Title 20

PART 416 SUBPART I

Subpart I - Determining Disability and Blindness Authority:Secs. 221(m), 702(a)(5), 1611, 1614, 1619, 1631(a), (c), (d)(1), and (p), and 1633 of the Social Security Act (42 U.S.C. 421(m), 902(a)(5), 1382, 1382c, 1382h, 1383(a), (c), (d)(1), and (p), 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, and 1382h note). Source:45 FR 55621, Aug. 20, 1980, unless otherwise noted.

20:2.0.1.1.9.9.394SUBJGRP 394
General
20:2.0.1.1.9.9.394.1SECTION 416.901
   416.901 Scope of subpart.
20:2.0.1.1.9.9.394.2SECTION 416.902
   416.902 Definitions for this subpart.
20:2.0.1.1.9.9.395SUBJGRP 395
Determinations
20:2.0.1.1.9.9.395.3SECTION 416.903
   416.903 Who makes disability and blindness determinations.
20:2.0.1.1.9.9.395.4SECTION 416.903a
   416.903a Program integrity.
20:2.0.1.1.9.9.395.5SECTION 416.903b
   416.903b Evidence from excluded medical sources of evidence.
20:2.0.1.1.9.9.395.6SECTION 416.904
   416.904 Decisions by other governmental agencies and nongovernmental entities.
20:2.0.1.1.9.9.396SUBJGRP 396
Definition of Disability
20:2.0.1.1.9.9.396.7SECTION 416.905
   416.905 Basic definition of disability for adults.
20:2.0.1.1.9.9.396.8SECTION 416.906
   416.906 Basic definition of disability for children.
20:2.0.1.1.9.9.396.9SECTION 416.907
   416.907 Disability under a State plan.
20:2.0.1.1.9.9.396.10SECTION 416.908
   416.908 [Reserved]
20:2.0.1.1.9.9.396.11SECTION 416.909
   416.909 How long the impairment must last.
20:2.0.1.1.9.9.396.12SECTION 416.910
   416.910 Meaning of substantial gainful activity.
20:2.0.1.1.9.9.396.13SECTION 416.911
   416.911 Definition of disabling impairment.
20:2.0.1.1.9.9.397SUBJGRP 397
Evidence
20:2.0.1.1.9.9.397.14SECTION 416.912
   416.912 Responsibility for evidence.
20:2.0.1.1.9.9.397.15SECTION 416.913
   416.913 Categories of evidence.
20:2.0.1.1.9.9.397.16SECTION 416.913a
   416.913a Evidence from our Federal or State agency medical or psychological consultants.
20:2.0.1.1.9.9.397.17SECTION 416.914
   416.914 When we will purchase existing evidence.
20:2.0.1.1.9.9.397.18SECTION 416.915
   416.915 Where and how to submit evidence.
20:2.0.1.1.9.9.397.19SECTION 416.916
   416.916 If you fail to submit medical and other evidence.
20:2.0.1.1.9.9.397.20SECTION 416.917
   416.917 Consultative examination at our expense.
20:2.0.1.1.9.9.397.21SECTION 416.918
   416.918 If you do not appear at a consultative examination.
20:2.0.1.1.9.9.398SUBJGRP 398
Standards To Be Used in Determining When a Consultative Examination Will Be Obtained in Connection With Disability Determinations
20:2.0.1.1.9.9.398.22SECTION 416.919
   416.919 The consultative examination.
20:2.0.1.1.9.9.398.23SECTION 416.919a
   416.919a When we will purchase a consultative examination and how we will use it.
20:2.0.1.1.9.9.398.24SECTION 416.919b
   416.919b When we will not purchase a consultative examination.
20:2.0.1.1.9.9.399SUBJGRP 399
Standards for the Type of Referral and for Report Content
20:2.0.1.1.9.9.399.25SECTION 416.919f
   416.919f Type of purchased examinations.
20:2.0.1.1.9.9.399.26SECTION 416.919g
   416.919g Who we will select to perform a consultative examination.
20:2.0.1.1.9.9.399.27SECTION 416.919h
   416.919h Your medical source.
20:2.0.1.1.9.9.399.28SECTION 416.919i
   416.919i Other sources for consultative examinations.
20:2.0.1.1.9.9.399.29SECTION 416.919j
   416.919j Objections to the medical source designated to perform the consultative examination.
20:2.0.1.1.9.9.399.30SECTION 416.919k
   416.919k Purchase of medical examinations, laboratory tests, and other services.
20:2.0.1.1.9.9.399.31SECTION 416.919m
   416.919m Diagnostic tests or procedures.
20:2.0.1.1.9.9.399.32SECTION 416.919n
   416.919n Informing the medical source of examination scheduling, report content, and signature requirements.
20:2.0.1.1.9.9.399.33SECTION 416.919o
   416.919o When a properly signed consultative examination report has not been received.
20:2.0.1.1.9.9.399.34SECTION 416.919p
   416.919p Reviewing reports of consultative examinations.
20:2.0.1.1.9.9.399.35SECTION 416.919q
   416.919q Conflict of interest.
