CFR / Title 20 / Part 220 / Sec. 220.187 If the annuitant's medical recovery was expected and the annuitant returned to work.

If the annuitant's impairment was expected to improve and the annuitant returned to full-time work with no significant medical limitations and acknowledges that medical improvement has occurred, the Board may find that the annuitant's disability ended in the month he or she returned to work. Unless there is evidence showing that the annuitant's disability has not ended, the Board will use the medical and other evidence already in the annuitant's file and the fact that he or she has returned to full-time work without significant limitations to determine that the annuitant is no longer disabled. (If the annuitant's impairment is not expected to improve, the Board will not ordinarily review his or her claim until the end of the trial work period, as described in Sec. 220.170.)

Example: Evidence obtained during the processing of the annuitant's claim showed that the annuitant had an impairment that was expected to improve about 18 months after the annuitant's disability began. The Board, therefore, told the annuitant that his or her claim would be reviewed again at that time. However, before the time arrived for the annuitant's scheduled medical reexamination, the annuitant told the Board that he or she had returned to work and the annuitant's impairment had improved. The Board investigated immediately and found that, in the 16th month after the annuitant's began, the annuitant returned to full-time work without any significant medical restrictions. Therefore, the Board would find that the annuitant's disability ended in the first month the annuitant returned to full-time work.

Sec. Appendix 1 to Part 220 [Reserved]

Sec. Appendix 2 to Part 220--Medical-Vocational Guidelines Sec. 200.00 Introduction.201.00 Maximum sustained work capability limited to sedentary work as a

result of severe medically determinable impairment(s).202.00 Maximum sustained work capability limited to light work as a

result of severe medically determinable impairment(s).203.00 Maximum sustained work capability limited to medium work as a

result of severe medically determinable impair- ment(s).204.00 Maximum sustained work capability limited to heavy work (or very

heavy work) as a result of severe medically determinable

impairment(s).

(a) The following rules reflect the major functional and vocational patterns which are encountered in cases which cannot be evaluated on medical considerations alone, where an individual with a severe medically determinable physical or mental impairment(s) is not engaging in substantial gainful activity and the individual's impairment(s) prevents the performance of his or her vocationally relevant past work. They also reflect the analysis of the various vocational factors (i.e., age, education, and work experience) in combination with the individual's residual functional capacity (used to determine his or her maximum sustained work capability for sedentary, light, medium, heavy, or very heavy work) in evaluating the individual's ability to engage in substantial gainful activity in other than his or her vocationally relevant past work. Where the findings of fact made with respect to a particular individual's vocational factors and residual functional capacity coincide with all of the criteria of a particular rule, the rule directs a conclusion as to whether the individual is or is not disabled. However, each of these findings of fact is subject to rebuttal and the individual may present evidence to refute such findings. Where any one of the findings of fact does not coincide with the corresponding criterion of a rule, the rule does not apply in that particular case and, accordingly, does not direct a conclusion of disabled or not disabled. In any instance where a rule does not apply, full consideration must be given to all of the relevant facts of the case in accordance with the definitions and discussions of each factor in the appropriate sections of the regulations.

(b) The existence of jobs in the national economy is reflected in the ``Decisions'' shown in the rules; i.e., in promulgating the rules, administrative notice has been taken of the numbers of unskilled jobs that exist throughout the national economy at the various functional levels (sedentary, light, medium, heavy, and very heavy) as supported by the ``Dictionary of Occupational Titles'' and the ``Occupational Outlook Handbook,'' published by the Department of Labor; the ``County Business Patterns'' and ``Census Surveys'' published by the Bureau of the Census; and occupational surveys of light and sedentary jobs prepared for the Social Security Administration by various State employment agencies. Thus, when all factors coincide with the criteria of a rule, the existence of such jobs is established. However, the existence of such jobs for individuals whose remaining functional capacity or other factors do not coincide with the criteria of a rule must be further considered in terms of what kinds of jobs or types of work may be either additionally indicated or precluded.

(c) In the application of the rules, the individual's residual functional capacity (i.e., the maximum degree to which the individual retains the capacity for sustained performance of the physical-mental requirements of jobs), age, education, and work experience must first be determined. When assessing the person's residual functional capacity, the Board considers his or her symptoms (such as pain), signs, and laboratory findings together with other evidence the Board obtains.

(d) The correct disability decision (i.e., on the issue of ability to engage in substantial gainful activity) is found by then locating the individual's specific vocational profile. If an individual's specific profile is not listed within this appendix 2, a conclusion of disabled or not disabled is not directed. Thus, for example, an individual's ability to engage in substantial gainful work where his or her residual functional capacity falls between the ranges of work indicated in the rules (e.g., the individual who can perform more than light but less than medium work), is decided on the basis of the principles and definitions in the regulations, giving consideration to the rules for specific case situations in this appendix 2. These rules represent various combinations of exertional capabilities, age, education and work experience and also provide an overall structure for evaluation of those cases in which the judgments as to each factor do not coincide with those of any specific rule. Thus, when the necessary judgments have been made as to each factor and it is found that no specific rule applies, the rules still provide guidance for decisionmaking, such as in cases involving combinations of impairments. For example, if strength limitations resulting from an individual's impairment(s) considered with the judgments made as to the individual's age, education and work experience correspond to (or closely approximate) the factors of a particular rule, the adjudicator then has a frame of reference for considering the jobs or types of work precluded by other, nonexertional impairments in terms of numbers of jobs remaining for a particular individual.

(e) Since the rules are predicated on an individual's having an impairment which manifests itself by limitations in meeting the strength requirements of jobs, they may not be fully applicable where the nature of an individual's impairment does not result in such limitations, e.g., certain mental, sensory, or skin impairments. In addition, some impairments may result solely in postural and manipulative limitations or environmental restrictions. Environmental restrictions are those restrictions which result in inability to tolerate some physical feature(s) of work settings that occur in certain industries or types of work, e.g., an inability to tolerate dust or fumes.

