SSR 02-2p: Rescinded

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Disability Insurance

Rescinded and replaced by SSR 15-1p effective March 18, 2015

[Federal Register: November 5, 2002 (Volume 67, Number 214)] [Page

67436-67439]

EFFECTIVE DATE: November 5, 2002.

Policy Interpretation Ruling

Purpose:

To provide guidance on SSA policy concerning the development and

evaluation of interstitial cystitis (IC) in disability claims filed under

titles II and XVI of the Social Security Act (the Act).

Citations:

Sections 216(i), 223(d), 223(f), 1614(a), and 1614(c) of the Act, as

amended; Regulations No. 4, subpart P, sections 404.1502, 404.1505,

404.1508, 404.1509, 404.1511, 404.1512, 404.1513, 404.1520, 404.1520a,

404.1521, 404.1523, 404.1525, 404.1526, 404.1528, 404.1529, 404.1530,

404.1545, 404.1546, 404.1561, 404.1594, and appendix 1; and Regulations

No. 16, subpart I, sections 416.902, 416.905, 416.906, 416.908, 416.909,

416.911, 416.912, 416.913, 416.920, 416.920a, 416.921, 416.923, 416.924,

416.925, 416.926, 416.926a, 416.928, 416.929, 416.930, 416.945, 416.946,

416.961, 416.994, and 416.994a.

Introduction:

The Act and our implementing regulations require that an individual

establish disability based on the existence of a medically determinable

impairment; that is, one that can be shown by medical evidence, consisting

of symptoms, signs, and laboratory findings. Disability may not be

established on the basis of an individual's statement of symptoms

alone.

.994, and 416.994a.

Introduction:

The Act and our implementing regulations require that an individual

establish disability based on the existence of a medically determinable

impairment; that is, one that can be shown by medical evidence, consisting

of symptoms, signs, and laboratory findings. Disability may not be

established on the basis of an individual's statement of symptoms

alone.

This Ruling explains that IC (a complex, chronic bladder disorder), when

accompanied by appropriate symptoms, signs, and laboratory findings, is a

medically determinable impairment that can be the basis for a finding of

"disability." It also provides guidance for the evaluation of claims

involving IC.

Policy Interpretation

General

- What Is IC? IC is a complex, chronic bladder disorder characterized by urinary

frequency, urinary urgency, and pelvic pain. IC occurs most frequently in

women (about 10 times more often than in men), and sometimes prior to age

18. IC may be associated with other disorders, such as fibromyalgia,

chronic fatigue syndrome, allergies, irritable bowel syndrome,

inflammatory bowel disease, endometriosis, and vulvodynia (vulvar/vaginal

pain). IC also may be associated with systemic lupus erythematosus. The symptoms of IC may vary in incidence, duration, and severity. The

causes of IC are currently unknown, and treatments are directed towards

relief of symptoms. While no treatment is uniformly effective for

everyone, there are many treatments available, and individuals may obtain

some measure of relief. However, response to treatment is variable, and

some individuals may have symptoms that are intractable to the current

treatments available. Treatment may include bladder distention; bladder

instillation; oral drugs, such as the prescription drug Elmiron,

antidepressants, antihistamines, and narcotic analgesics; and the use of

transcutaneous electrical nerve stimulation.

asure of relief. However, response to treatment is variable, and

some individuals may have symptoms that are intractable to the current

treatments available. Treatment may include bladder distention; bladder

instillation; oral drugs, such as the prescription drug Elmiron,

antidepressants, antihistamines, and narcotic analgesics; and the use of

transcutaneous electrical nerve stimulation.

- How Is IC Diagnosed? The diagnosis is one of exclusion. A physician must rule out other

conditions before making a diagnosis of IC because there is currently no

definitive test to identify IC. The symptoms of IC are similar to those of

other disorders, such as acute urinary tract or vaginal infections,

post-radiation bladder inflammation or infection, bladder cancer, kidney

stones, endometriosis, neurological disorders, sexually transmitted

diseases, and, in men, chronic bacterial and nonbacterial prostatitis. Symptoms of IC vary both in kind and in intensity from individual to

individual, and even in the same individual. The three most common

symptoms are an urgent need to urinate (urgency), a frequent need to

urinate (frequency), and pain in the bladder and surrounding pelvic

region. These symptoms may occur either singly or in combination. The pain

may range from mild discomfort to extreme distress. The intensity of the

pain may increase as the bladder fills, and decrease as it empties. In

addition, many patients experience vaginal, testicular or penile pain, or

low back and thigh pain. A woman's symptoms may worsen around the time of

menstruation

g pelvic

region. These symptoms may occur either singly or in combination. The pain

may range from mild discomfort to extreme distress. The intensity of the

pain may increase as the bladder fills, and decrease as it empties. In

addition, many patients experience vaginal, testicular or penile pain, or

low back and thigh pain. A woman's symptoms may worsen around the time of

menstruation. A diagnosis of IC is based on the presence of some or all of the

following: Presence of urinary urgency or frequency (day and/or night), either singly

