Social Security Ruling, SSR 19-4p; Titles II and XVI: Evaluating Cases Involving Primary Headache Disorders

 
CONTENT
Federal Register, Volume 84 Issue 165 (Monday, August 26, 2019)
[Federal Register Volume 84, Number 165 (Monday, August 26, 2019)]
[Notices]
[Pages 44667-44671]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-18310]
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SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA-2018-0023]
Social Security Ruling, SSR 19-4p; Titles II and XVI: Evaluating
Cases Involving Primary Headache Disorders
AGENCY: Social Security Administration.
ACTION: Notice of Social Security Ruling (SSR).
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SUMMARY: We are providing notice of SSR 19-4p. This SSR provides
guidance on how we establish that a person has a medically determinable
impairment of a primary headache disorder and how we evaluate primary
headache disorders in disability claims under titles II and XVI of the
Social Security Act.
DATES: We will apply this notice on August 26, 2019.
FOR FURTHER INFORMATION CONTACT: Cheryl A. Williams, Office of Medical
Policy, Social Security Administration,
[[Page 44668]]
6401 Security Boulevard, Baltimore, Maryland 21235-6401, (410) 965-
1020. For information on eligibility or filing for benefits, call our
national toll-free number, 1-800-772-1213 or TTY 1-800-325-0778, or
visit our internet site, Social Security Online, at http://www.socialsecurity.gov.
SUPPLEMENTARY INFORMATION: Although 5 U.S.C. 552(a)(1) and (a)(2) do
not require us to publish this SSR, we are doing so in accordance with
20 CFR 402.35(b)(1).
    Through SSRs, we make available to the public precedential
decisions relating to the Federal old-age, survivors, disability,
supplemental security income, and special veterans' benefits programs.
We may base SSRs on determinations or decisions made at all levels of
administrative adjudication, Federal court decisions, Commissioner's
decisions, opinions of the Office of the General Counsel, or other
interpretations of the law and regulations.
    Although SSRs do not have the same force and effect as statutes or
regulations, they are binding on all of our components in accordance
with 20 CFR 402.35(b)(1) and are binding as precedents in adjudicating
cases.
    This SSR will remain in effect until we publish a notice in the
Federal Register that rescinds it, or we publish a new SSR that
replaces or modifies it.
(Catalog of Federal Domestic Assistance, Programs Nos. 96.001, Social
Security--Disability Insurance; 96.002, Social Security--Retirement
Insurance; 96.004, Social Security--Survivors Insurance; 96.006,
Supplemental Security Income.)
Andrew Saul,
Commissioner of Social Security.
Policy Interpretation Ruling
Titles II and XVI: Evaluating Cases Involving Primary Headache
Disorders
    Purpose: This SSR provides guidance on how we establish that a
person has a medically determinable impairment (MDI) of a primary
headache disorder and how we evaluate primary headache disorders in
disability claims under titles II and XVI of the Social Security Act
(Act).\1\
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    \1\ For simplicity, we refer in this SSR only to initial adult
claims for disability benefits under titles II and XVI of the Act.
The policy interpretations in this SSR, however, also apply to
claims of children (that is, people who have not attained age 18)
who apply for benefits based on disability under title XVI of the
Act, continuing disability reviews of adults and children under
sections 223(f) and 1614(a)(4) of the Act, and redeterminations of
eligibility for benefits we make in accordance with section
1614(a)(3)(H) of the Act when a child who is receiving title XVI
payments based on disability attains age 18.
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    Citations: Sections 216(i), 223(d), 223(f), 1614(a)(3) and
1614(a)(4) of the Social Security Act, as amended; Regulations No. 4,
subpart P, sections 404.1502, 404.1505, 404.1509, 404.1512, 404.1513,
404.1520, 404.1520a, 404.1520b, 404.1521-404.1523, 404.1525, 404.1526,
404.1529, 404.1545, 404.1560, 404.1562-404.1569a, 404.1593, 404.1594,
appendices 1 and 2; and Regulations No. 16, subpart I, sections
416.902, 416.905, 416.906, 416.909, 416.912, 416.913, 416.920,
416.920a, 416.920b, 416.921-416.924, 416.924a, 416.925, 416.926,
416.926a, 416.929, 416.945, 416.960, 416.962-416.969a, 416.987,
416.993, 416.994, and 416.994a.