(1) In the evaluation of disability where the individual has solely a nonexertional type of impairment, determination as to whether disability exists shall be based on the principles in the appropriate sections of the regulations, giving consideration to the rules for specific case situations in this appendix 2. The rules do not direct factual conclusions of disabled or not disabled for individuals with solely nonexertional types of impairments.

(2) However, where an individual has an impairment or combination of impairments resulting in both strength limitations and nonexertional limitations, the rules in this subpart are considered in determining first whether a finding of disabled may be possible based on the strength limitations alone and, if not, the rule(s) reflecting the individual's maximum residual strength capabilities, age, education, and work experience provide a framework for consideration of how much the individual's work capability is further diminished in terms of any types of jobs that would be contraindicated by the nonexertional limitations. Also, in these combinations of nonexertional and exertional limitations which cannot be wholly determined under the rules in this appendix 2, full consideration must be given to all of the relevant facts in the case in accordance with the definitions and discussions of each factor in the appropriate sections of the regulations, which will provide insight into the adjudicative weight to be accorded each factor.

(a) Most sedentary occupations fall within the skilled, semi-skilled, professional, administrative, technical, clerical, and benchwork classifications. Approximately 200 separate unskilled sedentary occupations can be identified, each representing numerous jobs in the national economy. Approximately 85 percent of these jobs are in the machine trades and benchwork occupational categories. These jobs (unskilled sedentary occupations) may be performed after a short demonstration or within 30 days.

(b) These unskilled sedentary occupations are standard within the industries in which they exist. While sedentary work represents a significantly restricted range of work, this range in itself is not so prohibitively restricted as to negate work capability for substantial gainful activity.

(c) Vocational adjustment to sedentary work may be expected where the individual has special skills or experience relevant to sedentary work or where age and basic educational competences provide sufficient occupational mobility to adapt to the major segment of unskilled sedentary work. Inability to engage in substantial gainful activity would be indicated where an individual who is restricted to sedentary work because of a severe medically determinable impairment lacks special skills or experience relevant to sedentary work, lacks educational qualifications relevant to most sedentary work (e.g., has a limited education or less) and the individual's age, though not necessarily advanced, is a factor which significantly limits vocational adaptability.

(d) The adversity of functional restrictions to sedentary work at advanced age (55 and over) for individuals with no relevant past work or who can no longer perform vocationally relevant past work and have no transferable skills, warrants a finding of disabled in the absence of the rare situation where the individual has recently completed education which provides a basis for direct entry into skilled sedentary work. Advanced age and a history of unskilled work or no work experience would ordinarily offset any vocational advantages that might accrue by reason of any remote past education, whether it is more or less than limited education.

(e) The presence of acquired skills that are readily transferable to a significant range of skilled work within an individual's residual functional capacity would ordinarily warrant a finding of ability to engage in substantial gainful activity regardless of the adversity of age, or whether the individual's formal education is commensurate with his or her demonstrated skill level. The acquisition of work skills demonstrates the ability to perform work at the level of complexity demonstrated by the skill level attained regardless of the individual's formal educational attainments.

(f) In order to find transferability of skills to skilled sedentary work for individuals who are of advanced age (55 and over), there must be very little, if any, vocational adjustment required in terms of tools, work processes, work settings, or the industry.

(g) Individuals approaching advanced age (age 50-54) may be significantly limited in vocational adaptability if they are restricted to sedentary work. When such individuals have no past work experience or can no longer perform vocationally relevant past work and have no transferable skills, a finding of disabled ordinarily obtains. However, recently completed education which provides for direct entry into sedentary work will preclude such a finding. For this age group, even a high school education or more (ordinarily completed in the remote past) would have little impact for effecting a vocational adjustment unless relevant work experience reflects use of such education.

(h) The term ``younger individual'' is used to denote an individual age 18 through 49. For those within this group who are age 45-49, age is a less positive factor than for those who are age 18-44. Accordingly, for such individuals; (1) who are restricted to sedentary work, (2) who are unskilled or have no transferable skills, (3) who have no relevant past work or who can no longer perform vocationally relevant past work, and (4) who are either illiterate or unable to communicate in the English language, a finding of disabled is warranted. On the other hand, age is a more positive factor for those who are under age 45 and is usually not a significant factor in limiting such an individual's ability to make a vocational adjustment, even an adjustment to unskilled sedentary work, and even where the individual is illiterate or unable to communicate in English. However, a finding of disabled is not precluded for those individuals under age 45 who do not meet all of the criteria of a specific rule and who do not have the ability to perform a full range of sedentary work. The following examples are illustrative: Example 1: An individual under age 45 with a high school education can no longer do past work and is restricted to unskilled sedentary jobs because of a severe medically determinable cardiovascular impairment (which does not meet or equal the listings in appendix 1). A permanent injury of the right hand limits the individual to sedentary jobs which do not require bilateral manual dexterity. None of the rules in appendix 2 are applicable to this particular set of facts, because this individual cannot perform the full range of work defined as sedentary. Since the inability to perform jobs requiring bilateral manual dexterity significantly compromises the only range of work for which the individual is otherwise qualified (i.e., sedentary), a finding of disabled would be appropriate. Example 2: An illiterate 41 year old individual with mild mental retardation (IQ of 78) is restricted to unskilled sedentary work and cannot perform vocationally relevant past work, which had consisted of unskilled agricultural field work; his or her particular characteristics do not specifically meet any of the rules in appendix 2, because this individual cannot perform the full range of work defined as sedentary. In light of the adverse factors which further narrow the range of sedentary work for which this individual is qualified, a finding of disabled is appropriate.

(i) While illiteracy or the inability to communicate in English may significantly limit an individual's vocational scope, the primary work functions in the bulk of unskilled work relate to working with things (rather than with data or people) and in these work functions at the unskilled level, literacy or ability to communicate in English has the least significance. Similarly the lack of relevant work experience would have little significance since the bulk of unskilled jobs require no qualifying work experience. Thus, the functional capability for a full range of sedentary work represents sufficient numbers of jobs to indicate substantial vocational scope for those individuals age 18-44 even if they are illiterate or unable to communicate in English.