or in combination; Pain in the bladder and surrounding pelvic region; Suprapubic tenderness on physical examination; Glomerulations (pinpoint bleeding caused by recurrent irritation) on the

bladder wall after hydrodistention on cystoscopy; Hunner's ulcers on the bladder wall after hydrodistention on cystoscopy;

and, Absence of other disorders that could cause the symptoms. Diagnostic tests used to identify or exclude other disorders include

urinalysis, urine culture, urine cytology, cystoscopy, biopsy of the

bladder wall, and, in men, culture of prostate secretions. The standard test currently used to aid in the diagnosis of IC is a

cystoscopy with hydrodistention of the bladder (performed under

anesthesia). It can be used to reveal glomerulations or Hunner's ulcers. A

biopsy of the bladder wall can be taken to rule out diseases such as

bladder cancer. Cystoscopy with hydrodistention also makes it possible to

estimate bladder capacity, which is an important guide to treatment. The

hydrodistention of the bladder itself also sometimes provides a

therapeutic benefit, with a reduction in pain and urinary frequency for a

limited time period. A report on the results of a cystoscopy, if done,

should be part of the medical record. An absence of glomerulations or

Hunner's ulcers on cystoscopy does not exclude a diagnosis of IC; a

minority of individuals with IC (10%) will not have either of these

medical signs

so sometimes provides a

therapeutic benefit, with a reduction in pain and urinary frequency for a

limited time period. A report on the results of a cystoscopy, if done,

should be part of the medical record. An absence of glomerulations or

Hunner's ulcers on cystoscopy does not exclude a diagnosis of IC; a

minority of individuals with IC (10%) will not have either of these

medical signs. Cystoscopy should not be purchased to establish a diagnosis

of IC because it is an invasive procedure. While the medical findings discussed above are the principal symptoms,

signs, and laboratory findings currently used to establish a diagnosis of

IC, and, consequently, the existence of a medically determinable

impairment, they are not all-inclusive. As progress is made in medical

research into IC, additional signs and laboratory findings may be

identified and new diagnostic techniques may be developed that also would

establish a diagnosis of IC. The existence of IC may be documented with

medical signs or laboratory findings other than those listed above,

provided that such documentation is consistent with medically accepted

clinical practice and is consistent with the other evidence in the case

record.

- What Is a Medically Determinable Impairment? Sections 216(i) and 1614(a)(3) of the Act define

"disability" 1 as the inability

to engage in any substantial gainful activity by reason of any medically

determinable physical or mental impairment (or combination of impairments)

which can be expected to result in death or which has lasted or can be

expected to last for a continuous period of not less than 12

months. 2 Sections 223(d)(3) and 1614(a)(3)(D) of the Act and 20 CFR 404.1508 and

416.908 require that an impairment result from anatomical, physiological,

or psychological abnormalities that can be shown by medically acceptable

clinical and laboratory diagnostic techniques

ected to result in death or which has lasted or can be

expected to last for a continuous period of not less than 12

months. 2 Sections 223(d)(3) and 1614(a)(3)(D) of the Act and 20 CFR 404.1508 and

416.908 require that an impairment result from anatomical, physiological,

or psychological abnormalities that can be shown by medically acceptable

clinical and laboratory diagnostic techniques. The Act and regulations

further require that an impairment be established by medical evidence that

consists of symptoms, signs, and laboratory findings, and not only by an

individual's statement of symptoms.

- How Is IC Identified as a Medically Determinable Impairment? We 3 generally will rely on the

judgment of a physician who has made the diagnosis after a review of the

claimant's medical history, a physical examination of the claimant, and

any pertinent testing to establish the existence of IC. In the absence of

evidence to the contrary in the case record, we will find a medically

determinable impairment is established if the evidence contains the

appropriate symptoms, signs, and laboratory findings, as discussed under

question 2 above. However, if there is evidence that indicates that the

diagnosis is questionable, and the evidence is inadequate to determine

whether or not the individual is disabled, we will contact the treating

source for clarification, using the guidelines in 20 CFR 404.1512(e) and

416.912(e).