20:2.0.1.1.9.9.400SUBJGRP 400
Authorizing and Monitoring the Referral Process
20:2.0.1.1.9.9.400.36SECTION 416.919s
   416.919s Authorizing and monitoring the consultative examination.
20:2.0.1.1.9.9.401SUBJGRP 401
Procedures To Monitor the Consultative Examination
20:2.0.1.1.9.9.401.37SECTION 416.919t
   416.919t Consultative examination oversight.
20:2.0.1.1.9.9.402SUBJGRP 402
Evaluation of Disability
20:2.0.1.1.9.9.402.38SECTION 416.920
   416.920 Evaluation of disability of adults, in general.
20:2.0.1.1.9.9.402.39SECTION 416.920a
   416.920a Evaluation of mental impairments.
20:2.0.1.1.9.9.402.40SECTION 416.920b
   416.920b How we consider evidence.
20:2.0.1.1.9.9.402.41SECTION 416.920c
   416.920c How we consider and articulate medical opinions and prior administrative medical findings for claims filed on or after March 27, 2017.
20:2.0.1.1.9.9.402.42SECTION 416.921
   416.921 Establishing that you have a medically determinable impairment(s).
20:2.0.1.1.9.9.402.43SECTION 416.922
   416.922 What we mean by an impairment(s) that is not severe in an adult.
20:2.0.1.1.9.9.402.44SECTION 416.923
   416.923 Multiple impairments.
20:2.0.1.1.9.9.402.45SECTION 416.924
   416.924 How we determine disability for children.
20:2.0.1.1.9.9.402.46SECTION 416.924a
   416.924a Considerations in determining disability for children.
20:2.0.1.1.9.9.402.47SECTION 416.924b
   416.924b Age as a factor of evaluation in the sequential evaluation process for children.
20:2.0.1.1.9.9.403SUBJGRP 403
Medical Considerations
20:2.0.1.1.9.9.403.48SECTION 416.925
   416.925 Listing of Impairments in appendix 1 of subpart P of part 404 of this chapter.
20:2.0.1.1.9.9.403.49SECTION 416.926
   416.926 Medical equivalence for adults and children.
20:2.0.1.1.9.9.403.50SECTION 416.926a
   416.926a Functional equivalence for children.
20:2.0.1.1.9.9.403.51SECTION 416.927
   416.927 Evaluating opinion evidence for claims filed before March 27, 2017.
20:2.0.1.1.9.9.403.52SECTION 416.928
   416.928 [Reserved]
20:2.0.1.1.9.9.403.53SECTION 416.929
   416.929 How we evaluate symptoms, including pain.
20:2.0.1.1.9.9.403.54SECTION 416.930
   416.930 Need to follow prescribed treatment.
20:2.0.1.1.9.9.404SUBJGRP 404
Presumptive Disability and Blindness
20:2.0.1.1.9.9.404.55SECTION 416.931
   416.931 The meaning of presumptive disability or presumptive blindness.
20:2.0.1.1.9.9.404.56SECTION 416.932
   416.932 When presumptive payments begin and end.
20:2.0.1.1.9.9.404.57SECTION 416.933
   416.933 How we make a finding of presumptive disability or presumptive blindness.
20:2.0.1.1.9.9.404.58SECTION 416.934
   416.934 Impairments that may warrant a finding of presumptive disability or presumptive blindness.
20:2.0.1.1.9.9.405SUBJGRP 405
Drug Addiction and Alcoholism
20:2.0.1.1.9.9.405.59SECTION 416.935
   416.935 How we will determine whether your drug addiction or alcoholism is a contributing factor material to the determination of disability.
20:2.0.1.1.9.9.405.60SECTION 416.936
   416.936 Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability.
20:2.0.1.1.9.9.405.61SECTION 416.937
   416.937 What we mean by appropriate treatment.
20:2.0.1.1.9.9.405.62SECTION 416.938
   416.938 What we mean by approved institutions or facilities.
20:2.0.1.1.9.9.405.63SECTION 416.939
   416.939 How we consider whether treatment is available.
20:2.0.1.1.9.9.405.64SECTION 416.940
   416.940 Evaluating compliance with the treatment requirements.
20:2.0.1.1.9.9.405.65SECTION 416.941
   416.941 Establishment and use of referral and monitoring agencies.
20:2.0.1.1.9.9.406SUBJGRP 406
Residual Functional Capacity
20:2.0.1.1.9.9.406.66SECTION 416.945
   416.945 Your residual functional capacity.
20:2.0.1.1.9.9.406.67SECTION 416.946
   416.946 Responsibility for assessing your residual functional capacity.
20:2.0.1.1.9.9.407SUBJGRP 407
Vocational Considerations
20:2.0.1.1.9.9.407.68SECTION 416.960
   416.960 When we will consider your vocational background.
20:2.0.1.1.9.9.407.69SECTION 416.962
   416.962 Medical-vocational profiles showing an inability to make an adjustment to other work.
20:2.0.1.1.9.9.407.70SECTION 416.963
   416.963 Your age as a vocational factor.
20:2.0.1.1.9.9.407.71SECTION 416.964
   416.964 Your education as a vocational factor.
20:2.0.1.1.9.9.407.72SECTION 416.965
   416.965 Your work experience as a vocational factor.
20:2.0.1.1.9.9.407.73SECTION 416.966
   416.966 Work which exists in the national economy.
20:2.0.1.1.9.9.407.74SECTION 416.967
   416.967 Physical exertion requirements.
20:2.0.1.1.9.9.407.75SECTION 416.968
   416.968 Skill requirements.
20:2.0.1.1.9.9.407.76SECTION 416.969
   416.969 Listing of Medical-Vocational Guidelines in appendix 2 of subpart P of part 404 of this chapter.
20:2.0.1.1.9.9.407.77SECTION 416.969a
   416.969a Exertional and nonexertional limitations.
