has provided this information to the medical source, and the information may be compared with the individual's other statements in the case record. In addition, the evidence provided by a medical source may contain medical opinions about the individual's symptoms and their effects. Our adjudicators will weigh such opinions by applying the factors in 20 CFR 404.1527 and 416.927.
  • A longitudinal record of any treatment and its success or failure, including any side effects of medication.
  • Indications of other impairments, such as potential mental impairments, that could account for an individual's allegations.


Medical evidence from medical sources that have not treated or examined the individual is also important in the adjudicator's evaluation of an individual's statements about pain or other symptoms. For example, State agency medical and psychological consultants and other program physicians and psychologists may offer findings about the existence and severity of an individual's symptoms. We will consider these findings in evaluating the intensity, persistence, and limiting effects of the individual's symptoms. Adjudicators at the hearing level or at the Appeals Council level must consider the findings from these medical sources even though they are not bound by them. [15]


c. Non-Medical Sources

Other sources may provide information from which we may draw inferences and conclusions about an individual's statements that would be helpful to us in assessing the intensity, persistence, and limiting effects of symptoms. Examples of such sources include public and private agencies, other practitioners, educational personnel, non-medical sources such as family and friends, and agency personnel. We will consider any statements in the record noted by agency personnel who previously interviewed the individual, whether in person or by telephone. The adjudicator will consider any personal observations of the individual in terms of how consistent those observations are with the individual's statements about his or her symptoms as well as with all of the evidence in the file.


d. Factors to Consider in Evaluating the Intensity, Persistence, and Limiting Effects of an Individual's Symptoms

In addition to using all of the evidence to evaluate the intensity, persistence, and limiting effects of an individual's symptoms, we will also use the factors set forth in 20 CFR 404.1529(c)(3) and 416.929(c)(3). These factors include:


  1. Daily activities;
  2. The location, duration, frequency, and intensity of pain or other symptoms;
  3. Factors that precipitate and aggravate the symptoms;
  4. The type, dosage, effectiveness, and side effects of any medication an individual takes or has taken to alleviate pain or other symptoms;
  5. Treatment, other than medication, an individual receives or has received for relief of pain or other symptoms;
  6. Any measures other than treatment an individual uses or has used to relieve pain or other symptoms (e.g., lying flat on his or her back, standing for 15 to 20 minutes every hour, or sleeping on a board); and
  7. Any other factors concerning an individual's functional limitations and restrictions due to pain or other symptoms.


We will consider other evidence to evaluate only the factors that are relevant to assessing the intensity, persistence, and limiting effects of the individual's symptoms. If there is no information in the evidence of record regarding one of the factors, we will not discuss that specific factor in the determination or decision because it is not relevant to the case. We will discuss the factors pertinent to the evidence of record.


How we will determine if an individual's symptoms affect the ability to perform work-related activities for an adult, or age-appropriate activities for a child with a title XVI disability claim

If an individual's statements about the intensity, persistence, and limiting effects of symptoms are consistent with the objective medical evidence and the other evidence of record, we will determine that the individual's symptoms are more likely to reduce his or her capacities to perform work- related activities for an adult or reduce a child's ability to function independently, appropriately, and effectively in an age-appropriate manner for a child with a title XVI disability claim.[16] In contrast, if an individual's statements about the intensity, persistence, and limiting effects of symptoms are inconsistent with the objective medical evidence and the other evidence, we will determine that the individual's symptoms are less likely to reduce his or her capacities to perform work-related activities or abilities to function independently, appropriately, and effectively in an age-appropriate manner.We may or may not find an individual's symptoms and related limitations consistent with the evidence in his or her record. We will explain which of an individual's symptoms we found consistent or inconsistent with the evidence in his or her record and how our evaluation of the individual's symptoms led to our conclusions. We will evaluate an individual's symptoms considering all the evidence in his or her record.In determining whether an individual's symptoms will reduce his or her corresponding capacities to perform work-related activities or abilities to function independently, appropriately, and effectively in an age-appropriate manner, we will consider the consistency of the individual's own statements. To do so, we will compare statements an individual makes in connection with the individual's claim for disability benefits with any existing statements the individual made under other circumstances.We will consider statements an individual made to us at each prior step of the administrative review process, as well as statements the individual made in any subsequent or prior disability claims under titles II and XVI. If an individual's various statements about the intensity, persistence, and limiting effects of symptoms are consistent with one another and consistent with the objective medical evidence and other evidence in the record, we will determine that an individual's symptoms are more likely to reduce his or her capacities for work-related activities or reduce the abilities to function independently, appropriately, and effectively in an age- appropriate manner. However, inconsistencies in an individual's statements made at varying times does not necessarily mean they are inaccurate. Symptoms may vary in their intensity, persistence, and functional effects, or may worsen or improve with time. This may explain why an individual's statements vary when describing the intensity, persistence, or functional effects of symptoms.We will consider an individual's attempts to seek medical treatment for symptoms and to follow treatment once it is prescribed when evaluating whether symptom intensity and persistence affect the ability to perform work-related activities for an adult or the ability to function independently, appropriately, and effectively in an age- appropriate manner for a child with a title XVI disability claim. Persistent attempts to obtain relief of symptoms, such as increasing dosages and changing medications, trying a variety of treatments, referrals to specialists, or changing treatment sources may be an indication that an individual's symptoms are a source of distress and may show that they are intense and persistent.[17]In contrast, if the frequency or extent of the treatment sought by an individual is not comparable with the degree of the individual's subjective complaints, or if the individual fails to follow prescribed treatment that might improve symptoms, we may find the alleged intensity and persistence of an individual's symptoms are inconsistent with the overall evidence of record. We will not find an individual's symptoms inconsistent with the evidence in the record on this basis without considering possible reasons he or she may not comply with treatment or seek treatment consistent with the degree of his or her complaints. We may need to contact the individual regarding the lack of treatment or, at an administrative proceeding, ask why he or she has not complied with or sought treatment in a manner consistent with his or her complaints. When we consider the individual's treatment history, we may consider (but are not limited to) one or more of the following:


  • An individual may have structured his or her activities to minimize symptoms to a tolerable level by avoiding physical activities or mental stressors that aggravate his or her symptoms.
  • An individual may receive periodic treatment or evaluation for refills of medications because his or her symptoms have reached a plateau.
  • An individual may not agree to take prescription medications because the side effects are less tolerable than the symptoms.
  • An individual may not be able to afford treatment and may not have access to free or low-cost medical services.
  • A medical source may have advised the individual that there is no further effective treatment to prescribe or recommend that would benefit the individual.
  • An individual's symptoms may not be severe enough to prompt him or her to seek treatment, or the symptoms may be relieved with over the counter medications.
  • An individual's religious beliefs may prohibit prescribed treatment.
  • Due to various limitations (such as language or mental limitations), an individual may not understand the appropriate treatment for or the need for consistent treatment of his or her impairment.
  • Due to a mental impairment (for example, individuals with mental impairments that affect judgment, reality testing, or orientation), an individual may not be aware that he or she has a disorder that requires treatment.
  • A child may disregard the level and frequency of treatment needed to maintain or improve functioning because it interferes with his or her participation in activities typical of other children his or her age without impairments.


The above examples illustrate possible reasons an individual may not have pursued treatment. However, we will consider and address reasons for not pursuing treatment that are pertinent to an individual's case. We will review the case record to determine whether there are explanations for inconsistencies in the individual's statements about symptoms and their effects, and whether the evidence of record supports any of the individual's statements at the time he or she made them. We will explain how we considered the individual's reasons in our evaluation of the individual's symptoms.


Adjudication - How we will use our evaluation of symptoms in our five-step sequential evaluation process to determine whether an individual is disabled