Table No. 1--Residual Functional Capacity: Maximum Sustained Work Capability Limited to Sedentary Work as a

Result of Severe Medically Determinable Impairment(s)----------------------------------------------------------------------------------------------------------------

Previous work

Rule Age Education experience Decision----------------------------------------------------------------------------------------------------------------201.01................ Advanced age......... Limited or less..... Unskilled or none... Disabled.201.02................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

not transferable

\1\.201.03................ ......do............. ......do............ Skilled or Not disabled.

semiskilled--skills

transferable \1\.201.04................ ......do............. High school graduate Unskilled or none... Disabled.

or more--does not

provide for direct

entry into skilled

work \2\.201.05................ ......do............. High school graduate ......do............ Not disabled.

or more--provides

for direct entry

into skilled work

\2\.201.06................ ......do............. High school graduate Skilled or Disabled.

or more--does not semiskilled--skills

provide for direct not transferable

entry into skilled \1\.

work \2\.201.07................ ......do............. ......do............ Skilled or Not disabled.

semiskilled--skills

transferable \1\.201.08................ ......do............. High school graduate Skilled or Do.

or more--provides semiskilled--skills

for direct entry not transferable

into skilled work \1\.

\2\.201.09................ Closely approaching Limited or less..... Unskilled or none... Disabled.

advanced age.201.10................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

not transferable.201.11................ ......do............. ......do............ Skilled or Not disabled.

semiskilled--skills

transferable.201.12................ ......do............. High school graduate Unskilled or none... Disabled.

or more--does not

provide for direct

entry into skilled

work \3\.201.13................ ......do............. High school graduate ......do............ Not disabled.

or more--provides

for direct entry

into skilled work

\3\.201.14................ ......do............. High school graduate Skilled or Disabled.

or more--does not semiskilled--skills

provide for direct not transferable.

entry into skilled

work \3\.201.15................ ......do............. ......do............ Skilled or Not disabled.

semiskilled--skills

transferable.201.16................ ......do............. High school graduate Skilled or Do.

or more--provides semiskilled--skills

for direct entry not transferable.

into skilled work

\3\.201.17................ Younger individual Illiterate or unable Unskilled or none... Disabled.

age 45-49. to communicate in

English.201.18................ ......do............. Limited or less--at ......do............ Not disabled.

least literate and

able to communicate

in English.201.19................ ......do............. Limited or less..... Skilled or Do.

semiskilled--skills

not transferable.

201.20................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.201.21................ ......do............. High school graduate Skilled or Do.

or more. semiskilled--skills

not transferable.201.22................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.201.23................ Younger individual Illiterate or unable Unskilled or none... Do.\4\

age 18-44. to communicate in

English.201.24................ ......do............. Limited or less--at ......do............ Do.\4\

least literate and

able to communicate

in English.201.25................ ......do............. Limited or less..... Skilled or Do.\4\

semiskilled--skills

not transferable.201.26................ ......do............. ......do............ Skilled or Do.\4\

semiskilled--skills

transferable.201.27................ ......do............. High school graduate Unskilled or none... Do.\4\

or more.201.28................ ......do............. ......do............ Skilled or Do.\4\

semiskilled--skills

not transferable.201.29................ ......do............. ......do............ Skilled or Do.\4\

semiskilled--skills

transferable.----------------------------------------------------------------------------------------------------------------\1\ See 201.00(f).\2\ See 201.00(d).\3\ See 201.00(g).\4\ See 201.00(h).

(a) The functional capacity to perform a full range of light work includes the functional capacity to perform sedentary as well as light work. Approximately 1,600 separate sedentary and light unskilled occupations can be identified in eight broad occupational categories, each occupation representing numerous jobs in the national economy. These jobs can be performed after a short demonstration or within 30 days, and do not require special skills or experience.

(b) The functional capacity to perform a wide or full range of light work represents substantial work capability compatible with making a work adjustment to substantial numbers of unskilled jobs and, thus, generally provides sufficient occupational mobility even for severely impaired individuals who are not of advanced age and have sufficient educational competences for unskilled work.

(c) However, for individuals of advanced age who can no longer perform vocationally relevant past work and who have a history of unskilled work experience, or who have only skills that are not readily transferable to a significant range of semi-skilled or skilled work that is within the individual's functional capacity, or who have no work experience, the limitations in vocational adaptability represented by functional restriction to light work warrant a finding of disabled. Ordinarily, even a high school education or more which was completed in the remote past will have little positive impact on effecting a vocational adjustment unless relevant work experience reflects use of such education.

(d) Where the same factors in paragraph (c) of this section regarding education and work experience are present, but where age, though not advanced, is a factor which significantly limits vocational adaptability (i.e., closely approaching advanced age, 50-54) and an individual's vocational scope is further significantly limited by illiteracy or inability to communicate in English, a finding of disabled is warranted.

(e) The presence of acquired skills that are readily transferable to a significant range of semi-skilled or skilled work within an individual's residual functional capacity would ordinarily warrant a finding of not disabled regardless of the adversity of age, or whether the individual's formal education is commensurate with his or her demonstrated skill level. The acquisition of work skills demonstrates the ability to perform work at the level of complexity demonstrated by the skill level attained regardless of the individual's formal educational attainments.

(f) For a finding of transferability of skills to light work for individuals of advanced age who are closely approaching retirement age (age 60-64), there must be very little, if any, vocational adjustment required in terms of tools, work processes, work settings, or the industry.

(g) While illiteracy or the inability to communicate in English may significantly limit an individual's vocational scope, the primary work functions in the bulk of unskilled work relate to working with things (rather than with data or people) and in these work functions at the unskilled level, literacy or ability to communicate in English has the least significance. Similarly, the lack of relevant work experience would have little significance since the bulk of unskilled jobs require no qualifying work experience. The capability for light work, which includes the ability to do sedentary work, represents the capability for substantial numbers of such jobs. This, in turn, represents substantial vocational scope for younger individuals (age 18-49) even if illiterate or unable to communicate in English.