20:2.0.1.1.9.9.408SUBJGRP 408
Substantial Gainful Activity
20:2.0.1.1.9.9.408.78SECTION 416.971
   416.971 General.
20:2.0.1.1.9.9.408.79SECTION 416.972
   416.972 What we mean by substantial gainful activity.
20:2.0.1.1.9.9.408.80SECTION 416.973
   416.973 General information about work activity.
20:2.0.1.1.9.9.408.81SECTION 416.974
   416.974 Evaluation guides if you are an employee.
20:2.0.1.1.9.9.408.82SECTION 416.974a
   416.974a When and how we will average your earnings.
20:2.0.1.1.9.9.408.83SECTION 416.975
   416.975 Evaluation guides if you are self-employed.
20:2.0.1.1.9.9.408.84SECTION 416.976
   416.976 Impairment-related work expenses.
20:2.0.1.1.9.9.409SUBJGRP 409
Blindness
20:2.0.1.1.9.9.409.85SECTION 416.981
   416.981 Meaning of blindness as defined in the law.
20:2.0.1.1.9.9.409.86SECTION 416.982
   416.982 Blindness under a State plan.
20:2.0.1.1.9.9.409.87SECTION 416.983
   416.983 How we evaluate statutory blindness.
20:2.0.1.1.9.9.409.88SECTION 416.984
   416.984 If you are statutorily blind and still working.
20:2.0.1.1.9.9.409.89SECTION 416.985
   416.985 How we evaluate other visual impairments.
20:2.0.1.1.9.9.409.90SECTION 416.986
   416.986 Why and when we will find that you are no longer entitled to benefits based on statutory blindness.
20:2.0.1.1.9.9.410SUBJGRP 410
Disability Redeterminations for Individuals Who Attain Age 18
20:2.0.1.1.9.9.410.91SECTION 416.987
   416.987 Disability redeterminations for individuals who attain age 18.
20:2.0.1.1.9.9.411SUBJGRP 411
Continuing or Stopping Disability or Blindness
20:2.0.1.1.9.9.411.92SECTION 416.988
   416.988 Your responsibility to tell us of events that may change your disability or blindness status.
20:2.0.1.1.9.9.411.93SECTION 416.989
   416.989 We may conduct a review to find out whether you continue to be disabled.
20:2.0.1.1.9.9.411.94SECTION 416.989a
   416.989a We may conduct a review to find out whether you continue to be blind.
20:2.0.1.1.9.9.411.95SECTION 416.990
   416.990 When and how often we will conduct a continuing disability review.
20:2.0.1.1.9.9.411.96SECTION 416.991
   416.991 If your medical recovery was expected and you returned to work.
20:2.0.1.1.9.9.411.97SECTION 416.992
   416.992 What happens if you fail to comply with our request for information.
20:2.0.1.1.9.9.411.98SECTION 416.992a
   416.992a [Reserved]
20:2.0.1.1.9.9.411.99SECTION 416.993
   416.993 Medical evidence in continuing disability review cases.
20:2.0.1.1.9.9.411.100SECTION 416.994
   416.994 How we will determine whether your disability continues or ends, disabled adults.
20:2.0.1.1.9.9.411.101SECTION 416.994a
   416.994a How we will determine whether your disability continues or ends, and whether you are and have been receiving treatment that is medically necessary and available, disabled children.
20:2.0.1.1.9.9.411.102SECTION 416.995
   416.995 If we make a determination that your physical or mental impairment(s) has ceased, did not exist or is no longer disabling (Medical Cessation Determination).
20:2.0.1.1.9.9.411.103SECTION 416.996
   416.996 Continued disability or blindness benefits pending appeal of a medical cessation determination.
20:2.0.1.1.9.9.411.104SECTION 416.998
   416.998 If you become disabled by another impairment(s).
20:2.0.1.1.9.9.411.105SECTION 416.999
   416.999 What is expedited reinstatement
20:2.0.1.1.9.9.411.106SECTION 416.999a
   416.999a Who is eligible for expedited reinstatement
20:2.0.1.1.9.9.411.107SECTION 416.999b
   416.999b How do I request reinstatement
20:2.0.1.1.9.9.411.108SECTION 416.999c
   416.999c How do we determine provisional benefits
20:2.0.1.1.9.9.411.109SECTION 416.999d
   416.999d How do we determine reinstated benefits