In evaluating an individual's symptoms, it is not sufficient for our adjudicators to make a single, conclusory statement that "the individual's statements about his or her symptoms have been considered" or that "the statements about the individual's symptoms are (or are not) supported or consistent." It is also not enough for our adjudicators simply to recite the factors described in the regulations for evaluating symptoms. The determination or decision must contain specific reasons for the weight given to the individual's symptoms, be consistent with and supported by the evidence, and be clearly articulated so the individual and any subsequent reviewer can assess how the adjudicator evaluated the individual's symptoms. Our adjudicators must base their findings solely on the evidence in the case record, including any testimony from the individual or other witnesses at a hearing before an administrative law judge or hearing officer. The subjective statements of the individual and witnesses obtained at a hearing should directly relate to symptoms the individual alleged. Our adjudicators are prohibited from soliciting additional non- medical evidence outside of the record on their own, except as set forth in our regulations and policies. Adjudicators must limit their evaluation to the individual's statements about his or her symptoms and the evidence in the record that is relevant to the individual's impairments. In evaluating an individual's symptoms, our adjudicators will not assess an individual's overall character or truthfulness in the manner typically used during an adversarial court litigation. The focus of the evaluation of an individual's symptoms should not be to determine whether he or she is a truthful person. Rather, our adjudicators will focus on whether the evidence establishes a medically determinable impairment that could reasonably be expected to produce the individual's symptoms and given the adjudicator's evaluation of the individual's symptoms, whether the intensity and persistence of the symptoms limit the individual's ability to perform work-related activities or, for a child with a title XVI disability claim, limit the child's ability to function independently, appropriately, and effectively in an age-appropriate manner. In determining whether an individual is disabled or continues to be disabled, our adjudicators follow a sequential evaluation process.[18] The first step of our five-step sequential evaluation process considers whether an individual is performing substantial gainful activity. If the individual is performing substantial gainful activity, we find him or her not disabled. If the individual is not performing substantial gainful activity, we proceed to step 2. We do not consider symptoms at the first step of the sequential evaluation process. At step 2 of the sequential evaluation process, we determine whether an individual has a severe medically determinable physical or mental impairment or combination of impairments that has lasted or can be expected to last for a continuous period of at least 12 months or end in death.[19] A severe impairment is one that affects an individual's ability to perform basic work-related activities for an adult or that causes more than minimal functional limitations for a child with a title XVI disability claim.[20] At this step, we will consider an individual's symptoms and functional limitations to determine whether his or her impairment(s) is severe unless the objective medical evidence alone establishes a severe medically determinable impairment or combination of impairments that meets our duration requirement.[21] If an individual does not have a severe medically determinable impairment that meets our duration requirement, we will find the individual not disabled at step 2. If the individual has a severe medically determinable impairment that has met or is expected to meet our duration requirement, we proceed to the next step.At step 3 of the sequential evaluation process, we determine whether an individual's impairment(s) meets or medically equals the severity requirements of a listed impairment. To decide whether the impairment meets the level of severity described in a listed impairment, we will consider an individual's symptoms when a symptom(s) is one of the criteria in a listing to ensure the symptom is present in combination with the other criteria. If the symptom is not one of the criteria in a listing, we will not evaluate an individual's symptoms at this step as long as all other findings required by the specific listing are present. Unless the listing states otherwise, it is not necessary to provide information about the intensity, persistence, or limiting effects of a symptom as long as all other findings required by the specific listing are present.[22] In considering whether an individual's 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 the symptoms, signs, and laboratory findings are at least equal in severity to the listed criteria. However, we will not substitute the individual's allegations of pain or other symptoms for a missing or deficient sign or laboratory finding to raise the severity of the impairment(s) to that of a listed impairment.[23] If an individual's impairment meets or medically equals the severity requirements of a listing, we find him or her disabled. If an individual's impairment does not meet or medically equal a listing, we proceed to assess the individual's residual functional capacity at step 4 of the sequential evaluation process unless the individual is a child with a title XVI disability claim.For a child with a title XVI disability claim whose impairment does not meet or medically equal the severity requirements of a listing, we consider whether his or her impairment functionally equals the listings. This means that the impairment results in “marked” limitations in two out of six domains of functioning or an “extreme” limitation in one of the six domains.[24] We will evaluate an individual's symptoms at this step when we rate how a child's impairment-related symptoms affect his or her ability to function independently, appropriately, and effectively in an age-appropriate manner in each functional domain. If a child's impairment functionally equals a listing, we find him or her disabled. If a child's impairment does not functionally equal the listings, we find him or her not disabled. For a child with a title XVI disability claim, the sequential evaluation process ends at this step.If the individual's impairment does not meet or equal a listing, we will assess and make a finding about an individual's residual functional capacity based on all the relevant medical and other evidence in the individual's case record. An individual's residual functional capacity is the most the individual can still do despite his or her impairment-related limitations. We consider the individual's symptoms when determining his or her residual functional capacity and the extent to which the individual's impairment-related symptoms are consistent with the evidence in the record.[25]After establishing the residual functional capacity, we determine whether an individual is able to do any past relevant work. At step 4, we compare the individual's residual functional capacity with the requirements of his or her past relevant work. If the individual's residual functional capacity is consistent with the demands of any of his or her past relevant work, either as the individual performed it or as the occupation is generally performed in the national economy, then we will find the individual not disabled. If none of the individual's past relevant work is within his or her residual functional capacity, we proceed to step 5 of the sequential evaluation process.At step 5 of the sequential evaluation process, we determine whether the individual is able to adjust to other work that exists in significant numbers in the national economy. We consider the same residual functional capacity, together with the individual's age, education, and past work experience. If the individual is able to adjust to other work that exists in significant numbers in the national economy, we will find him or her not disabled. If the individual cannot adjust to other work that exists in significant numbers in the national economy, we find him or her disabled. At step 5 of the sequential evaluation process, we will not consider an individual's symptoms any further because we considered the individual's symptoms when we determined the individual's residual functional capacity.


EFFECTIVE DATE: This SSR is effective on March 28, 2016

CROSS-REFERENCES: SSR 96-3p, “Titles II and XVI: Considering Allegations of Pain and Other Symptoms in Determining Whether a Medically Determinable Impairment is Severe,” SSR 96-8p, “Titles II and XVI: Assessing Residual Functional Capacity in Initial Claims,” 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;” and Program Operations Manual System, sections DI 24515.061 and DI 24515.064.



[1] ACUS made several recommendations in its March 12, 2015 final report, “Evaluating Subjective Symptoms in Disability Claims.” Among other things, ACUS recommended we consider amending SSR 96-7p to clarify that subjective symptom evaluation is not an examination of an individual's character, but rather is an evidence-based analysis of the administrative record to determine whether the nature, intensity, frequency, or severity of an individual's symptoms impact his or her ability to work. In any revised SSR, ACUS also recommended we more closely follow our regulatory language about symptom evaluation, which does not use the term “credibility” and instead directs adjudicators to consider medical and other evidence to evaluate the intensity and persistence of symptoms to determine how the individual's symptoms limit capacity for work if he or she is an adult, or for a child with a title XVI disability claim, how symptoms limit ability to function. ACUS further recommended when revising SSR 96-7p, we offer additional guidance to adjudicators on regulatory implementation problems that have been identified since we published SSR 96-7p.