Table No. 2--Residual Functional Capacity: Maximum Sustained Work Capability Limited to Light Work as a Result

of Severe Medically Determinable Impairment(s)----------------------------------------------------------------------------------------------------------------

Previous work

Rule Age Education experience Decision----------------------------------------------------------------------------------------------------------------202.01................ Advanced age......... Limited or less..... Unskilled or none... Disabled.202.02................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

not transferable.202.03................ ......do............. ......do............ Skilled or Not disabled.

semiskilled--skills

transferable \1\.202.04................ ......do............. High school graduate Unskilled or none... Disabled.

or more--does not

provide for direct

entry into skilled

work \2\.202.05................ ......do............. High school graduate ......do............ Not disabled.

or more--provides

for direct entry

into skilled work

\2\.202.06................ ......do............. High school graduate Skilled or Disabled.

or more--does not semiskilled--skills

provide for direct not transferable.

entry into skilled

work \2\.202.07................ ......do............. ......do............ Skilled or Not disabled.

semiskilled--skills

transferable \2\.202.08................ ......do............. High school graduate Skilled or Do.

or more--provides semiskilled--skills

for direct entry not transferable.

into skilled work

\2\.202.09................ Closely approaching Illiterate or unable Unskilled or none... Disabled.

advanced age. to communicate in

English.202.10................ ......do............. Limited or less--At ......do............ Not disabled.

least literate and

able to communicate

in English.202.11................ ......do............. Limited or less..... Skilled or Do.

semiskilled--skills

not transferable.202.12................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.202.13................ ......do............. High school graduate Unskilled or none... Do.

or more.202.14................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

not transferable.202.15................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.202.16................ Younger individual... Illiterate or unable Unskilled or none... Do.

to communicate in

English.202.17................ ......do............. Limited or less--At ......do............ Do.

least literate and

able to communicate

in English.202.18................ ......do............. Limited or less..... Skilled or Do.

semiskilled--skills

not transferable.202.19................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.202.20................ ......do............. High school graduate Unskilled or none... Do.

or more.202.21................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

not transferable.202.22................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.----------------------------------------------------------------------------------------------------------------\1\ See 202.00(f).\2\ See 202.00(c).

(a) The functional capacity to perform medium work includes the functional capacity to perform sedentary, light, and medium work. Approximately 2,500 separate sedentary, light, and medium occupations can be identified, each occupation representing numerous jobs in the national economy which do not require skills or previous experience and which can be performed after a short demonstration or within 30 days.

(b) The functional capacity to perform medium work represents such substantial work capability at even the unskilled level that a finding of disabled is ordinarily not warranted in cases where a severely impaired individual retains the functional capacity to perform medium work. Even the adversity of advanced age (55 or over) and a work history of unskilled work may be offset by the substantial work capability represented by the functional capacity to perform medium work. However, an individual with a marginal education and long work experience (i.e., 35 years or more) limited to the performance of arduous unskilled labor, who is not working and is no longer able to perform this labor because of a severe impairment(s), may still be found disabled even though the individual is able to do medium work.

(c) However, the absence of any relevant work experience becomes a more significant adversity for individuals of advanced age (55 and over). Accordingly, this factor, in combination with a limited education or less, militates against making a vocational adjustment to even this substantial range of work and a finding of disabled is appropriate. Further, for individuals closely approaching retirement age (60-64) with a work history of unskilled work and with marginal education or less, a finding of disabled is appropriate.

Table No. 3--Residual Functional Capacity: Maximum Sustained Work Capability Limited to Medium Work as a Result

of Severe Medically Determinable Impairment(s)----------------------------------------------------------------------------------------------------------------

Previous work

Rule Age Education experience Decision----------------------------------------------------------------------------------------------------------------203.01................ Closely approaching Marginal or none.... Unskilled or none... Disabled.

retirement age.203.02................ ......do............. Limited or less..... None................ Do.203.03................ ......do............. Limited............. Unskilled........... Not disabled.203.04................ ......do............. Limited or less..... Skilled or Do.

semiskilled--skills

not transferable.203.05................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.203.06................ ......do............. High school graduate Unskilled or none... Do.

or more.203.07................ ......do............. High school graduate Skilled or Do.

or more--does not semiskilled--skills

provide for direct not transferable.

entry into skilled

work.203.08................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.203.09................ ......do............. High school graduate Skilled or Do.

or more--provides semiskilled--skills

for direct entry not transferable.

into skilled work.203.10................ Advanced age......... Limited or less..... None................ Disabled.203.11................ ......do............. ......do............ Unskilled........... Not disabled.203.12................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

not transferable.203.13................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.203.14................ ......do............. High school graduate Unskilled or none... Do.

or more.203.15................ ......do............. High school graduate Skilled or Do.

or more--does not semiskilled--skills

provide for direct not transferable.

entry into skilled

work.203.16................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.203.17................ ......do............. High school graduate Skilled or Do.

or more--provides semiskilled--skills

for direct entry not transferable.

into skilled work.203.18................ Closely approaching Limited or less..... Unskilled or none... Do.

advanced age.203.19................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

not transferable.203.20................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.203.21................ ......do............. High school graduate Unskilled or none... Do.

or more.203.22................ ......do............. High school graduate Skilled or Do.

or more--does not semiskilled--skills

provide for direct not transferable.

entry into skilled

work.203.23................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.203.24................ ......do............. High school graduate Skilled or Do.

or more--provides semiskilled--skills

for direct entry not transferable.

into skilled work.203.25................ Younger individual... Limited or less..... Unskilled or none... Do.