- How Do We Consider IC in the Sequential Evaluation

Process? 4 Once we determine that the individual has the medically determinable

impairment IC, we will consider it in determining whether: The individual's impairment(s) is severe. The individual's impairment(s) meets or equals the requirements of a

listed impairment in the listings. The individual's impairment(s) prevents him or her from doing past

relevant work and other work that exists in significant numbers in the

national economy.

has the medically determinable

impairment IC, we will consider it in determining whether: The individual's impairment(s) is severe. The individual's impairment(s) meets or equals the requirements of a

listed impairment in the listings. The individual's impairment(s) prevents him or her from doing past

relevant work and other work that exists in significant numbers in the

national economy.

- Can We Find an Individual Disabled Based on IC Alone? If an individual has the medically determinable impairment IC that is

"severe" as described in question 7 below, we may find that the IC

medically equals a listing, if appropriate. (See 20 CFR 404.1525 and

416.925.) (In the case of a child seeking benefits under title XVI, we

also may find that it functionally equals the listings (20 CFR 416.926a).)

We also may find in a title II claim, or an adult claim under title XVI,

that the IC results in a finding that the individual is disabled based on

his or her residual functional capacity (RFC), age, education, and past

work experience. An individual with IC also may report symptoms suggestive of a mental

impairment (for example, the individual may say that he or she is anxious

or depressed, having difficulties with memory and concentration, etc.). If

the evidence supports a possible discrete mental impairment or symptoms

such as anxiety or depression resulting from the individual's IC or the

side effects of medication, we will develop the possible mental

impairment. If the evidence does not establish a medically determinable

mental impairment, but does establish the presence of symptoms such as

anxiety or depression resulting from the individual's IC or side effects

of medication, we will determine whether there are any work-related

functional limitations resulting from the symptoms. We will address any

work- related functional limitations at steps 4 and 5 of the sequential

evaluation process.

What Is IC?

mental impairment, but does establish the presence of symptoms such as

anxiety or depression resulting from the individual's IC or side effects

of medication, we will determine whether there are any work-related

functional limitations resulting from the symptoms. We will address any

work- related functional limitations at steps 4 and 5 of the sequential

evaluation process.

What Is IC?

IC is a complex, chronic bladder disorder characterized by urinary

frequency, urinary urgency, and pelvic pain. IC occurs most frequently in

women (about 10 times more often than in men), and sometimes prior to age

18. IC may be associated with other disorders, such as fibromyalgia,

chronic fatigue syndrome, allergies, irritable bowel syndrome,

inflammatory bowel disease, endometriosis, and vulvodynia (vulvar/vaginal

pain). IC also may be associated with systemic lupus erythematosus.

The symptoms of IC may vary in incidence, duration, and severity. The

causes of IC are currently unknown, and treatments are directed towards

relief of symptoms. While no treatment is uniformly effective for

everyone, there are many treatments available, and individuals may obtain

some measure of relief. However, response to treatment is variable, and

some individuals may have symptoms that are intractable to the current

treatments available. Treatment may include bladder distention; bladder

instillation; oral drugs, such as the prescription drug Elmiron,

antidepressants, antihistamines, and narcotic analgesics; and the use of

transcutaneous electrical nerve stimulation.

How Is IC Diagnosed?

er, response to treatment is variable, and

some individuals may have symptoms that are intractable to the current

treatments available. Treatment may include bladder distention; bladder

instillation; oral drugs, such as the prescription drug Elmiron,

antidepressants, antihistamines, and narcotic analgesics; and the use of

transcutaneous electrical nerve stimulation.

How Is IC Diagnosed?

The diagnosis is one of exclusion. A physician must rule out other

conditions before making a diagnosis of IC because there is currently no

definitive test to identify IC. The symptoms of IC are similar to those of

other disorders, such as acute urinary tract or vaginal infections,

post-radiation bladder inflammation or infection, bladder cancer, kidney

stones, endometriosis, neurological disorders, sexually transmitted

diseases, and, in men, chronic bacterial and nonbacterial prostatitis.

Symptoms of IC vary both in kind and in intensity from individual to

individual, and even in the same individual. The three most common

symptoms are an urgent need to urinate (urgency), a frequent need to

urinate (frequency), and pain in the bladder and surrounding pelvic

region. These symptoms may occur either singly or in combination. The pain

may range from mild discomfort to extreme distress. The intensity of the

pain may increase as the bladder fills, and decrease as it empties. In

addition, many patients experience vaginal, testicular or penile pain, or

low back and thigh pain. A woman's symptoms may worsen around the time of

menstruation.