[2] See 20 CFR 404.1528(a) and 416.928(a) for how our regulations define symptoms.


[3] See 20 CFR 404.1529 and 416.929 for how we evaluate statements of symptoms.


[4] See 20 CFR 404.1528(b) and 416.928(b) for how our regulations define signs.


[5] See 20 CFR 404.1528(c) and 416.928(c) for how our regulations define laboratory findings.


[6] See 20 CFR 404.1513(a) and 416.913(a) for a list of acceptable medical sources.


[7] See 20 CFR 404.1508 and 416.908 for what is needed to show a medically determinable impairment.


[8] By “complete medical history,” we mean the individual's complete medical history for at least the 12 months preceding the month in which he or she filed an application, unless there is a reason to believe that development of an earlier period is necessary or the individual says that his or her alleged disability began less than 12 months before he or she filed an application. 20 CFR 404.1512(d) and 416.912(d).


[9] See 20 CFR 404.1529(c)(2) and 416.929(c)(2).


[10] See 20 CFR 404.1529(c)(2) and 416.929(c)(2).


[11] See 20 CFR 404.1529 and 416.929.


[12] See 20 CFR 404.1513 and 416.913.


[13] See 20 CFR 404.1529(c)(3) and 416.929(c)(3)


[14] See 20 CFR 416.928(a).


[15] See 20 CFR 404.1527 and 416.927.


[16] See 20 CFR 404.1529(c)(4) and 416.929(c)(4).


[17] See 20 CFR 404.1529(c) and 416.929(c).


[18] See 20 CFR 404.1520 and 416.920. For continuing disability, see 404.1594, 416.994 and 416.994a.


[19] See 20 CFR 404.1520(a)(4)(ii) and 416.920(a)(4)(ii).


[20] See 20 CFR 416.924(c).


[21] See 20 CFR 416.920(c) for adults and 416.924(c) for children.


[22] See 20 CFR 404.1529(d)(2) and 416.929(d)(2).


[23] See 20 CFR 404.1529(d)(3) and 416.929(d)(3).


[24] See 20 CFR 416.926a.


[25] See 20 CFR 404.1545 and 416.945.

A woman is standing in front of a building looking at her cell phone.

New SSA Rule: Shorter Relevant Work Period for Disability Claims

By Bob Hansen • May 1, 2024
Written By Rick Gach If you're applying for Social Security disability benefits, a recent rule change by the Social Security Administration (SSA) could have a significant impact on your claim. Effective June 8, 2024, the SSA will be making changes to how they evaluate your past work when determining your eligibility for disability benefits. Under the new rule, the SSA will only consider jobs you've held within the past 5 years as relevant to your disability claim. This is a significant reduction from the previous 15-year period. Additionally, any past work that lasted fewer than 30 calendar days will no longer be considered as part of your work history. What does this mean for you? In short, these changes should make the disability application process less burdensome and more focused on your recent work experience. You'll no longer need to struggle to remember details of jobs you held more than 5 years ago, which can often be difficult and lead to errors in your application. By focusing on your more recent work history, the SSA aims to improve the accuracy of the information you provide and potentially speed up the decision-making process. Another positive aspect of this rule change is that the SSA is updating its work history report forms and instructions. The new forms will align with the 5-year relevant work period and exclude jobs lasting under 30 days. This should make completing the paperwork easier and less time-consuming for you. It's important to note that the SSA expects this rule change to result in an increase in disability benefit approvals. While this may lead to higher program costs, the SSA believes that the benefits to claimants like you justify the expense. During the rulemaking process, most commenters supported the proposed changes, recognizing the positive impact they could have on the lives of disability applicants. As you prepare to file your disability claim or if you're in the midst of the application process, be sure to keep this new rule in mind. If you have any questions about how the changes might affect your specific case, don't hesitate to reach out to the SSA or your disability attorney for guidance. Remember, the SSA's goal with this rule change is to make the disability application process more manageable and efficient for you. By reducing the burden of providing extensive work history details and focusing on your more recent and relevant experiences, the SSA hopes to provide better service and support as you navigate your disability claim. If you have any questions about how the new Social Security rule might impact your disability claim or if you need assistance navigating the application process, the experienced attorneys at Hogan Smith SSD are here to help. With a deep understanding of the ever-changing disability claim landscape, we can provide you with the guidance and support you need to maximize your chances of success. Don't let the complexities of the disability claim process overwhelm you. Call Hogan Smith SSD today at 407-377-0700 or visit our website at www.hogansmithssd.com to schedule a consultation with one of our knowledgeable attorneys. Let us put our expertise to work for you and help you secure the disability benefits you deserve. Source: https://www.federalregister.gov/documents/2024/04/18/2024-08150/intermediate-improvement-to-the-disability-adjudication-process-including-how-we-consider-past-work#print