203.26................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

not transferable.203.27................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.203.28................ ......do............. High school graduate Unskilled or none... Do.

or more.203.29................ ......do............. High school graduate Skilled or Do.

or more--does not semiskilled--skills

provide for direct not transferable.

entry into skilled

work.203.30................ ......do............. ......do............ Skilled or Do.

semiskilled--skills

transferable.203.31................ ......do............. High school graduate Skilled or Do.

or more--provides semiskilled--skills

for direct entry not transferable.

into skilled work.----------------------------------------------------------------------------------------------------------------

204.00 Maximum sustained work capability limited to heavy work (or very heavy work) as a result of severe medically determinable impairment(s). The residual functional capacity to perform heavy work or very heavy work includes the functional capability for work at the lesser functional levels as well, and represents substantial work capability for jobs in the national economy at all skill and physical demand levels. Individuals who retain the functional capacity to perform heavy work (or very heavy work) ordinarily will not have a severe impairment or will be able to do their past work--either of which would have already provided a basis for a decision of ``not disabled''. Environmental restrictions ordinarily would not significantly affect the range of work existing in the national economy for individuals with the physical capability for heavy work (or very heavy work). Thus an impairment which does not preclude heavy work (or very heavy work) would not ordinarily be the primary reason for unemployment, and generally is sufficient for a finding of not disabled, even though age, education, and skill level of prior work experience may be considered adverse. [56 FR 12980, Mar. 28, 1991, as amended at 68 FR 60294, Oct. 22, 2003]

Sec. Appendix 3 to Part 220--Railroad Retirement Board Occupational

Disability Standards

1. Introduction

1.01 The Board uses this appendix to adjudicate the occupational disability claims of employees with medical conditions and job titles covered by the Tables in this appendix. The Tables are divided into ``Body Parts'', with each Body Part further divided by job title. Under each job title there is a list of impairments and tests with accompanying test results which establish a finding of ``D'' (disabled). The use of these Tables is a three-step process. In the first step we determine whether the employee's regular railroad occupation is covered by the Tables; next we establish the existence of an impairment covered by the Tables; finally, we reach a disability determination. If we do not find an employee disabled under these Tables, the employee may still be found disabled using Independent Case Evaluation (ICE), as explained in subpart C of this part.

1.02 The Cancer Tables are treated in a different way than other body systems. Different types of cancer and their treatments have different functional impacts. In the Cancer Tables the impact of the impairment is seen as being significant or not significant. Therefore, these tables contain an ``S'' (significant) which is equivalent to a ``D'' rating. A detailed explanation of how to use those tables is in that section. The steps to use the remaining Tables are explained below:

2. Confirming the Impairment

2.01 Once we determine that the employee's regular railroad occupation is covered by the Job Titles in the Tables, we must determine the existence of an impairment covered by the Tables. This is done through the use of Confirmatory Tests. These tests can include information from medical records, surgical or operative reports, or specific diagnostic test results. Confirmatory Tests are listed in the initial section regarding each Body Part covered in the Tables. If an impairment cannot be confirmed because of inconsistent medical information, ICE may be required.

2.02 There are two types of Confirmatory Tests as follows.

2.03 ``Highly Recommended'' Tests--The designation of a confirmatory test as being ``highly recommended'' means that the test is almost always performed to confirm the existence of the impairment. For many conditions, only one ``highly recommended'' test finding is suggested to confirm the impairment. However, there may be times when that test is not available or is negative, but other more detailed testing confirms the impairment.

2.04 Example A: To confirm the condition of pulmonary hypertension, the Tables under Body Part C., Cardiac, designate as ``highly recommended'': an electrocardiogram which indicates definite right ventricular hypertrophy. However, the impairment may also be confirmed by insertion of a Swan-Ganz catheter into the pulmonary artery and the pulmonary artery pressure measured directly.

2.05 There may be some conditions for which several ``highly recommended'' tests are suggested to confirm an impairment. In these circumstances, we will use all ``highly recommended'' tests to establish the existence of the impairment.

2.06 Example B: Under Body Part E., Lumbar Sacral Spine, three highly recommended medical findings are identified for the diagnosis of chronic back pain, not otherwise specified. These findings include:

A. A history of back pain under medical treatment for at least one year, and

B. A history of back pain unresponsive to therapy for at least one year, and

C. A history of back pain with functional limitations for at least one year.

2.07 All three of these criteria must be satisfied to confirm the existence of chronic back pain.

2.08 Sometimes the employee may have undergone detailed testing which is as reliable as one of the ``highly recommended'' tests listed in the Tables. In cases where an impairment has not been confirmed by one of the designated ``highly recommended'' tests, the impairment may still be confirmed by ``recommended'' tests (see below) or by evidence acceptable under section 220.27 of this part.

2.09 Recommended Tests--The designation of a confirmatory test as ``recommended'' means that the test need not be performed, or be positive, to confirm the impairment. However, a positive test provides significant support for confirming the impairment. If there are no ``highly recommended'' tests for confirming the impairment, at least one of the ``recommended'' tests should be positive.

2.10 There are two categories of recommended tests which are described below.

A. Imaging studies--These studies can include MRI, CAT scan, myelogram, or plain film x-rays. For conditions where several of these imaging studies are identified as ``recommended'' tests, at least one of the test results should be positive and meet the confirmatory test criteria. For some conditions, such as degenerative disc condition, there are several equivalent imaging methods to confirm a diagnosis.

B. Other tests--This category of tests refers to non-imaging studies.

2.11 If there are no ``highly recommended'' confirmatory tests designated to confirm an impairment and the ``recommended'' confirmatory tests only include non-imaging procedures, at least one of these tests should be positive to confirm the impairment. The greater the number of tests that are positive, the greater the confidence that the correct diagnosis has been established.

2.12 Example: Under Body Part C., Cardiac, the diagnostic confirmatory tests for ventricular ectopy, a cardiac arrhythmia, include the following ``recommended'' tests:

A. Medical record review, i.e., a review of the claimant's medical records, or

B. Holter monitoring, or

C. Provocative testing producing a definite arrhythmia.

2.13 In this situation, only one of the ``recommended'' confirmatory tests need be positive to confirm the impairment. However, the more tests that are positive, the stronger the support for the diagnosis.