A diagnosis of IC is based on the presence of some or all of the

following:

- Presence of urinary urgency or frequency (day and/or night), either singly

or in combination;

- Pain in the bladder and surrounding pelvic region;

- Suprapubic tenderness on physical examination;

- Glomerulations (pinpoint bleeding caused by recurrent irritation) on the

bladder wall after hydrodistention on cystoscopy;

sis of IC is based on the presence of some or all of the

following:

- Presence of urinary urgency or frequency (day and/or night), either singly

or in combination;

- Pain in the bladder and surrounding pelvic region;

- Suprapubic tenderness on physical examination;

- Glomerulations (pinpoint bleeding caused by recurrent irritation) on the

bladder wall after hydrodistention on cystoscopy;

- Hunner's ulcers on the bladder wall after hydrodistention on cystoscopy;

and,

- Absence of other disorders that could cause the symptoms.

Presence of urinary urgency or frequency (day and/or night), either singly

or in combination;

Pain in the bladder and surrounding pelvic region;

Suprapubic tenderness on physical examination;

Glomerulations (pinpoint bleeding caused by recurrent irritation) on the

bladder wall after hydrodistention on cystoscopy;

Hunner's ulcers on the bladder wall after hydrodistention on cystoscopy;

and,

Absence of other disorders that could cause the symptoms.

Diagnostic tests used to identify or exclude other disorders include

urinalysis, urine culture, urine cytology, cystoscopy, biopsy of the

bladder wall, and, in men, culture of prostate secretions.

The standard test currently used to aid in the diagnosis of IC is a

cystoscopy with hydrodistention of the bladder (performed under

anesthesia). It can be used to reveal glomerulations or Hunner's ulcers. A

biopsy of the bladder wall can be taken to rule out diseases such as

bladder cancer. Cystoscopy with hydrodistention also makes it possible to

estimate bladder capacity, which is an important guide to treatment. The

hydrodistention of the bladder itself also sometimes provides a

therapeutic benefit, with a reduction in pain and urinary frequency for a

limited time period. A report on the results of a cystoscopy, if done,

should be part of the medical record

adder cancer. Cystoscopy with hydrodistention also makes it possible to

estimate bladder capacity, which is an important guide to treatment. The

hydrodistention of the bladder itself also sometimes provides a

therapeutic benefit, with a reduction in pain and urinary frequency for a

limited time period. A report on the results of a cystoscopy, if done,

should be part of the medical record. An absence of glomerulations or

Hunner's ulcers on cystoscopy does not exclude a diagnosis of IC; a

minority of individuals with IC (10%) will not have either of these

medical signs. Cystoscopy should not be purchased to establish a diagnosis

of IC because it is an invasive procedure.

While the medical findings discussed above are the principal symptoms,

signs, and laboratory findings currently used to establish a diagnosis of

IC, and, consequently, the existence of a medically determinable

impairment, they are not all-inclusive. As progress is made in medical

research into IC, additional signs and laboratory findings may be

identified and new diagnostic techniques may be developed that also would

establish a diagnosis of IC. The existence of IC may be documented with

medical signs or laboratory findings other than those listed above,

provided that such documentation is consistent with medically accepted

clinical practice and is consistent with the other evidence in the case

record.

What Is a Medically Determinable Impairment?

Sections 216(i) and 1614(a)(3) of the Act define

"disability" 1 as the inability

to engage in any substantial gainful activity by reason of any medically

determinable physical or mental impairment (or combination of impairments)

which can be expected to result in death or which has lasted or can be

expected to last for a continuous period of not less than 12

months. 2

able Impairment?

Sections 216(i) and 1614(a)(3) of the Act define

"disability" 1 as the inability

to engage in any substantial gainful activity by reason of any medically

determinable physical or mental impairment (or combination of impairments)

which can be expected to result in death or which has lasted or can be

expected to last for a continuous period of not less than 12

months. 2

Sections 223(d)(3) and 1614(a)(3)(D) of the Act and 20 CFR 404.1508 and

416.908 require that an impairment result from anatomical, physiological,

or psychological abnormalities that can be shown by medically acceptable

clinical and laboratory diagnostic techniques. The Act and regulations

further require that an impairment be established by medical evidence that

consists of symptoms, signs, and laboratory findings, and not only by an

individual's statement of symptoms.

How Is IC Identified as a Medically Determinable Impairment?

We 3 generally will rely on the

judgment of a physician who has made the diagnosis after a review of the

claimant's medical history, a physical examination of the claimant, and

any pertinent testing to establish the existence of IC. In the absence of

evidence to the contrary in the case record, we will find a medically

determinable impairment is established if the evidence contains the

appropriate symptoms, signs, and laboratory findings, as discussed under

question 2 above. However, if there is evidence that indicates that the

diagnosis is questionable, and the evidence is inadequate to determine

whether or not the individual is disabled, we will contact the treating

source for clarification, using the guidelines in 20 CFR 404.1512(e) and

416.912(e).