Major SSI Policy Change: Rental Subsidies No Longer Reduce Benefits

By Bob Hansen • April 18, 2024
Written by Rick Gach If you or a loved one receives Supplemental Security Income (SSI), a recent policy change from the Social Security Administration (SSA) could significantly impact your monthly benefits. As of September 30, 2024, rental subsidies will no longer count as income when calculating SSI eligibility and payment amounts. This is a substantial shift that could provide a much-needed financial boost for SSI recipients nationwide. What does this mean for SSI beneficiaries? Let's break it down: Currently, if an SSI recipient receives free or reduced rent, such as living with a family member rent-free, the SSA considers this "in-kind support and maintenance" (ISM). The value of this ISM is counted as income, which reduces the individual's SSI payment. For example, if an SSI recipient receives $300 worth of ISM in the form of free rent, their monthly SSI payment would be reduced by $300. Under the new rule, effective September 30, 2024, rental subsidies will no longer be counted as ISM. This means that SSI recipients who receive free or reduced rent will be able to keep their full SSI payment without any reduction. In the example above, the individual would receive their full SSI payment (e.g., $914 in 2023), even while benefiting from the $300 rental subsidy. This policy change is a significant win for SSI beneficiaries. It allows individuals to maintain stable housing situations with support from family or other sources without jeopardizing their SSI benefits. The extra money in their monthly SSI checks can make a real difference in covering essential expenses like food, healthcare, and utilities. Moreover, this change may allow more individuals to qualify for SSI in the first place. By excluding rental subsidies from income calculations, some people who were previously over the income limit may now be eligible for SSI benefits. If you or someone you know receives SSI and benefits from a rental subsidy, it's important to understand how this policy change may impact your situation. As always, our team at Hogan Smith is here to help navigate the complexities of SSI and ensure you receive the maximum benefits you deserve. Contact us today to discuss your case and learn more about how this new rule may apply to you.
Understanding Representative Payees in Social Security Benefits: Your Rights and Choices

Understanding Representative Payees in Social Security Benefits: Your Rights and Choices

By Bob Hansen • April 10, 2024
Written By Rick Gach The Social Security Administration (SSA) provides financial assistance to millions of Americans through various programs, such as retirement, disability, and supplemental security income (SSI). In some cases, the SSA may require a representative payee to manage the benefits on behalf of the recipient. This blog post will explore the reasons behind this requirement and the rights of beneficiaries in choosing their representative payee. Why Does the SSA Require a Representative Payee? The SSA may determine that a beneficiary needs a representative payee if they believe the individual cannot manage their finances independently. This decision is made to ensure that the benefits are used for the recipient's basic needs and well-being. Some reasons why the SSA might require a representative payee include: Mental or physical impairments that hinder the ability to manage finances History of substance abuse or mismanagement of funds Being a minor child receiving benefits The representative payee is responsible for using the benefits to pay for the beneficiary's living expenses, such as food, housing, medical care, and personal needs. They must also keep accurate records of how the funds are spent and report to the SSA when required. Your Rights in Choosing a Representative Payee As a beneficiary, you have the right to participate in selecting your representative payee. The SSA will consider your preferences when appointing a payee, but they must also ensure that the chosen individual is suitable for the role. Here are some key points to keep in mind: You can suggest a preferred representative payee to the SSA, such as a family member, friend, or organization you trust. If you disagree with the SSA's choice of representative payee, you have the right to appeal the decision and present evidence supporting your preferred choice. You can request a change in representative payee if you believe the current payee is not acting in your best interests or mismanaging your benefits. If no suitable family member or friend is available, the SSA may appoint an organizational payee, such as a social service agency or non-profit organization. It is essential to choose a representative payee whom you trust and who will prioritize your well-being. Open communication with your payee is crucial to ensure that your needs are met and that your benefits are being managed appropriately. Conclusion The representative payee system is designed to protect the interests of Social Security beneficiaries who may have difficulty managing their finances. While the SSA makes the final decision on appointing a payee, beneficiaries have the right to participate in the selection process and voice their preferences. By understanding the role of a representative payee and your rights as a beneficiary, you can work towards ensuring that your benefits are managed effectively and in your best interests. SSI - Representative Payee
Social Security Administration Removes Barriers to Accessing SSI Payments