2.14 In no circumstance will the Board require that an invasive test be performed to confirm an impairment. Several of the Confirmatory Tests which are described in the Tables are invasive and it is not the intention of the Board to suggest that these be performed. The inclusion of invasive tests in the Tables Confirmatory Tests section is intended to help the Board evaluate the significance of findings from such tests that may have already been performed and which are part of the submitted medical record.

2.15 If an employee's impairment(s) cannot be confirmed by use of the confirmatory tests listed in the Tables, it still may be confirmed by medical evidence described in section 220.27 of this part. However, if a claimant's impairment(s) cannot be confirmed through use of the Tables or under section 220.27, and the medical evidence is complete and in concordance, the claimant will be found not disabled.

3. Disability Determination

3.01 Once the Board determines that the employee's regular railroad occupation is covered by one of the Job Titles in the Tables and that his or her alleged impairment fits into a Body Part covered by the Tables and can be confirmed, we examine the results of any of the disability tests listed under the impairment. If the results from any of these tests indicate a ``D'' finding, the employee is found disabled. If none of the test results indicate a ``D'' finding, then the employee's claim is evaluated using ICE.

3.02 Example: A trainman has angina as confirmed by the recommended tests under Body Part A: Cardiac--Angina. An echocardiogram shows that he has poor ejection fraction <=35%. The employee is rated disabled. If none of the results of the listed disability tests match the results required for a ``D'' finding, then the employee's claim is evaluated under ICE.

Tables

A. Cancer

B. Endocrine

C. Cardiac

D. Respiratory

E. Lumbar Sacral Spine

F. Cervical Spine

G. Shoulder and Elbow

H. Hand and Arm

I. Hip

J. Knee

K. Ankle and Foot

A. Cancer

Cancer

Cancer conditions can be viewed as belonging to one of three categories.

Category 1: Significant impact on functional capacity or anticipated life span.

Category 2: Intermediate impact on functional capacity; large individual variability.

Category 3: No significant impact on functional capacity or expected life span.

The factors that are considered in developing these categories include the following:

Type of Cancer

The functional impact of different malignancies varies tremendously and each malignancy has to be considered on an individual basis.

Magnitude of Disease

The disability standards are based upon the magnitude or extent of disease. The extent of disease affects both anticipated life span and the functional capacity or work ability of the individual. Localized cancer including cancer ``in situ'' can frequently be completely cured and not have an impact on functional capacity or life span. In contrast, many cancers that have distant or significant regional spread generally have a poor prognosis. The magnitude or extent of disease is classified into three categories: local, regional and distant.

The criteria which are used to classify a cancer into one of the three categories are based upon the distillation of several staging methods into a single system [Miller, et al. (1992). Cancer Statistics Review, 1973-1989; NIH Publication No. 92-2789].

Effects of Treatment

Although some types of cancer may be potentially curable with radical surgery and/or radiation therapy, the treatment regimen may result in a significant impairment that could affect functional capacity and ability to work. For example, a person with a laryngeal tumor which had spread regionally could be cured by a complete laryngectomy and radiotherapy. However, this treatment could result in a loss of speech and significantly impair the individual's communicative skills or ability to use certain types of respiratory protective equipment.

Prognosis

Some cancers may have minimal impact on a person's functional capacity, but have a very poor prognosis with respect to life expectancy. For example, an individual with early stage brain cancer may be minimally impaired, but have a poor prognosis and minimal potential for surviving longer than two years. Five and two year survival data are presented in the Cancer Disability Guideline Table which follows.

The Cancer Disability Guideline Table provides information concerning the probability of survival for five years for local, regional, and distant disease for each type of malignancy. In addition, two-year survival data are also presented for all disease stages. The five-year survival data are based upon data collected from population-based registries in Connecticut, New Mexico, Utah, Hawaii, Atlanta, Detroit, Seattle and the San Francisco and East Bay area between 1983 and 1987 (Miller, 1992). The two-year data are from a cohort study initially diagnosed in 1988.

Assessment

The malignancies are classified as disabling (Category 1), potentially disabling (Category 2) and non-disabling (Category 3). Category 2 conditions must be evaluated with respect to how the worker's tumor affects the worker's ability to perform the job and an assessment of his life span.

Information concerning the potential impact of the malignancy on a worker's ability to perform a job is identified in the Functional Impact column in the table. All railroad occupations in the Tables are considered together. Functional impacts are classified as significant if the treatment or sequelae from treatment including radiotherapy, chemotherapy and/or surgery is likely to impair the worker from performing the job. If the treatment results in a significant impairment of another organ system, the individual should be evaluated for disability associated with impairment of that body part. For example, a person undergoing an amputation for a bone malignancy would have to be evaluated for an amputation of that body part. For many cancers, it is difficult to make generalizations regarding the level of impairment that will occur after the person has initiated or completed treatment. Nonsignificant impacts include those that are unlikely to have any effect on the individual's work capacity. ----------------------------------------------------------------------------------------------------------------

Disability Functional

Cancer type 2-year\1\ 5-year\1\ status\2\ impact\3\----------------------------------------------------------------------------------------------------------------Brain:

Local.......................... .................... 26 1 S

Regional....................... .................... 27.9 1 S

Distant........................ .................... 23.6 1 SFemale Breast:

Regional....................... .................... 71.1 2 S

Distant........................ .................... 17.8 1 SColon:

Local.......................... .................... 91 2 S

Regional....................... .................... 60.1 2 S

Distant........................ .................... 6 1 SRectal:

Local.......................... .................... 84.5 2 S

Regional....................... .................... 50.7 2 S

Distant........................ .................... 5.3 1 SEsophagus:

Local.......................... .................... 18.5 1 S

Regional....................... .................... 5.2 1 S

Distant........................ .................... 1.8 1 SHodgkin's Disease:\4\