How Do We Consider IC in the Sequential Evaluation

Process? 4

Once we determine that the individual has the medically determinable

impairment IC, we will consider it in determining whether:

- The individual's impairment(s) is severe.

hether or not the individual is disabled, we will contact the treating

source for clarification, using the guidelines in 20 CFR 404.1512(e) and

416.912(e).

How Do We Consider IC in the Sequential Evaluation

Process? 4

Once we determine that the individual has the medically determinable

impairment IC, we will consider it in determining whether:

- The individual's impairment(s) is severe.

- The individual's impairment(s) meets or equals the requirements of a

listed impairment in the listings.

- The individual's impairment(s) prevents him or her from doing past

relevant work and other work that exists in significant numbers in the

national economy.

The individual's impairment(s) is severe.

The individual's impairment(s) meets or equals the requirements of a

listed impairment in the listings.

The individual's impairment(s) prevents him or her from doing past

relevant work and other work that exists in significant numbers in the

national economy.

Can We Find an Individual Disabled Based on IC Alone?

If an individual has the medically determinable impairment IC that is

"severe" as described in question 7 below, we may find that the IC

medically equals a listing, if appropriate. (See 20 CFR 404.1525 and

416.925.) (In the case of a child seeking benefits under title XVI, we

also may find that it functionally equals the listings (20 CFR 416.926a).)

We also may find in a title II claim, or an adult claim under title XVI,

that the IC results in a finding that the individual is disabled based on

his or her residual functional capacity (RFC), age, education, and past

work experience.

25 and

416.925.) (In the case of a child seeking benefits under title XVI, we

also may find that it functionally equals the listings (20 CFR 416.926a).)

We also may find in a title II claim, or an adult claim under title XVI,

that the IC results in a finding that the individual is disabled based on

his or her residual functional capacity (RFC), age, education, and past

work experience.

An individual with IC also may report symptoms suggestive of a mental

impairment (for example, the individual may say that he or she is anxious

or depressed, having difficulties with memory and concentration, etc.). If

the evidence supports a possible discrete mental impairment or symptoms

such as anxiety or depression resulting from the individual's IC or the

side effects of medication, we will develop the possible mental

impairment. If the evidence does not establish a medically determinable

mental impairment, but does establish the presence of symptoms such as

anxiety or depression resulting from the individual's IC or side effects

of medication, we will determine whether there are any work-related

functional limitations resulting from the symptoms. We will address any

work- related functional limitations at steps 4 and 5 of the sequential

evaluation process.

Sequential Evaluation: Step 2, Severe Impairment

- When Is IC a "Severe" Impairment? As with any other medical condition, we will find that IC is a "severe"

impairment when, alone or in combination with another medically

determinable physical or mental impairment(s), it significantly limits an

individual's physical or mental ability to do basic work activities. (For

children applying for disability under title XVI, we will find that IC is

a "severe" impairment when it causes more than minimal functional

limitations.) We also will consider the effects of any symptoms (such as

pain or fatigue) that could limit functioning

sical or mental impairment(s), it significantly limits an

individual's physical or mental ability to do basic work activities. (For

children applying for disability under title XVI, we will find that IC is

a "severe" impairment when it causes more than minimal functional

limitations.) We also will consider the effects of any symptoms (such as

pain or fatigue) that could limit functioning. (See SSR 85-28 , "Titles II and XVI: Medical

Impairments That Are Not Severe" and SSR

96-3p , "Titles II and XVI: Considering Allegations of Pain and Other

Symptoms In Determining Whether a Medically Determinable Impairment Is

Severe.") Therefore, we will find that an impairment(s) is "not severe"

only if it is a slight abnormality (or a combination of slight

abnormalities) that has no more than a minimal effect on the individual's

ability to do basic work activities (or, for a child applying under title

XVI, if it causes no more than minimal functional limitations).

When Is IC a "Severe" Impairment?

As with any other medical condition, we will find that IC is a "severe"

impairment when, alone or in combination with another medically

determinable physical or mental impairment(s), it significantly limits an

individual's physical or mental ability to do basic work activities. (For

children applying for disability under title XVI, we will find that IC is

a "severe" impairment when it causes more than minimal functional

limitations.) We also will consider the effects of any symptoms (such as

pain or fatigue) that could limit functioning

sical or mental impairment(s), it significantly limits an

individual's physical or mental ability to do basic work activities. (For

children applying for disability under title XVI, we will find that IC is

a "severe" impairment when it causes more than minimal functional

limitations.) We also will consider the effects of any symptoms (such as

pain or fatigue) that could limit functioning. (See SSR 85-28 , "Titles II and XVI: Medical

Impairments That Are Not Severe" and SSR

96-3p , "Titles II and XVI: Considering Allegations of Pain and Other

Symptoms In Determining Whether a Medically Determinable Impairment Is

Severe.") Therefore, we will find that an impairment(s) is "not severe"

only if it is a slight abnormality (or a combination of slight

abnormalities) that has no more than a minimal effect on the individual's

ability to do basic work activities (or, for a child applying under title

XVI, if it causes no more than minimal functional limitations).