Introduction
    Primary headache disorders are among the most common disorders of
the nervous system.\2\ Examples of these disorders include migraine
headaches, tension-type headaches, and cluster headaches. We are
issuing this SSR to explain our policy on how we establish that a
person has an MDI of a primary headache disorder and how we evaluate
primary headache disorders in disability claims. In 2018, the Headache
Classification Committee of the International Headache Society
published the third edition of the International Classification of
Headache Disorders (ICHD-3).\3\ The ICHD-3 provides classification of
headache disorders and diagnostic criteria for scientific, educational,
and clinical use. We referred to the ICHD-3 criteria in developing this
SSR.
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    \2\ See World Health Organization. (2016). Headache disorders.
Retrieved from http://www.who.int/news-room/fact-sheets/detail/headache-disorders.
    \3\ See International Headache Society (IHS). (2018). The
international classification of headache disorders (3rd ed.).
Retrieved from https://www.ichd-3.org/wp-content/uploads/2018/01/The-International-Classification-of-Headache-Disorders-3rd-Edition-2018.pdf.
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    We consider a person age 18 or older disabled if he or she is
unable to engage in any substantial gainful activity due to any
medically determinable physical or mental impairment(s) that can be
expected to result in death, or that has lasted or can be expected to
last for a continuous period of not less than 12 months.\4\ In our
sequential evaluation process, we determine whether a medically
determinable physical or mental impairment is severe at step 2.\5\ A
severe MDI or combination of MDIs significantly limits a person's
physical or mental ability to do basic work activities. We require that
the MDI(s) result from anatomical, physiological, or psychological
abnormalities that can be shown by medically acceptable clinical and
laboratory diagnostic techniques.\6\ Our regulations further require
that the MDI(s) be established by objective medical evidence \7\ from
an acceptable medical source (AMS).\8\ We will not use a person's
statement of symptoms, a diagnosis, or a medical opinion to establish
the existence of an MDI(s).\9\ We also will not make a finding of
disability based on a person's statement of symptoms alone.\10\
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    \4\ See sections 223(d)(1)(A) and 1614(a)(3)(A) of the Act.
    \5\ See 20 CFR 404.1520(a)(4)(ii) and (c) and 416.920(a)(4)(ii)
and (c).
    \6\ See sections 223(d)(3) and 1614(a)(3)(D) of the Act, and 20
CFR 404.1521 and 416.921.
    \7\ Objective medical evidence is defined as signs, laboratory
findings, or both. See 20 CFR 404.1502(f).
    \8\ See 20 CFR 404.1502, 404.1513, 404.1521, 416.902, 416.913,
and 416.921.
    \9\ See 20 CFR 404.1521 and 416.921.
    \10\ See 20 CFR 404.1529(a) and 416.929(a).
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Policy Interpretation
    In this SSR, we explain how we establish a primary headache
disorder as an MDI and how we evaluate claims involving primary
headache disorders. The following information is in a question and
answer format. Question 1 explains what primary headache disorders are.
Question 2 explains how the medical community diagnoses primary
headache disorders. Questions 3, 4, 5, and 6 provide the ICHD-3
diagnostic criteria for four common types of primary headache
disorders.\11\ Question 7 explains how we establish a primary headache
disorder as an MDI. Questions 8 and 9 address how we evaluate primary
headache disorders in the sequential evaluation process.
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    \11\ Although this SSR only provides information about four
common types of primary headache disorders, diagnostic criteria for
other types of primary headache disorders can be found in the ICHD-
3.
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List of Questions
    1. What are primary headache disorders?
    2. How does the medical community diagnose a primary headache
disorder?
    3. What are the ICHD-3 diagnostic criteria for migraine with aura?
    4. What are the ICHD-3 diagnostic criteria for migraine without
aura?
    5. What are the ICHD-3 diagnostic criteria for chronic tension-type
headache?
    6. What are the ICHD-3 diagnostic criteria for cluster headache (a
type of trigeminal autonomic cephalalgias)?
    7. How do we establish a primary headache disorder as an MDI?
    8. How do we evaluate an MDI of a primary headache disorder under
the Listing of Impairments?
[[Page 44669]]
    9. How do we consider an MDI of a primary headache disorder in
assessing a person's residual functional capacity?
    1. What are primary headache disorders?
    Headaches are complex neurological disorders involving recurring
pain in the head, scalp, or neck. Headaches can occur in adults and
children. The National Institute of Neurological Disorders and Stroke
(NINDS), the American Academy of Neurology, and other professional
organizations classify headaches as either primary or secondary
headaches. Primary headaches occur independently and are not caused by
another medical condition. Secondary headaches are symptoms of another
medical condition such as fever, infection, high blood pressure,
stroke, or tumors.
