Social Security Ruling (SSR) 96-5p sets out the issues that are reserved to the Commissioner of Social Security disability case. Social Security used to be part of the Health and Human Services Department of the federal government, which was headed by the Secretary of Health and Human Services. However, in March of 1995 the Social Security Administration became and independent agency, and now is headed by a Commissioner of its own.
Certain issues in a disability case are reserved to the Commissioner, who acts through agents such as Administrative Law Judges and the Appeals Council. These issues that are reserved to the Commissioner are: whether or not a claimant’s medical impairment(s) meet or medically equal one of Social Security’s listed impairments (which set forth strict medical criteria for impairments of major body systems, and psychological impairments with symptoms that are deemed to be severe enough to preclude full-time work); what a person’s residual functional capacity (RFC) is (or the maximum a person can do in spite of his or her impairment(s)); whether a person’s RFC prevents a claimant from doing his or her prior work; how the vocational factors of age, education, and prior work experience apply in a given case; and whether or not a person is disabled.
These are all ultimate legal issues. According to Social Security’s rulings, allowing a medical source to determine these ultimate issues would be an abdication of the Commissioner’s duty to decide a disability case.
Medical source opinions on ultimate issues reserved to the Commissioner are never entitled to controlling weight or special significance, no matter how qualified the source may be. However, such opinions cannot be ignored and must be weighed along with all of the other evidence in the file.
There is a difference between a residual functional capacity (RFC) opinion from a treating medical source and an administrative assessment of an individual’s RFC. The former contains opinions that may be entitled to varying degrees of deference and weight, while the latter is the adjudicator’s legal decision regarding an individual’s capacity to engage in work-like activities. An adjudicator may determine that certain work-related restrictions opined by a person’s treating medical source are entitled to controlling weight, if they are well-supported by medically acceptable laboratory and diagnostic techniques, and are not inconsistent with other substantial evidence in the case filed. These opinions may relate to a person’s limitations to do various work activities, such as lifting and carrying, pushing and pulling, standing and walking, and remembering and carrying out instructions, to name just a few. But the ultimate responsibility to assess a person’s RFC lies with the Commissioner.
Oftentimes, treating medical sources will render an opinion on whether or not a person is “disabled.” Such opinions cannot be ignored, and must be taken into consideration. However, because the ultimate decision of “disabled” or “not disabled” is an ultimate legal decision that rests with the Commissioner, these opinions are never entitled to special significance or controlling weight. The same principle applies to treating medical source opinions regarding the categories of work an individual is capable of performing.
Sometimes a medical source will render an opinion that a person is capable of only “sedentary” work, or “light” work. However, according to Social Security’s rules and regulations, adjudicators should not assume that a medical source is familiar with the agency’s definition of different work categories, such as “very heavy”, “heavy”, “medium”, “light”, or “sedentary.” The agency’s definitions of these different levels of work are terms of art used for adjudicating disability cases, and may not necessarily comport with a medical source’s understanding of these work categories.
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This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.