Sequential Evaluation: Step 3, the Listings

- How Do We Evaluate IC at Step 3 of Sequential Evaluation, the Listings? IC may be a factor in both "meets" and "equals" determinations. Because there is no listing for IC, we will find that an individual with

IC "meets" the requirements of a listing if he or she has another

impairment that, by itself, meets the requirements of a listing. We also

will find that a listing is met if there is an impairment that, in

combination with IC, meets the requirements of a listing. For example, IC

may increase the severity of coexisting or related impairments, including

mental disorders, to the extent that the combination of impairments meets

the requirements of a listing. This also may be true in the reverse;

coexisting or related impairments may increase the severity of IC. We also may find that IC, by itself, is medically equivalent to a listed

impairment (or, in the case of a child applying under title XVI, also

functionally equivalent to the listings)

ental disorders, to the extent that the combination of impairments meets

the requirements of a listing. This also may be true in the reverse;

coexisting or related impairments may increase the severity of IC. We also may find that IC, by itself, is medically equivalent to a listed

impairment (or, in the case of a child applying under title XVI, also

functionally equivalent to the listings). We also will find equivalence if an individual has multiple impairments,

including IC, no one of which meets or equals the requirements of a

listing, but the combination of impairments is equivalent in severity to a

listed impairment. However, we will not make assumptions about the severity or functional

effects of IC combined with other impairments. IC in combination with

another impairment may or may not increase the severity or functional

limitations of the other impairment. We will evaluate each case based on

the information in the case record. Further, we will never deny an individual's claim because the individual's

IC does not meet or medically equal a listing. If an individual with IC

has a severe impairment that does not meet or medically equal a listing,

we may still find the individual disabled based on other rules in the

"sequential evaluation process" that we use to evaluate all disability

claims.

How Do We Evaluate IC at Step 3 of Sequential Evaluation, the Listings?

IC may be a factor in both "meets" and "equals" determinations.

isting. If an individual with IC

has a severe impairment that does not meet or medically equal a listing,

we may still find the individual disabled based on other rules in the

"sequential evaluation process" that we use to evaluate all disability

claims.

How Do We Evaluate IC at Step 3 of Sequential Evaluation, the Listings?

IC may be a factor in both "meets" and "equals" determinations.

Because there is no listing for IC, we will find that an individual with

IC "meets" the requirements of a listing if he or she has another

impairment that, by itself, meets the requirements of a listing. We also

will find that a listing is met if there is an impairment that, in

combination with IC, meets the requirements of a listing. For example, IC

may increase the severity of coexisting or related impairments, including

mental disorders, to the extent that the combination of impairments meets

the requirements of a listing. This also may be true in the reverse;

coexisting or related impairments may increase the severity of IC.

We also may find that IC, by itself, is medically equivalent to a listed

impairment (or, in the case of a child applying under title XVI, also

functionally equivalent to the listings).

We also will find equivalence if an individual has multiple impairments,

including IC, no one of which meets or equals the requirements of a

listing, but the combination of impairments is equivalent in severity to a

listed impairment.

However, we will not make assumptions about the severity or functional

effects of IC combined with other impairments. IC in combination with

another impairment may or may not increase the severity or functional

limitations of the other impairment. We will evaluate each case based on

the information in the case record.

tion of impairments is equivalent in severity to a

listed impairment.

However, we will not make assumptions about the severity or functional

effects of IC combined with other impairments. IC in combination with

another impairment may or may not increase the severity or functional

limitations of the other impairment. We will evaluate each case based on

the information in the case record.

Further, we will never deny an individual's claim because the individual's

IC does not meet or medically equal a listing. If an individual with IC

has a severe impairment that does not meet or medically equal a listing,

we may still find the individual disabled based on other rules in the

"sequential evaluation process" that we use to evaluate all disability

claims.