    Primary headache disorders are a collection of chronic headache
illnesses characterized by repeated exacerbations of overactivity or
dysfunction of pain-sensitive structures in the head. Examples of
common primary headaches include migraines, tension-type headaches, and
trigeminal autonomic cephalalgias. They are typically severe enough to
require prescribed medication and sometimes warrant emergency
department visits.\12\ The purpose of the emergency department care is
to determine the correct headache diagnosis, exclude secondary causes
of the headache (such as infection, mass-lesion, or hemorrhage),
initiate acute therapy in appropriate cases, and provide referral to an
appropriate healthcare provider for further care and management of the
headaches.\13\
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    \12\ Clinicians may use terms such as ``severe'' or ``moderate''
to characterize a person's medical condition or symptoms and these
terms may be seen in medical evidence. These terms will not always
have the same meaning in the clinical setting as they do in our
program.
    \13\ Lange, S.E. (2011). Primary headache disorders in the
emergency department. Advanced Emergency Nursing Journal, 33(3).
doi:10.1097/TME.0b013e3182261105.
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    Migraines are vascular headaches involving throbbing and pulsating
pain caused by the activation of nerve fibers that reside within the
wall of brain blood vessels traveling within the meninges (the three
membranes covering the brain and spinal cord). There are two major
types of migraine: Migraine with aura and migraine without aura.
Migraine with aura is accompanied by visual, sensory, or other central
nervous system symptoms. Migraine without aura is accompanied by
nausea, vomiting, or photophobia (light sensitivity) and phonophobia
(sound sensitivity). Migraine without aura is the most common form of
migraine.
    Tension-type headaches are characterized by pain or discomfort in
the head, scalp, face, jaw, or neck, and are usually associated with
muscle tightness in these areas. There are two types of tension-type
headaches: Episodic and chronic. Episodic tension-type headaches are
further divided into infrequent episodic tension-type headaches, which
typically do not require medical management, and frequent episodic
tension-type headaches, which may require medical management. Chronic
tension-type headaches generally evolve from episodic tension-type
headaches. Chronic tension-type headaches and frequent episodic
tension-type headaches may be disabling depending on the frequency of
the headache attacks, type of accompanying symptoms, response to
treatment, and functional limitations.
    Trigeminal autonomic cephalalgias are characterized by unilateral
(one-sided) pain. There are three types: Cluster headache, paroxysmal
hemicrania (rare), and short-lasting unilateral neuralgiform headache
attacks with conjunctival injection and tearing (SUNCT; very rare).
Cluster headaches are characterized by sudden headaches that occur in
``clusters,'' are usually less frequent and shorter than migraine
headaches, and may be mistaken for allergies because they often occur
seasonally.
    2. How does the medical community diagnose a primary headache
disorder?
    In accordance with the ICHD-3 guidelines, the World Health
Organization (WHO) protocols, and the NINDS definition of headache
disorders, physicians diagnose a primary headache disorder only after
excluding alternative medical and psychiatric causes of a person's
symptoms.\14\ Physicians diagnose a primary headache disorder after
reviewing a person's full medical and headache history and conducting a
physical and neurological examination.\15\ It is helpful to a physician
when a person keeps a ``headache journal'' to document when the
headaches occur, how long they last, what symptoms are associated with
the headaches, and other co-occurring environmental factors.
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    \14\ ICHD-3 provides classification of headache disorders and
diagnostic criteria.
    \15\ Ebell, M.H. (2006). Diagnosis of migraine headache.
American Family Physician, 74(12).
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    To rule out other medical conditions that may result in the same or
similar symptoms, a physician may also conduct laboratory tests or
imaging scans.\16\ For example, physicians may use magnetic resonance
imaging (MRI) to rule out other possible causes of headaches--such as a
tumor--meaning that an unremarkable MRI is consistent with a primary
headache disorder diagnosis. Other tests used to exclude causes of
headache symptoms include computed tomography (CT) scan of the head, CT
angiography (CTA), blood chemistry and urinalysis, sinus x-ray,
electroencephalogram (EEG), eye examination, and lumbar puncture. A
scan may describe an incidental abnormal finding, which does not
preclude the diagnosis of a primary headache disorder. While imaging
may be useful in ruling out other possible causes of headache symptoms,
it is not required for a primary headache disorder diagnosis.