Social Security Administration Removes Barriers to Accessing SSI Payments

By Bob Hansen • March 27, 2024
In a significant move to improve access to critical benefits, the Social Security Administration (SSA) has published a final rule titled "Omitting Food from In-Kind Support and Maintenance (ISM) Calculations." This rule, set to take effect on September 30, 2024, is the first of several updates to the agency's Supplemental Security Income (SSI) regulations aimed at helping people receiving and applying for SSI. The SSI program provides monthly payments to adults and children with disabilities or blindness, as well as adults aged 65 and older, who have limited income and resources. These benefits help cover basic needs such as rent, food, clothing, and medicine. To be eligible for SSI, applicants must meet specific requirements, including income and resource limits. Under the previous rules, ISM included food, shelter, or both that a person receives, and the agency counted ISM as unearned income, potentially affecting a person's eligibility or reducing their payment amount. The new rule removes food from ISM calculations, eliminating a significant barrier for SSI eligibility due to an applicant's or recipient's receipt of informal food assistance from friends, family, and community support networks. This change brings several important benefits: 1. The new policy is easier to understand and use by applicants, recipients, and agency employees. 2. Applicants and recipients will have less information to report about food assistance received from family and friends, reducing a significant source of burden. 3. Reducing month-to-month variability in payment amounts will improve payment accuracy. 4. The agency will see administrative savings because less time will be spent administering food ISM.  As a representative for claimants in their disability claims with the SSA, I welcome this change. The removal of food from ISM calculations will help more individuals access the critical benefits they need to support themselves and their families. By simplifying the application process and reducing the burden on applicants, the SSA is taking a significant step towards promoting equity and removing barriers to accessing payments. The SSA has stated that it will continue to examine programmatic policy and make regulatory and sub-regulatory changes as appropriate. In the coming weeks, we can expect more announcements related to the SSI program, further demonstrating the agency's commitment to improving access to benefits for those who need them most. If you or someone you know is interested in applying for SSI, visit the Social Security Administration's website for more information on eligibility and how to apply. As always, if you need assistance with your disability claim, do not hesitate to reach out to a qualified representative who can guide you through the process and help ensure you receive the benefits you deserve.
Completing the Third Party Function Report for SSA: A Comprehensive Guide

Completing the Third Party Function Report for SSA: A Comprehensive Guide

By Bob Hansen • March 27, 2024
If you're in the process of applying for Social Security Disability benefits, you may be asked to have a friend, family member, or caregiver complete a Third Party Function Report. This form, also known as the SSA-3380-BK, is designed to provide the Social Security Administration (SSA) with valuable insights into your daily activities, limitations, and overall functioning. In this blog post, we'll walk you through the key steps and tips for completing this important form. 1. Choose the right person: Select someone who knows you well and has regular interaction with you, such as a close family member, friend, or caregiver. This person should be able to provide accurate and detailed information about your daily activities and limitations. 2. Provide specific examples: When describing your limitations, it's essential to be as specific as possible. Instead of simply stating that you have difficulty walking, provide concrete examples, such as "I can only walk for 10 minutes before needing to rest due to severe back pain." The more detailed the examples, the better the SSA can understand your situation. 3. Be honest and comprehensive: It's crucial to provide an honest and complete picture of your daily challenges. Don't downplay or exaggerate your limitations. Be sure to include information about any assistance you require or adaptive devices you use to complete daily tasks. 4. Discuss the impact on daily activities: Focus on how your impairments affect your ability to perform everyday tasks, such as personal care, household chores, and social interactions. Provide examples of activities you struggle with or can no longer do because of your condition. 5. Address good days and bad days: Many people with disabilities experience fluctuations in their symptoms. It's important to discuss how your condition varies on good days versus bad days, and how often you experience each type of day. 6. Collaborate with the person completing the form: Work closely with the person filling out the Third Party Function Report on your behalf. Schedule a meeting or phone call to discuss your daily experiences, challenges, and limitations in detail. This collaboration will help ensure that the information provided is accurate and comprehensive. 7. Review the completed form: Before the Third Party Function Report is submitted, take the time to review the form for any errors, inconsistencies, or omissions. If necessary, provide additional information or clarification to ensure that the SSA has a clear understanding of your situation. Remember, the Third Party Function Report is an opportunity for the SSA to gain a better understanding of how your impairments affect your daily life. By following these tips and providing detailed, accurate information, you can increase your chances of a successful disability claim. If you have any questions or concerns about the Third Party Function Report, don't hesitate to reach out to your disability attorney or advocate for guidance.
A doctor is talking to a patient in a hospital hallway.

Medicare Parts A - D

By Bob Hansen • March 16, 2024
Medicare is a health insurance plan for people who are age 65 or older. People who are disabled or have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease) can get Medicare at any age. Medicare has four parts: Hospital insurance (Part A) helps pay for inpatient hospital care and certain follow-up services. Medical insurance (Part B) helps pay for doctors’ services, outpatient hospital care and other medical services. Medicare Advantage plans (Part C) are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through a provider organization under Part C. Prescription drug coverage (Part D) helps pay for medications doctors prescribe for medical treatment. Who is eligible for hospital insurance (Part A)? Most people get hospital insurance when they turn 65. You qualify for it automatically if you are eligible for Social Security or Railroad Retirement benefits. Or you may qualify based on a spouse’s (including divorced spouse’s) work. Others qualify because they are government employees not covered by Social Security who paid the Medicare tax. If you get Social Security disability benefits for 24 months, you will qualify for hospital insurance. If you get disability benefits because you have amyotrophic lateral sclerosis (Lou Gehrig’s disease), you do not have to wait 24 months to qualify. Also, people who have permanent kidney failure that requires maintenance dialysis or a kidney replacement qualify for hospital insurance if they have worked long enough or if they are the spouse or child of a person who has worked long enough. Who can get medical insurance (Part B)? Almost anyone who is eligible for hospital insurance can sign up for medical insurance. Part B is an optional program. It is not free. In 2008, the standard monthly premium is $96.40. Some people with higher incomes will pay higher premiums. Who can get Medicare Advantage plans (Part C)? Anyone who has Medicare hospital insurance (Part A) and medical insurance (Part B) can join a Medicare Advantage plan. Medicare Advantage plans include: Medicare managed care plans; Medicare preferred provider organization (PPO) plans; Medicare private fee-for-service plans; and Medicare specialty plans. You might have to pay a monthly premium because of the extra benefits the Medicare Advantage plan offers. Who can get Medicare prescription drug coverage (Part D)? Anyone who has Medicare hospital insurance (Part A) or medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Prescription insurance is optional, and you pay an additional monthly premium for the coverage. For more information, contact SSA and ask for Medicare (Publication No. 05-10043). Help with Medicare expenses for people with low income. If you have a low income and few resources, your state may pay your Medicare premiums and, in some cases, other “out-of-pocket” medical expenses, such as deductibles and coinsurance. Only your state can decide whether you qualify for help under this program. If you think you qualify, contact your state or local medical assistance (Medicaid) agency, social services or welfare office. You can get more information about this program from the publication, If you need help paying Medicare costs, there are programs that can help you save money (Publication CMS-10126). To get a copy, call the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227). If you are deaf or hard of hearing, you may call TTY 1-877-486-2048. “Extra help” with Medicare prescription costs : If you have limited income and resources, you may qualify for extra help to pay for your prescription drugs under Medicare Part D. Social Security’s role is to help you understand how you may qualify and to process your application for extra help. To see if you qualify or to apply, call Social Security’s toll-free number or visit our website.
A laptop computer is sitting on a wooden table next to a pile of money and a calculator.