Sequential Evaluation: Steps 4 and 5, Assessing Functioning in Adults;

Step 3, Assessing Functional Equivalence in Children

- How Do We Evaluate IC in Assessing Residual Functional Capacity (RFC) in

Adults and Functional Equivalence in Children? IC can cause limitation of function. The functions likely to be limited

depend on many factors, including urinary frequency and pain. An

individual may have limitations in any of the exertional functions such as

sitting, standing, walking, lifting, carrying, pushing, and pulling. It

also may affect ability to do postural functions, such as climbing,

balancing, stooping, and crouching. The ability to tolerate extreme heat,

humidity, or hazards also may be affected. The effects of IC may not be obvious. For example, many people with IC

have chronic pelvic pain, which can affect the ability to focus and

sustain attention on the task at hand. Nocturia (nighttime urinary

frequency) may disrupt sleeping patterns. This can lead to drowsiness and

lack of mental clarity during the day. IC also may affect an individual's

social functioning. The presence of urinary frequency alone can

necessitate trips to the bathroom as often as every 10 to 15 minutes, day

and night

the ability to focus and

sustain attention on the task at hand. Nocturia (nighttime urinary

frequency) may disrupt sleeping patterns. This can lead to drowsiness and

lack of mental clarity during the day. IC also may affect an individual's

social functioning. The presence of urinary frequency alone can

necessitate trips to the bathroom as often as every 10 to 15 minutes, day

and night. Consequently, some individuals with IC essentially may confine

themselves to their homes. In assessing RFC, we must consider all of the

individual's symptoms in deciding how such symptoms may affect functional

capacities. An assessment also should be made of the effect IC has upon the

individual's ability to perform routine movement and necessary physical

activity within the work environment. Individuals with IC may have

problems with the ability to sustain a function over time. As explained in SSR 96-8p ("Titles II

and XVI: Assessing Residual Functional Capacity in Initial Claims"), our

RFC assessments must consider an individual's maximum remaining ability to

do sustained work activities in an ordinary work setting on a regular and

continuing basis. A "regular and continuing basis" means 8 hours a day,

for 5 days a week, or an equivalent work

schedule. 5 In cases involving

IC, fatigue may affect the individual's physical and mental ability to

sustain work activity. This may be particularly true in cases involving

urinary frequency. For a child applying for benefits under title XVI, we will evaluate the

functional consequences of IC (either alone or in combination with other

impairments) to decide if the child's impairment(s) functionally equals

the listings

C, fatigue may affect the individual's physical and mental ability to

sustain work activity. This may be particularly true in cases involving

urinary frequency. For a child applying for benefits under title XVI, we will evaluate the

functional consequences of IC (either alone or in combination with other

impairments) to decide if the child's impairment(s) functionally equals

the listings. For example, the functional limitations imposed by IC, by

itself or in combination with another impairment(s), may establish an

extreme limitation in one broad area of functioning (e.g., attending and

completing tasks) or marked limitations in two broad areas of functioning

(e.g., attending and completing tasks, and interacting and relating with

others). As with any other impairment, we will explain how we reached our

conclusions on whether IC caused any physical or mental limitations.

How Do We Evaluate IC in Assessing Residual Functional Capacity (RFC) in

Adults and Functional Equivalence in Children?

IC can cause limitation of function. The functions likely to be limited

depend on many factors, including urinary frequency and pain. An

individual may have limitations in any of the exertional functions such as

sitting, standing, walking, lifting, carrying, pushing, and pulling. It

also may affect ability to do postural functions, such as climbing,

balancing, stooping, and crouching. The ability to tolerate extreme heat,

humidity, or hazards also may be affected.

on many factors, including urinary frequency and pain. An

individual may have limitations in any of the exertional functions such as

sitting, standing, walking, lifting, carrying, pushing, and pulling. It

also may affect ability to do postural functions, such as climbing,

balancing, stooping, and crouching. The ability to tolerate extreme heat,

humidity, or hazards also may be affected.

The effects of IC may not be obvious. For example, many people with IC

have chronic pelvic pain, which can affect the ability to focus and

sustain attention on the task at hand. Nocturia (nighttime urinary

frequency) may disrupt sleeping patterns. This can lead to drowsiness and

lack of mental clarity during the day. IC also may affect an individual's

social functioning. The presence of urinary frequency alone can

necessitate trips to the bathroom as often as every 10 to 15 minutes, day

and night. Consequently, some individuals with IC essentially may confine

themselves to their homes. In assessing RFC, we must consider all of the

individual's symptoms in deciding how such symptoms may affect functional

capacities.

An assessment also should be made of the effect IC has upon the

individual's ability to perform routine movement and necessary physical

activity within the work environment. Individuals with IC may have

problems with the ability to sustain a function over time.