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    \16\ Friedman, B.W. & Grosberg, B.M. (2009). Diagnosis and
management of the primary headache disorders in the emergency
department setting. Emergency Medicine Clinics of North America,
27(1). doi:10.1016/j.emc.2008.09.005.
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    3. What are the ICHD-3 diagnostic criteria for migraine with aura?
    The ICHD-3 diagnostic criteria for migraine with aura are headaches
not better accounted for by another ICHD-3 diagnosis and at least two
headache attacks meeting the following criteria:
     One or more of the following fully reversible aura
symptoms:
    [cir] Visual,
    [cir] Sensory,
    [cir] Speech or language,
    [cir] Motor,
    [cir] Brainstem, or
    [cir] Retinal; and
     At least three of the following six characteristics:
    [cir] At least one aura symptom spreads gradually over at least 5
minutes;
    [cir] Two or more aura symptoms occur in succession;
    [cir] Each individual aura symptom lasts 5 to 60 minutes;
    [cir] At least one aura symptom is unilateral (aphasia is always
regarded as a unilateral symptom; dysarthria may or may not be);
    [cir] At least one aura symptom is positive (scintillations and
pins and needles are positive symptoms of aura); or
    [cir] The aura is accompanied or followed within 60 minutes by
headache.
    4. What are the ICHD-3 diagnostic criteria for migraine without
aura?
    The ICHD-3 diagnostic criteria for migraine without aura are
headaches not better accounted for by another ICHD-3 diagnosis and at
least five headache attacks satisfying the following criteria:
[[Page 44670]]
     Lasting 4 to 72 hours (untreated or unsuccessfully
treated); 17 18 and
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    \17\ When the person falls asleep during a migraine attack and
wakes up without it, duration of the attack is calculated until the
time of awakening.
    \18\ In children (persons under age 18), attacks may last 2-72
hours.
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     At least two of the following four characteristics:
    [cir] Unilateral location;
    [cir] Pulsating quality;
    [cir] Moderate or severe pain intensity; or
    [cir] Aggravation by or causing avoidance of routine physical
activity (for example, walking or climbing stairs); and
     During headache, at least one of the following:
    [cir] Nausea or vomiting, or
    [cir] Photophobia and phonophobia.
    5. What are the ICHD-3 diagnostic criteria for chronic tension-type
headache?
    The ICHD-3 diagnostic criteria for chronic tension-type headache
are headaches not better accounted for by another ICHD-3 diagnosis,
occurring on at least 15 days per month on average for more than 3
months, and satisfying the following criteria:
     Lasting hours to days, or unremitting; and
     At least two of the following four characteristics:
    [cir] Bilateral location;
    [cir] Pressing or tightening (non-pulsating) quality;
    [cir] Mild or moderate intensity; or
    [cir] Not aggravated by routine physical activity (such as walking
or climbing stairs); and
     No more than one of photophobia, phonophobia, or mild
nausea; and
     Neither moderate nor severe \19\ nausea nor vomiting.
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    \19\ See note 12 above.
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    6. What are the ICHD-3 diagnostic criteria for cluster headache (a
type of trigeminal autonomic cephalalgias)?
    The ICHD-3 diagnostic criteria for cluster headache are headaches
not better accounted for by another ICHD-3 diagnosis and at least five
headache attacks satisfying the following criteria:
     Severe or very severe \20\ unilateral orbital,
supraorbital, or temporal pain lasting 15 to 180 minutes (when
untreated);
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    \20\ Id.
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     One or both of the following:
    [cir] A sense of restlessness or agitation or
    [cir] At least one of the following symptoms or signs occurring on
the same side of the body as the headache:
    [ssquf] Conjunctival injection (red eye);
    [ssquf] Lacrimation (secretion of tears);
    [ssquf] Nasal congestion or rhinorrhea (runny nose);
    [ssquf] Eyelid edema (puffy eyelid);
    [ssquf] Forehead and facial sweating;
    [ssquf] Miosis (excessive constriction of the pupil); or
    [ssquf] Ptosis (drooping of the upper eyelid); and
     Occurring with a frequency between one every other day and
eight per day.
    7. How do we establish a primary headache disorder as an MDI?
    We establish a primary headache disorder as an MDI by considering
objective medical evidence (signs, laboratory findings, or both) from
an AMS.\21\ We may establish only a primary headache disorder as an
MDI. We will not establish secondary headaches (for example, headache
attributed to trauma or injury to the head or neck or to infection) as
MDIs because secondary headaches are symptoms of another underlying
medical condition. We evaluate the underlying medical condition as the
MDI. Generally, successful treatment of the underlying condition will
alleviate the secondary headaches.