Earnings that Trigger a Trial Work Period

By Bob Hansen • March 16, 2024
During a trial work period, a beneficiary receiving Social Security disability benefits may test his or her ability to work and still be considered disabled. We do not consider services performed during the trial work period as showing that the disability has ended until services have been performed in at least 9 months (not necessarily consecutive) in a rolling 60-month period. In 2007, any month in which earnings exceed $640 is considered a month of services for an individual's trial work period. In 2008, this monthly amount increases to $670. Monthly earnings that trigger a trial work period Year Monthly earnings: 1978 & prior $50 1979-1989 75 1990-2000 200 2001 530 2002 560 2003 570 2004 580 2005 590 2006 620 2007 640 2008 670
A woman is holding a blister pack of pills in her hands.

Picking a Medicare Drug Plan

By Bob Hansen • March 16, 2024
THE SAVAGE TRUTH | Enrollment time is here again -- follow these steps to choose what works best November 17, 2008 TERRY SAVAGE savage@suntimes.com Here we go again. Starting today, seniors have six weeks to sign up for another year of Medicare Part D -- the prescription drug benefit -- that goes along with Medicare Part A (hospitalization), Part B (outpatient and doctor costs) and Medigap (the supplement that covers other costs including co-payments and deductibles). It's a must-do project, even if you're among the few seniors who don't currently take prescription drugs. If you don't sign up when you first become eligible, there will be big penalties to pay once you do need some prescriptions -- and for sure you will need them at some point. The Medicare.gov Web site sorts through all of the alternative plans to find you the best coverage at the least cost in a plan that is available at a pharmacy near you. The only exceptions are those seniors who are covered by a comparable company or retiree prescription plan, or those who have signed up for an all-in-one Medicare Advantage plan. Some seniors have prescription drug access through the Veterans Administration, though they may want to choose an inexpensive Part D plan for drugs the VA does not cover. For those who recently turned 65 and now qualify for Medicare, this will be the first time going through the process of choosing the least-expensive plan. But every senior, even those currently enrolled and happy with their drug plan, should go through the process of reviewing the alternatives for 2009. That's because each year, the plans change the prices of the drugs they cover and may not even include the same medicines in the year ahead. So here's my annual, step-by-step guide through the Medicare.gov Web site, the only place that can sort through all of the alternative plans to find you the best coverage at the least cost in a plan that is available at a pharmacy near you! Finding your plan at Medicare.gov Step 1. Get a complete list of all of the medicines and dosages you are now taking. The easiest way is to ask your pharmacist for this list, or simply line up all of your prescription bottles. Step 2. Go to www.Medicare.gov. (If you don't have a computer, you can call 800-MEDICARE, and they will help you through this process over the telephone.) Step 3. Click on the line near the top of the first page screen that says: "Medicare Prescription Drug Plans -- 2009 Plan Data." Step 4. On the next page, click on the box that says "Find and Compare Plans." Step 5. On the next page, you have a choice of either a "personalized" search or a "generalized" search. If you already have your red, white, and blue Medicare card, you can use the personalized search, in which you input your Medicare number and other information from your card. (You can use the generalized search to find and compare plans in your ZIP code.) Step 6. On the next page, you can enter the drugs you are currently taking, and the dosages. Even if you do not take prescription drugs now, you must fill out this page, stating that fact. This list can be saved securely for your future visits to Medicare.gov. You can either type in the names of your drugs, or search for them alphabetically. The most common dosage will automatically pop up, but you should be sure that is the dosage you are taking. The program will also let you know if there is a less-expensive generic available. When you've finished listing your prescriptions, click "continue" to move on to the next page where you can recheck the list of names and dosages. Then click "continue" again. Step 7. You'll be asked if you have a specific pharmacy that you'd like to work with -- one that's within walking distance of your home, for example. Then click again. Step 8. You've finally arrived at the most important page -- the one that lists all of the plans, ranked with the lowest total cost at the top of the list. You can select up to three plans to compare. You can click to see how you might lower your cost, perhaps by switching to a generic. Or the program might suggest an alternative but less-expensive drug in the same category. That's something you'd have to discuss with your physician. This year, there are also "star" ratings, up to five stars, based on a survey done for Medicare about the quality and performance of those plans over the last year. Step 9. After comparing the plans by cost, click on the name of each plan provider to find full details, including a helpful graph of the average monthly cost, as well as information about participating pharmacies and mail order availability. You can print out the pages for each plan, and keep them handy. Step 10. Before signing up, call the plan's toll-free number and reconfirm their prices and coverages for the drugs you take, as well as all co-payments. Then you're ready to ask them to send you the application so you can sign up! A plea for help: Government should be required to make these decisions easier for seniors. But since it hasn't, I'm asking the more computer-literate among you to clip this column, find a senior, and offer to help. It's easy once you've done it. And that's The Savage Truth. Terry Savage is a registered investment adviser. Distributed by Creators Syndicate. Copyright Terry Savage Productions Ltd. Visit www.terrysavage.com and suntimes.com.
A person is wearing an apple watch on their wrist.