As explained in SSR 96-8p ("Titles II

and XVI: Assessing Residual Functional Capacity in Initial Claims"), our

RFC assessments must consider an individual's maximum remaining ability to

do sustained work activities in an ordinary work setting on a regular and

continuing basis. A "regular and continuing basis" means 8 hours a day,

for 5 days a week, or an equivalent work

schedule. 5 In cases involving

IC, fatigue may affect the individual's physical and mental ability to

sustain work activity. This may be particularly true in cases involving

urinary frequency.

ity to

do sustained work activities in an ordinary work setting on a regular and

continuing basis. A "regular and continuing basis" means 8 hours a day,

for 5 days a week, or an equivalent work

schedule. 5 In cases involving

IC, fatigue may affect the individual's physical and mental ability to

sustain work activity. This may be particularly true in cases involving

urinary frequency.

For a child applying for benefits under title XVI, we will evaluate the

functional consequences of IC (either alone or in combination with other

impairments) to decide if the child's impairment(s) functionally equals

the listings. For example, the functional limitations imposed by IC, by

itself or in combination with another impairment(s), may establish an

extreme limitation in one broad area of functioning (e.g., attending and

completing tasks) or marked limitations in two broad areas of functioning

(e.g., attending and completing tasks, and interacting and relating with

others).

As with any other impairment, we will explain how we reached our

conclusions on whether IC caused any physical or mental limitations.

Effective Date:

This Ruling is effective November 5, 2002.

Cross-References:

SSR 85-28 , "Titles II and XVI: Medical

Impairments That Are Not Severe"; SSR

96-2p , "Titles II and XVI: Giving Controlling Weight to Treating

Source Medical Opinions"; SSR 96-3p ,

"Titles II and XVI: Considering Allegations of Pain and Other Symptoms in

Determining Whether a Medically Determinable Impairment is Severe"; SSR 96-4p , "Titles II and XVI: Symptoms,

Medically Determinable Physical and Mental Impairments, and Exertional and

Nonexertional Limitations"; SSR 96-5p ,

"Titles II and XVI: Medical Source Opinions on Issues Reserved to the

Commissioner"; 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

airments, and Exertional and

Nonexertional Limitations"; SSR 96-5p ,

"Titles II and XVI: Medical Source Opinions on Issues Reserved to the

Commissioner"; 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"; SSR 96-7p , "Titles II and XVI:

Evaluation of Symptoms in Disability Claims: Assessing the Credibility of

an Individual's Statements"; SSR 96-8p ,

"Titles II and XVI: Assessing Residual Functional Capacity in Initial

Claims"; and SSR 96-9p , "Titles II and

XVI: Determining Capability to Do Other Work—Implications of a

Residual Functional Capacity for Less Than a Full Range of Sedentary

Work."

1 Except for statutory

blindness.

2 For a child under age 18

claiming benefits under title XVI, disability will be established if the

child is suffering from a medically determinable physical or mental

impairment (or combination of impairments) that results in "marked and

severe functional limitations." See section 1614(a)(3)(C) of the Act and

20 CFR 416.906. However, for clarity, the following discussions refer only

to claims of individuals claiming disability benefits under title II and

individuals age 18 or older claiming disability benefits under title XVI.

The concepts in this ruling, however, are also intended to apply in

determining disability based on IC for individuals under age 18 under

title XVI.

3 The terms we and us in this

Social Security Ruling have the same meaning as in 20 CFR 404.1502 and

416.902. We or us refers to either the Social Security

Administration or the State agency making the disability or blindness

determination; i.e. , our adjudicators at all levels of the

administrative review process and our quality reviewers.

or individuals under age 18 under

title XVI.

3 The terms we and us in this

Social Security Ruling have the same meaning as in 20 CFR 404.1502 and

416.902. We or us refers to either the Social Security

Administration or the State agency making the disability or blindness

determination; i.e. , our adjudicators at all levels of the

administrative review process and our quality reviewers.

4 For ease of reading, we refer

in this Ruling only to the steps of the sequential evaluation processes

for initial adult claims, 20 CFR 404.1520 and 416.920. We use separate

sequential evaluation processes when we do continuing disability reviews; i.e. , reviews to determine whether individuals who are receiving

disability benefits are still disabled, or when we determine whether an

individual has a "closed period of disability." These rules are set out in

20 CFR 404.1594 and 416.994, and the guidance in this Ruling applies to

all of the appropriate steps in those regulations as well.

5 However, see footnote 2 of SSR 96-8p . That footnote explains that

the ability to work 8 hours a day for 5 days a week is not always required

for a finding at step 4 of the sequential evaluation process for adults

when an individual can do past relevant work that was part-time work, if

that work was substantial gainful activity, performed within the

applicable period, and lasted long enough for the person to learn to do

it.