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    \21\ See 20 CFR 404.1502(a) and 416.902(a).
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    We will not establish the existence of an MDI based only on a
diagnosis or a statement of symptoms; however, we will consider the
following combination of findings reported by an AMS when we establish
a primary headache disorder as an MDI:
     A primary headache disorder diagnosis from an AMS. Other
disorders have similar symptoms, signs, and laboratory findings. A
diagnosis of one of the primary headache disorders by an AMS identifies
the specific condition that is causing the person's symptoms. The
evidence must document that the AMS who made the diagnosis reviewed the
person's medical history, conducted a physical examination, and made
the diagnosis of primary headache disorder only after excluding
alternative medical and psychiatric causes of the person's symptoms. In
addition, the treatment notes must be consistent with the diagnosis of
a primary headache disorder.\22\
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    \22\ As explained in question 2, a person's ``headache journal''
may aid a physician in diagnosing a headache disorder after
reviewing a person's full medical and headache history. We do not
require evidence from a person's ``headache journal'' in order to
establish an MDI of a headache disorder. Our current rules require
objective medical evidence, consisting of signs, laboratory finding,
or both, from an AMS to establish an MDI. We will, however, consider
evidence from a person's ``headache journal'' when it is part of the
record, either as part of the treatment notes or as separate
evidence, along with all evidence in the record.
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     An observation of a typical headache event, and a detailed
description of the event including all associated phenomena, by an AMS.
During a physical examination, an AMS is often able to observe and
document signs that co-occur prior to, during, and following the
headache event. Examples of co-occurring observable signs include
occasional tremors, problems concentrating or remembering, neck
stiffness, dizziness, gait instability,skin flushing, nasal congestion
or rhinorrhea (runny nose), puffy eyelid, forehead or facial sweating,
pallor, constriction of the pupil, drooping of the upper eyelid, red
eye, secretion of tears, and the need to be in a quiet or dark room
during the examination. In the absence of direct observation of a
typical headache event by an AMS, we may consider a third party
observation of a typical headache event, and any co-occurring
observable signs, when the third party's description of the event is
documented by an AMS and consistent with the evidence in the case file.
     Remarkable or unremarkable findings on laboratory tests.
We will make every reasonable effort to obtain the results of
laboratory tests. We will not routinely purchase tests related to a
person's headaches or allegations of headaches. We will not purchase
imaging or other diagnostic or laboratory tests that are complex, may
involve significant risk, or are invasive.
     Response to treatment. Medications and other medical
interventions are generally tailored to a person's unique symptoms,
predicted response, and risk of side effects. Examples of medications
used to treat primary headache disorders include, but are not limited
to, botulinum neurotoxin (Botox[supreg]), anticonvulsants, and
antidepressants. We will consider whether the person's headache
symptoms have improved, worsened, or remained stable despite treatment
and consider medical opinions related to the person's physical strength
and functional abilities. When evidence in the file from an AMS
documents ongoing headaches that persist despite treatment, such
findings may constitute medical signs that help to establish the
presence of an MDI.\23\
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    \23\ See 20 CFR 404.1502(g) and 416.902(l).
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    8. How do we evaluate an MDI of a primary headache disorder under
the Listing of Impairments?
    Primary headache disorder is not a listed impairment in the Listing
of Impairments (listings); \24\ however, we may find that a primary
headache disorder, alone or in combination with
[[Page 44671]]
another impairment(s), medically equals a listing.\25\
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    \24\ See 20 CFR part 404, subpart P, Appendix 1, and 20 CFR
404.1525 and 416.925.
    \25\ See 20 CFR 404.1526 and 416.926 and SSR 17-2p: Titles II
and XVI: Evidence Needed by Adjudicators at the Hearings and Appeals
Council Levels of the Administrative Review Process to Make Findings
about Medical Equivalence, 82 FR 15263 (2017) (also available at:
https://www.ba.ssa.gov/OP_Home/rulings/di/01/SSR2017-02-di-01.html).
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    Epilepsy (listing 11.02) is the most closely analogous listed
impairment for an MDI of a primary headache disorder. While uncommon, a
person with a primary headache disorder may exhibit equivalent signs
and limitations to those detailed in listing 11.02 (paragraph B or D
for dyscognitive seizures), and we may find that his or her MDI(s)
medically equals the listing.