How Long Does it Take to Get a Hearing?

By Bob Hansen • March 16, 2024
Rank ODAR Office Processing Time #5 Ft. Lauderdale 264 days #38 Orlando 393 days #87 Jacksonville 477 days #90 Savannah 480 days #118 Miami 592 days #120 Tampa 593 days #122 Atlanta 595 days #132 Atlanta North 614 days #145 Jackson 685 days
A woman is holding a pink ribbon on her chest.

Compassionate Allowances

By Bob Hansen • March 16, 2024
Compassionate allowances are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate allowances will allow Social Security to quickly target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly. List of Conditions: 1 Acute Leukemia 2 Adrenal Cancer - with distant metastases or inoperable, unresectable or recurrent 3 Alexander Disease (ALX) - Neonatal and Infantile 4 Amyotrophic Lateral Sclerosis (ALS) 5 Anaplastic Adrenal Cancer - with distant metastases or inoperable, unresectable or recurrent 6 Astrocytoma - Grade III and IV 7 Bladder Cancer - with distant metastases or inoperable or unresectable 8 Bone Cancer - with distant metastases or inoperable or unresectable 9 Breast Cancer - with distant metastases or inoperable or unresectable 10 Canavan Disease (CD) 11 Cerebro Oculo Facio Skeletal (COFS) Syndrome 12 Chronic Myelogenous Leukemia (CML) - Blast Phase 13 Creutzfeldt-Jakob Disease (CJD) - Adult 14 Ependymoblastoma (Child Brain Tumor) 15 Esophageal Cancer 16 Farber's Disease (FD) - Infantile 17 Friedreichs Ataxia (FRDA) 18 Frontotemporal Dementia (FTD), Picks Disease -Type A - Adult 19 Gallbladder Cancer 20 Gaucher Disease (GD) - Type 2 21 Glioblastoma Multiforme (Brain Tumor) 22 Head and Neck Cancers - with distant metastasis or inoperable or uresectable 23 Infantile Neuroaxonal Dystrophy (INAD) 24 Inflammatory Breast Cancer (IBC) 25 Kidney Cancer - inoperable or unresectable 26 Krabbe Disease (KD) - Infantile 27 Large Intestine Cancer - with distant metastasis or inoperable, unresectable or recurrent 28 Lesch-Nyhan Syndrome (LNS) 29 Liver Cancer 30 Mantle Cell Lymphoma (MCL) 31 Metachromatic Leukodystrophy (MLD) - Late Infantile 32 Niemann-Pick Disease (NPD) - Type A 33 Non-Small Cell Lung Cancer - with metastases to or beyond the hilar nodes or inoperable, unresectable or recurrent 34 Ornithine Transcarbamylase (OTC) Deficiency 35 Osteogenesis Imperfecta (OI) - Type II 36 Ovarian Cancer - with distant metastases or inoperable or unresectable 37 Pancreatic Cancer 38 Peritoneal Mesothelioma 39 Pleural Mesothelioma 40 Pompe Disease - Infantile 41 Rett (RTT) Syndrome 42 Salivary Tumors 43 Sandhoff Disease 44 Small Cell Cancer (of the Large Intestine, Ovary, Prostate, or Uterus) 45 Small Cell Lung Cancer 46 Small Intestine Cancer - with distant metastases or inoperable, unresectable or recurrent 47 Spinal Muscular Atrophy (SMA) - Types 0 And 1 48 Stomach Cancer - with distant metastases or inoperable, unresectable or recurrent 49 Thyroid Cancer 50 Ureter Cancer - with distant metastases or inoperable, unresectable or recurrent 
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