Stage 1........................ .................... 90-95 3 S

Stage 2........................ .................... 86 2 S

Stage 3........................ .................... <80 2 S

Stage 4........................ .................... <80 1 SKidney/Renal Pelvis:

Local.......................... .................... 85.4 3 S

Regional....................... .................... 56.3 2 S

Distant........................ .................... 9 1 SLarynx:

Local.......................... .................... 84.2 2 S

Regional....................... .................... 52.5 2 S

Distant........................ .................... 24 1 SAcute Lymphocytic Leukemia:

All............................ .................... 51.1 2 SChronic Lymphocytic Leukemia:

All............................ .................... 66.2 2 SAcute Myelogenous Leukemia:

All............................ .................... 9.7 1 SChronic Myelogenous Leukemia:

All............................ .................... 21.7 1 SLiver/Intrahepatic Bile Duct:

Local.......................... .................... 15.1 1 S

Regional....................... .................... 5.8 1 S

Distant........................ .................... 1.9 1 SLung/Bronchus:\5\

Local.......................... .................... 45.6 2 S

Regional....................... .................... 13.1 1 S

Distant........................ .................... 1.3 1 SMelanomas of Skin:

Regional....................... .................... 53.6 2 S

Distant........................ .................... 12.8 1 SOral Cavity/Pharyngeal:

Local.......................... .................... 76.2 2 S

Regional....................... .................... 40.9 2 S

Distant........................ .................... 18.7 1 SPancreas:

Local.......................... .................... 6.1 1 S

Regional....................... .................... 3.7 1 S

Distant........................ .................... 1.4 1 SProstate:

Local.......................... .................... 91 3 S

Regional....................... .................... 80.4 2 S

Distant........................ .................... 28 1 SStomach:

Local.......................... .................... 55.4 1 S

Regional....................... .................... 17.3 1 S

Distant........................ .................... 2.1 1 STesticular:

Distant........................ .................... 65.5 1 SThyroid:

Regional....................... .................... 93.1 3 S

Distant........................ .................... 47.2 1 SBladder:

Regional....................... .................... 46 2 S

Distant........................ .................... 9.1 1 S----------------------------------------------------------------------------------------------------------------\1\Source of 2 and 5 year survival data: Miller BA et al. Cancer Statistics Review 1973-1989. NIH Publication

No. 92-2789.\2\Disability Status:Category 1: Significant impact on functional capacity or life span.Category 2: Intermediate impact.Category 3: No significant impact on functional capacity or life span.\3\Functional Impacts:(S) Significant--significant potential for the effects of treatment (radiotheraphy, chemotherapy. surgery) to

affect functional capacity.\4\Hodgkin's disease data presented for each stage derived from American Cancer Society. American Cancer Society

Textbook reference for unstaged cancer is derived from Cancer Statistics Review (See 3). In addition to other

data, see: American Cancer Society Textbook of Clinical Oncology. Eds: Holleb AI, Fink DJ, Murphy GP, Atlanta:

American Cancer Society, Inc. 1991.)\5\Small cell carcinoma is classified as a 1.

B. Endocrine----------------------------------------------------------------------------------------------------------------

Confirmatory test Minimum result Requirements----------------------------------------------------------------------------------------------------------------

BODY PART: ENDOCRINE

CONFIRMATORY TESTS----------------------------------------------------------------------------------------------------------------Diabetes, requiring insulin (IDDM):

Medical record review.............. Confirmation of condition and Highly recommended.

need for insulin use.---------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------

Disability test Test result Disability classification----------------------------------------------------------------------------------------------------------------

BODY PART: ENDOCRINE

JOB TITLE: ENGINEER----------------------------------------------------------------------------------------------------------------Diabetes, requiring insulin (IDDM):

Medical record review.............. Confirmation of condition and D

need for insulin use.----------------------------------------------------------------------------------------------------------------

C. Cardiac----------------------------------------------------------------------------------------------------------------

Confirmatory test Minimum result Requirements----------------------------------------------------------------------------------------------------------------

BODY PART: CARDIAC

CONFIRMATORY TESTS----------------------------------------------------------------------------------------------------------------Angina:

Medical record review.............. Confirmed history of ischemia Recommended.

including copies of

electrocardiogram.

Stress test........................ Definite ischemia on exercise Recommended.

test.

Thallium study..................... Definite ischemia with Recommended.

exercise.Aortic valve disease:

Cardiac catheterization............ Proven and significant....... Recommended.

Echocardiogram..................... Significant valve disease.... Recommended.Coronary artery disease:

Medical record review.............. Documented ischemia with Recommended.

electrocardiogram

confirmation.

Medical record review.............. Documented myocardial Recommended.

infarction.

Stress test........................ Positive..................... Recommended.

Thallium study..................... Definite ischemia with Recommended.

exercise.

Angiography........................ Definite occlusion (<=60%) of Recommended.

one vessel.Cardiomyopathy:

Echocardiogram..................... Proven ejection fraction Recommended.

<=35%.

Catheterization.................... Poor global function and not Recommended.

coronary artery disease.Hypertension:

Medical record review.............. Documentation of hypertension Highly recommended.

for one year.

Medical record review.............. Definite diagnosis by Highly recommended.

cardiologist or internist.

Medical record review.............. Confirmation of medication Highly recommended.

use.Arrhythmia: heart block:

Medical record review.............. Proven episode with Recommended.

electrocardiogram

confirmation.

Electrocardiogram.................. Documentation of arrhythmia.. Recommended.Mitral valve disease:

Cardiac catheterization............ Significant valve disease.... Recommended.

Echocardiogram..................... Significant valve disease.... Recommended.

Pericardial disease:

Medical record review.............. Confirmed by cardiologist or Highly recommended.

internist.Pulmonary hypertension:

Physical examination............... Increased pulmonic sound or Recommended.

pulmonary ejection murmur by

cardiologist or internist.

Electrocardiogram.................. Definite right ventricular Highly recommended.

hypertension.Ventricular ectopy:

Medical record review.............. Definite episode within one Recommended.

year.