    Paragraph B of listing 11.02 requires dyscognitive seizures
occurring at least once a week for at least 3 consecutive months
despite adherence to prescribed treatment. To evaluate whether a
primary headache disorder is equal in severity and duration to the
criteria in 11.02B, we consider: A detailed description from an AMS of
a typical headache event, including all associated phenomena (for
example, premonitory symptoms, aura, duration, intensity, and
accompanying symptoms); the frequency of headache events; adherence to
prescribed treatment; side effects of treatment (for example, many
medications used for treating a primary headache disorder can produce
drowsiness, confusion, or inattention); and limitations in functioning
that may be associated with the primary headache disorder or effects of
its treatment, such as interference with activity during the day (for
example, the need for a darkened and quiet room, having to lie down
without moving, a sleep disturbance that affects daytime activities, or
other related needs and limitations).
    Paragraph D of listing 11.02 requires dyscognitive seizures
occurring at least once every 2 weeks for at least 3 consecutive months
despite adherence to prescribed treatment, and marked limitation in one
area of functioning. To evaluate whether a primary headache disorder is
equal in severity and duration to the criteria in 11.02D, we consider
the same factors we consider for 11.02B and we also consider whether
the overall effects of the primary headache disorder on functioning
results in marked limitation in: Physical functioning; understanding,
remembering, or applying information; interacting with others;
concentrating, persisting, or maintaining pace; or adapting or managing
oneself.
    9. How do we consider an MDI of a primary headache disorder in
assessing a person's residual functional capacity?
    If a person's primary headache disorder, alone or in combination
with another impairment(s), does not medically equal a listing at step
three of the sequential evaluation process, we assess the person's
residual functional capacity (RFC). We must consider and discuss the
limiting effects of all impairments and any related symptoms when
assessing a person's RFC.\26\ The RFC is the most a person can do
despite his or her limitation(s).
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    \26\ See 20 CFR 404.1545 and 416.945.
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    We consider the extent to which the person's impairment-related
symptoms are consistent with the evidence in the record. For example,
symptoms of a primary headache disorder, such as photophobia, may cause
a person to have difficulty sustaining attention and concentration.
Consistency and supportability between reported symptoms and objective
medical evidence is key in assessing the RFC.
    This SSR is applicable on August 26, 2019.\27\
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    \27\ We will use this SSR beginning on its applicable date. We
will apply this SSR to new applications filed on or after the
applicable date of the SSR and to claims that are pending on and
after the applicable date. This means that we will use this SSR on
and after its applicable date in any case in which we make a
determination or decision. We expect that Federal courts will review
our final decisions using the rules that were in effect at the time
we issued the decisions. If a court reverses our final decision and
remands a case for further administrative proceedings after the
applicable date of this SSR, we will apply this SSR to the entire
period at issue in the decision we make after the court's remand.
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    Cross References: SSR 83-12: Title II and XVI: Capability To Do
Other Work--The Medical-Vocational Rules as a Framework for Evaluating
Exertional Limitations Within a Range of Work or Between Ranges of
Work; SSR 83-14: Titles II and XVI: Capability To Do Other Work--The
Medical-Vocational Rules as a Framework for Evaluating a Combination of
Exertional and Nonexertional Impairments; SSR 85-15: Titles II and XVI:
Capability To Do Other Work--The Medical-Vocational Rules as a
Framework for Evaluating Solely Nonexertional Impairments; SSR 86-8:
Titles II and XVI: The Sequential Evaluation Process; SSR 96-8p: Titles
II and XVI: Assessing Residual Functional Capacity in Initial Claims;
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; SSR 11-2p: Titles II and XVI: Documenting and
Evaluating Disability in Young Adults; SSR 16-3p: Titles II and XVI:
Evaluation of Symptoms in Disability Claims; SSR 17-2p: Titles II and
XVI: Evidence Needed by Adjudicators at the Hearings and Appeals
Council Levels of the Administrative Review Process to Make Findings
about Medical Equivalence; and Program Operations Manual System (POMS)
DI 22001.001, DI 22505.001, DI 22505.003, DI 24501.020, DI 24501.021,
DI 24503.005, DI 24503.025, DI 24503.030, DI 24503.035, DI 24505.001,
DI 24510.005, DI 24510.057, DI 24515.012, DI 24515.062, DI 24515.063,
DI 25025.001, DI 25505.025, and DI 25505.030.
[FR Doc. 2019-18310 Filed 8-23-19; 8:45 am]
 BILLING CODE 4191-02-P