Holter monitoring.................. Definite arrhythmia.......... Recommended.

Provocative testing................ Positive response............ Recommended.Arrhythmia: supraventricular

tachycardia:

Medical record review.............. Definite episode within one Recommended.

year.

Holter monitoring.................. Definite arrhythmia.......... Recommended.Post heart transplant:

Medical record review.............. Documented................... Highly recommended.---------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------

Disability test Test result Disability classification----------------------------------------------------------------------------------------------------------------

BODY PART: CARDIAC

JOB TITLE: TRAINMAN----------------------------------------------------------------------------------------------------------------Angina:

Echocardiogram..................... Poor ejection fraction <=35%. D

Stress test........................ Peak exercise <=7 METS....... D

Medical record review.............. Unstable as diagnosed by D

cardiologist.

Stress test........................ Documented hypotensive D

response.

Stress test: significant ST changes Definite ischemia <=7 METS... DAortic valve disease:

Cardiac catheterization............ Aortic gradient 25-50 mm HG..

Echocardiogram..................... Poor ejection fraction <=35%. D

Stress test........................ Peak exercise <=7 METS....... DCoronary artery disease:

Myocardial infarction.............. Multiple infarctions......... D

Echocardiogram..................... Confirmed ventricular D

aneurysm.

Cardiac catheterization............ Aortic gradient 25-50 mm Hg.. D

Cardiac catheterization............ Poor ejection fraction <=35%. D

Stress test........................ Peak exercise <=7 METS....... D

Medical record review.............. Unstable as diagnosed by a D

Cardiologist.

Stress test........................ Documented hypotensive D

response.

Stress test........................ Definite ischemia <= 7 METS.. D

Isotope, e.g., thallium study...... Definite ischemia <= 7 METS.. DCardiomyopathy:

Cardiac catheterization............ Poor ejection fraction <=35%. D

Echocardiogram..................... Poor ejection fraction <=35%. D

Stress test........................ Peak exercise <=7 METS....... DHypertension:

Medical record review.............. Diastolic <=120 and systolic D

<=160, 50% of the time and

evidence of end organ damage

(blood creatinine <=2;

urinary protein <=\1/2\ gm;

or EKG evidence of ischemia).Arrhythmia: heart block:

Holter............................. Documented asystole length D

<=1.5-2 seconds.

Medical record review.............. Documented syncope with D

proven arrhythmia.Mitral valve disease:

Cardiac catheterization............ Mitral valve gradient =5 mm Hg.

Cardiac catheterization............ Mitral regurgitation severe.. D

Cardiac catheterization............ Poor ejection fraction <=35%. D

Echocardiogram..................... Poor ejection fraction <=35%. D

Stress test........................ Peak exercise <=7 METS....... DPericardial disease:

Cardiac catheterization............ Poor ejection fraction <=35%. D

Echocardiogram..................... Poor ejection fraction <=35%. DVentricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope... DArrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope... D

Post heart transplant:

Medical record review.............. Post heart transplant........ D----------------------------------------------------------------------------------------------------------------

BODY PART: CARDIAC

JOB TITLE: ENGINEER----------------------------------------------------------------------------------------------------------------Angina:

Echocardiogram..................... Poor ejection fraction <=35%. D

Stress test........................ Peak exercise <=5 METS....... D

Medical record review.............. Unstable as diagnosed by D

cardiologist.

Stress test........................ Documented hypotensive D

response.

Stress test: significant ST changes Definite ischemia <=5 METS... DAortic valve disease:

Cardiac catheterization............ Aortic gradient 25-50 mm HG.. D

Echocardiogram..................... Poor ejection fraction <=35%. D

Stress test........................ Peak exercise <=5 METS....... DCoronary artery disease:

Myocardial infarction.............. Multiple infarctions......... D

Echocardiogram..................... Confirmed ventricular D

aneurysm.

Cardiac catheterization............ Aortic gradient 25-50 mm Hg.. D

Cardiac catheterization............ Poor ejection fraction <=35%. D

Stress test........................ Peak exercise <=5 METS....... D

Medical record review.............. Unstable as diagnosed by a D

Cardiologist.

Stress test........................ Documented hypotensive D

response.

Stress test........................ Definite ischemia <=5 METS... D

Isotope, e.g., thallium study...... Definite ischemia <=5 METS... DCardiomyopathy:

Cardiac catheterization............ Poor ejection fraction <=35%. D

Echocardiogram..................... Poor ejection fraction <=35%. D

Stress test........................ Peak exercise <=5 METS....... DHypertension:

Medical record review.............. Diastolic <=120 and systolic D

<=160, 50% of the time and

evidence of end organ damage

(blood creatinine <=2;

urinary protein <=\1/2\ gm;

or EKG evidence of ischemia).Arrhythmia: heart block:

Holter............................. Documented asystole length D

<=1.5-2 seconds.

Medical record review.............. Documented syncope with D

proven arrhythmia.Mitral valve disease:

Cardiac catheterization............ Mitral valve gradient =10 mm Hg.

Cardiac catheterization............ Mitral regurgitation severe.. D

Cardiac catheterization............ Poor ejection fraction <=35%. D

Echocardiogram..................... Poor ejection fraction <=35%. D

Stress test........................ Peak exercise <=5 METS....... DPericardial disease:

Cardiac catheterization............ Poor ejection fraction <=35%. D

Echocardiogram..................... Poor ejection fraction <=35%. DVentricular ectopy:

Medical record review.............. Documented life threatening D

arrhythmia.

Holter............................. Uncontrolled ventricular D

rhythm.

Medical record review.............. Documented related syncope... DArrhythmia: supraventricular

tachycardia:

Medical record review.............. Documented related syncope... DPost heart transplant:

Medical record review.............. Post heart transplant........ D----------------------------------------------------------------------------------------------------------------

BODY PART: CARDIAC

JOB TITLE: DISPATCHER----------------------------------------------------------------------------------------------------------------Angina: