OTIS R. BOWEN, SECRETARY OF HEALTH AND HUMAN SERVICES, PETITIONER V. JANET J. YUCKERT No. 85-1409 In the Supreme Court of the United States October Term, 1986 On Writ of Certiorari to the United States Court of Appeals for the Ninth Circuit Brief for the Petitioner TABLE OF CONTENTS Opinions below Jurisdiction Statutory and regulatory provisions involved Question Presented Statement A. The statutory and regulatory framework B. The proceedings in this case Summary of argument Argument: The severity regulation constitutes a valid exercise of the Secretary's authority under 42 U.S.C. 405(a) to issue rules regulating the receipt of evidence and manner of proof in disability cases and to give content to the statutory definition in 42 U.S.C. 423(d)(1)(A) of the term "disability" A. The validity of the severity regulation is supported by the statutory definition of the term "disability" in 42 U.S.C. 423(d)(1)(A), as well as other provisions of the Act, and is expressly sanctioned by the Social Security Disability Benefits Reform Act of 1984 B. The legislative history of the relevant amendments to the Social Security Act and the administrative history of the disability program conform the validity of the severity regulation Conclusion Appendix OPINIONS BELOW The opinion of the court of appeals (Pet. App. 1a-12a) is reported at 774 F.2d 1365. The order of the district court (Pet. App. 14a) and the recommendation of the magistrate (Pet. App. 15a-19a) are unreported. JURISDICTION The judgment of the court of appeals was entered on October 24, 1985 (Pet. App. 13a). By order dated January 14, 1986, Justice Rehnquist extended the time within which to file a petition for a writ of certiorari to and including February 21, 1986. The petition was filed on that date and was granted on May 19, 1986. The jurisdiction of this Court is invoked under 28 U.S.C. 1254(l). STATUTORY AND REGULATORY PROVISIONS INVOLVED Section 223(d)(1)(A), (2)(A) and (C) of the Social Security Act, as codified at 42 U.S.C. (& Supp. II) 423(d)(1)(A), (2)(A) and (C); Section 1614(a)(3)(A), (B) and (G) of the Social Security Act, as codified at 42 U.S.C. (& Supp. II) 1382c(a)(3)(A), (B) and (G); and 20 C.F.R. 404.1520, 404.1521, 416.920, 416.921, are reproduced at App., infra, 1a-7a. QUESTION PRESENTED Whether the court of appeals erroneously invalidated a regulation promulgated by the Secretary of Health and Human Services, 20 C.F.R. 404.1520(c), which provides that a person seeking Social Security disability benefits will be found not to be disabled if he does not have a medically "severe" impairment that significantly limits his ability to do basic work activities. STATEMENT The court of appeals in this case invalidated a regulation that is an integral part of the sequential evaluation process established by the Secretary of Health and Human Services for determining whether a person seeking Social Security disability benefits is disabled. The regulation provides that if the claimant does not have a medically "severe" impairment -- defined to mean an impairment that significantly limits his mental or physical ability to do the basic work activities that are necessary for most jobs -- the claimant will be found not to be disabled. A. THE STATUTORY AND REGULATORY FRAMEWORK Title II of the Social Security Act provides, inter alia, for the payment of insurance benefits to a person who is "under a disability." 42 U.S.C. (Supp. II) 423(a)(1)(D). Disability benefits also are provided under the Supplemental Security Income (SSI) program established by Title XVI of the Act. 42 U.S.C. (& Supp. II) 1382(a). The term "disability" is defined to mean inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months * * * (.) 42 U.S.C. 423(d)(1)(A); see also 42 U.S.C. 1382c(a)(3)(A). The Act further provides in relevant part that an individual shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work. 42 U.S.C. (Supp. II) 423(d)(2)(A); 42 U.S.C. 1382c(a)(3)(B). To implement these statutory definitions, the Secretary by regulation has established a five-step "sequential evaluation" process to be followed by the decision-maker (the state agency, the administrative law judge (ALJ), or the Appeals Council) in determining whether a claimant is disabled. 20 C.F.R. 404.1520, 416.920. See Bowen v. City of New York, No. 84-1923 (June 2, 1986), slip op. 2-3; Heckler v. Campbell, 461 U.S. 458, 460 (1983). At step 1 of that process, the decision-maker determines whether the individual is engaged in work that constitutes substantial gainful activity. If so, he is not disabled. 20 C.F.R. 404.1520(b), 416.920(b). If the claimant is not engaged in substantial gainful activity, the sequential evaluation process continues to step 2, which is at issue in this case. At step 2, the decisionmaker determines whether the individual has demonstrated the existence of a medically "severe" impairment or combination of impairments. 20 C.F.R. 404.1520(c), 416.920(c). An impairment is not "severe" if it does not "significantly limit (the claimant's) physical or mental ability to do basic work activities" (20 C.F.R. 404.1521(a), 416.921(a)), which are defined to mean "the abilities and aptitudes necessary to do most jobs" (20 C.F.R. 404.1521(b), 416.921(b)). The regulations identify examples of such abilities and aptitudes: (1) "(p)hysical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling"; (2) "(c)apacities for seeing, hearing, and speaking"; (3) "(u)nderstanding, carrying out, and remembering simple instructions"; (4) "(u)se of judgment"; (5) "(r)esponding appropriately to supervision, co-workers and usual work situations"; and (6) "(d)ealing with changes in a routine work setting" (20 C.F.R. 404.1521(b), 416.921(b)). If the claimant does not have an impairment that significantly limits his ability to do such basic work activities, he will be found not to be disabled at step 2, without consideration of his age, education, and work experience. 20 C.F.R. 404.1520(c), 416.920(c). /1/ If the claimant is found to have a "severe" impairment, the decision-maker then must determine at step 3 of the sequential evaluation process whether the impairment is so serious as to meet or equal the listed impairments that are deemed by the Secretary to be of sufficient severity to preclude substantial gainful activity, without the need to consider the claimant's age, education, and work experience. 20 C.F.R. 404.1520(d), 416.920(d); 20 C.F.R. Pt. 404, Subpt. P, App. 1. If the individual's impairment is not one that is "conclusively presumed" to be disabling under these listings (see Bowen v. City of New York, slip op. 2), the decision-maker then must determine at step 4 whether the impairment prevents the individual from performing his own past work. If the claimant can do his past work, he is found not to be disabled. 20 C.F.R. 404.1520(e), 416.920(e). But if the claimant cannot do his past work, the decision-maker must determined at step 5 whether, in light of the claimant's age, education, and work experience, he nevertheless is able to perform other work that exists in the national economy. At this final step, the Secretary ordinarily applies the medical-vocational guidelines that were sustained by this Court in Heckler v. Campbell, supra. B. THE PROCEEDINGS IN THIS CASE 1. Respondent applied for Social Security disability benefits and SSI benefits in October 1980 (R. 82, 86). /2/ She alleged that she was disabled on the basis of labyrinthine (inner ear) dysfunction with occasional episodes of dizziness; loss of visual focus; and flat feet (Pet. App. 15a, 26a; R. 82). After her claim was denied at the initial determination and reconsideration stages (J.A. 19-26; R. 90-96, 98), respondent requested a hearing before an ALJ. The record before the ALJ showed that respondent was 45 years old and had a high school education, two years of business college, and real estate training (Pet. App. 26a). From 1963 to 1977, she had been employed as a travel agent (id. at 15a, 26a). From September 1978 through September 1979, with interruptions due to illness, respondent worked in real estate sales (id. at 15a); she testified that "the market kind of just fell because of the high interest rates and so I left that job in September of 1979" (R. 52). Following the hearing (R. 34-81), the ALJ concluded that respondent's impairments were not severe within the meaning of 20 C.F.R. 404.1520(c) and 416.920(c) and denied her claim (Pet. App. 24a-27a). The ALJ found that although respondent was not "free from episodes of dizziness or vision problems," she was "exaggerating the effects of her impairments" and, in particular, "appear(ed) to be overemphasizing the effect of her impairments on her ability to perform basic functions" (id. at 28a). The ALJ found in this regard that "(m)ultiple tests given (to respondent) failed to divulge objective clinical findings of abnormalities that support (the alleged) severity of the stated impairments" (id. at 27a), observing that respondent was successfully pursuing a "relatively difficult" two-year community college training plan for computer programming (id. at 27a-28a). In the ALJ's view, respondent's success in computer training, "coupled with generally negative clinical findings" and her ability to perform various activities, such as driving her car 80 to 90 miles per week, demonstrated that her vision and balance problems "(did) not significantly limit her ability to perform basic work-related functions, e.g., real estate salesperson" (id. at 28a). /3/ The Appeals Council denied respondent's request for review (Pet. App. 21a-22a), explaining that additional psychological testing data submitted to the Appeals Council by respondent's representative did not undermine the ALJ's decision (id. at 22a): The over-all results of all the testing indicated an average range of intellectual abilities, with no profound irregularities and the majority of skills still fully intact. Only the finger dexterity test administered showed a degree of difficulty. The Appeals Council notes in that regard that the limitations potentially imposed by the difficulty you might experience in small detailed parts dexterity does not indicate an inability to perform any substantial gainful activity. The weight of the entire evidence of record in your case, including the new evidence, supports the administrative law judge's finding that you do not have any significant impairment of work-related abilities. 2. Respondent then sought judicial review in the United States District Court for the Western District of Washington pursuant to 42 U.S.C. 405(g). The case was referred to a magistrate, who recommended that the district court affirm the Secretary's decision that respondent had not established that she had a severe impairment (Pet. App. 15a-19a). The magistrate noted the testimony by a vocational expert and a statement by a physician that respondent's impairments were incapacitating (id. at 18a). On the other hand, the magistrate found that respondent's success in the community college program "is substantial evidence of her ability to perform basic work activities" (id. at 17a-18a). In the magistrate's view, this determination was "reinforced" by the opinion of respondent's counselor at the state Department of Vocational Rehabilitation that respondent would have little problem in obtaining employment when she completed her training (id. at 18a). Although the evidence thus was conflicting regarding the severity of respondent's impairments, the magistrate concluded: "It is the function of the Secretary, * * * not of this court, to weigh that evidence and to resolve the issue. Because there is substantial evidence in support of the Secretary's conclusion, this court is required to affirm her determination" (id. at 19a). The district court adopted the magistrate's report and affirmed the Secretary's decision denying respondent's claim (id. at 14a, 20a). 3. The court of appeals reversed and remanded (Pet. App. 1a-12a). The court of appeals did not reach the question whether there was substantial evidence to support the Secretary's decision that respondent did not have a severe impairment that significantly limited her ability to do basic work activities. Instead, the court held that the regulation that permits the Secretary to deny benefits at step 2 of the sequential evaluation process because of the absence of a severe impairment is invalid. /4/ The court therefore directed that the case be remanded to the Secretary to be reconsidered without reliance on the severity regulation. a. The court of appeals recognized that under 42 U.S.C. 405(a), "Congress has delegated to the Secretary broad power 'to prescribe standards for applying certain sections of the (Social Security) Act'" (Pet. App. 8a, quoting Schweiker v. Gray Panthers, 453 U.S. 34, 43 (1981)). The court further recognized that the severity regulation must be sustained unless it exceeds the Secretary's statutory authority or is arbitrary and capricious (Pet. App. 8a, citing Heckler v. Campbell, 461 U.S. 458, 466 (1983)). However, the court held that the severity regulation violates the Social Security Act because, in the court's view, "it does not permit the individualized assessment of disability required by the Act" (Pet. App. 8a). The court gave three reasons for its conclusion. First, the court believed that the regulation is inconsistent with 42 U.S.C. 423(d)(2)(A), which provides that a claimant "shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy * * *." The court interpreted this provision to require the Secretary specifically "to consider factors such as (the claimant's) age, education, work experience, and ability to do past work" in every disability determination, irrespective of whether the claimant has demonstrated that his impairment satisfies a threshold level of severity (Pet. App. 5a, 9a). Second, the court "reject(ed)' the Secretary's contention that the legislative history of the Act, particularly the (Social Security Disability Benefits Reform Act of 1984), supports the sequential evaluation process" (Pet. App. 9a). The court acknowledged that Congress considered the severity regulation when it enacted the 1984 Act and had failed to eliminate the established requirement that the claimant demonstrate a severe impairment. However, relying on the fact that the House Report had "urge(d)" the Secretary to revise the severity criteria in order "'to reflect the real impact of impairments upon the ability to work'" (id. at 10a, quoting H.R. Rep. 98-618, 98th Cong., 2d Sess. 8 (1984)), the court believed that the legislative history of the 1984 Act did not suggest a congressional intent to permit a finding of non-disability to be based on medical evidence alone (Pet. App. 10a). Third, the court held that the regulation is contrary to judicial decisions that it construed to require that "disability determinations be made according to a two-step process, with the claimant first showing an inability to perform (his) past relevant work, and the Secretary then showing that the claimant nevertheless retains the ability to do other work" (Pet. App. 10a). Because the court believed that "the severity regulations ignores vocational factors where a claimant's impairment is found nonsevere," it held that the regulation "conflicts with this precedent and thus improperly denies benefits to a claimant who has made a prima facie showing of disability" (id. at 10a-11a). b. The court of appeals acknowledged, albeit only in a footnote (Pet. App. 9a n.6), that the Secretary had adopted a new Social Security Ruling, SSR 85-28, for the purpose of clarifying the application of the severity standard at step 2 of the sequential evaluation process. See Pet. App. 37a-44a. SSR 85-28 reflects both the Secretary's ongoing reevaluation of step 2 (see pages 47-48 & note 29, infra) and the Secretary's response to concerns expressed by several courts of appeals that the regulation might be too strictly applied. The Secretary explained in SSR 85-28 that the current severity regulation, which was promulgated in 1978 /5/ and revised somewhat in 1980, /6/ was not intended to alter the threshold level of impairment severity that had been applied prior to 1978. Under the pre-1978 standard, a claimant could be found not to be disabled on medical evidence alone (i.e., without specific consideration of his age, education, and work experience) if his impairment was "a slight neurosis, slight impairment of sight or hearing, or other slight abnormality or a combination of slight abnormalities." 20 C.F.R. 404.1502(a) (1977). Accordingly, the Secretary emphasized in SSR 85-28 that benefits are to be denied at step 2 of the current sequential evaluation regulations only when an individual's impairments "would have no more than a minimal effect on (his) ability to work even if the individual's age, education, or work experience were specifically considered" (Pet. App. 41a). The court of appeals recognized that SSR 85-28 interprets the severity regulation in the same manner as that approved by five other circuit courts (Pet. App. 8a-9a n.6). /7/ However, the court expressed no view on the validity of SSR 85-28 because it had not then been formally published /8/ and because the court in any event concluded that "the regulation it interprets is inconsistent with the Social Security Act" (ibid.). SUMMARY OF ARGUMENT The severity regulation at issue in this case is applied at step 2 of the five-step sequential process for the evaluation of disability claims. It is a screening mechanism that implements the congressional intent that Social Security disability benefits are to be paid only to those individuals whose impairments are sufficiently serious that they may properly be regarded as a substantial cause of their alleged inability to work. The Secretary is authorized by 42 U.S.C. 405(a) to adopt such regulations for the purposes of prescribing the procedures and evidentiary showings required in the adjudication of disability claims and of giving content to the statutory standards of eligibility. Contrary to the court of appeals' view, the particular regulation at issue here is fully supported by the text, legislative history, and consistent administrative implementation of the Social Security Act. A. The basic statutory definition of the term "disability," set forth in 42 U.S.C. 423(d)(1)(A), is the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment." The severity regulation gives content to and is fully consistent with that definition. Although the regulation requires that the claimant's impairment must satisfy a certain threshold level of severity based on medical evidence alone, that level of severity is measured essentially in vocational terms: the effect of the impairment on the claimant's mental and physical capacity to work. Thus, the regulation provides that a person is not disabled if he does not have an impairment (or combination of impairments) that "significantly limits" his ability to do "basic work activities" (20 C.F.R. 404.1520(c)), which are the "abilities and aptitudes necessary to do most jobs" (20 C.F.R. 404.1521(b)). If the claimant has not shown that his impairment significantly limits his ability to do such "basic work activities," then his impairment plainly does not render him unable to perform "any substantial gainful activity" within the meaning of the statutory definition of "disability" in 42 U.S.C. 423(d)(1)(A). Moreover, a number of provisions of the Act make clear that the claimant must demonstrate on the basis of medical evidence that he has a physical or mental impairment to which his alleged inability to work may properly be attributed. Section 423(d)(1)(A) itself requires that the impairment by "medically determinable" and that the inability to work be "by reason of" such an impairment. In addition, the term "physical or mental impairment" is defined to mean one that is "demonstrable by medically acceptable clinical and laboratory diagnostic techniques." 42 U.S.C. 423(d)(3). As this Court has recognized, the claimant bears the burden of making such a medical showing (Mathews v. Eldridge, 424 U.S. 319, 336 (1976)), and that burden is confirmed by 42 U.S.C. (Supp. II) 423(d)(5)(A), which provides that "(a)n individual shall not be considered to be under a disability unless he furnishes such medical and other evidence of the existence thereof as the Secretary may require." The court of appeals did not discuss these statutory provisions that support the severity regulation. Instead, it found the regulation to be inconsistent with 42 U.S.C. (Supp. II) 423(d)(2)(A), which provides that an individual shall be determined to be under a disability "only if" his impairment is "of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy." The court of appeals believed that the reference in this provision to the claimant's "age, education, and work experience" requires a consideration of these factors in every disability determination and that benefits therefore cannot be denied on the basis of medical evidence alone. Contrary to that court's view, however, Section 423(d)(2)(A) by its terms states further conditions of eligibility that must be satisfied before an application for benefits may be granted. It does not impose any additional conditions that must be satisfied in order for an application to be denied, where the Secretary has determined that the claimant has failed to satisfy the requirements of the basic definition of the term "disability" in Section 423(d)(1)(A) and implementing regulations -- including, as here, the threshold requirement that the claimant's impairment be severe. Moreover, as the interpretative guidance in SSR-85-28 makes clear, the severity regulation is consistent with Section 423(d)(2)(A) even if that provision does impose additional limitations on the denial of an application. In SSR 85-28, the Secretary explained that an impairment is found to be "not severe" only when the medical evidence establishes that the impairment "would have no more than a minamal effect on (the) individual's ability to work even if the individual's age, education, or work experience were specifically considered" (Pet. App. 41a). In any event, the validity of the severity regulation is expressly confirmed by 42 U.S.C. (Supp. II) 423(d)(2)(C), which was added by the Social Security Disability Benefits Reform Act of 1984. This new provision requires that the combined effect of all of the individual's impairments be considered in determining whether his condition is of "sufficient medical severity" that it could be the basis of eligibility, and further provides that if the Secretary does find a "medically severe" combination of impairments, the effect of those impairments shall be considered "throughout the disability determination process." The quoted phrases plainly contemplate the continued use of the severity step of the sequential evaluation process. B. The validity of the severity step of the sequential evaluation process is further confirmed by the legislative history of the relevant provisions of the Social Security Act and by the administration of the disability program since its inception in 1954. As an initial matter, the Senate and House reports on the Social Security Amendments of 1954 stress that the claimant must be "totally disabled"; that he must have both a medically determinable impairment of "serious proportions" and an inability to work "by reason of such impairment"; and that the impairment must be of a "degree of severity" to justify its consideration as the cause of his failure to obtain substantial gainful work. H.R. Rep. 1698, 83d Cong., 2d Sess. 23 (1954); S. Rep. 1987, 83d Cong., 2d Sess. 21 (1954). This expression of congressional intent firmly supports the requirement that a claimant's impairment satisfy a threshold level of severity. Moreover, the Secretary made clear in instructions issued to the state agencies immediately after the 1954 amendments were enacted that a person could be found on medical evidence alone not to be disabled, and this administrative interpretation was carried forward in formal regulations promulgated in 1960. This contemporaneous implementation of the Act is entitled to great weight. When Congress enacted 42 U.S.C. 423(d)(2)(A) in the 1967 amendments to the Social Security Act, it did not overrule or express disapproval of this position reflected in published regulations since 1960. To the contrary, in language that is a virtual blueprint for the sequential evaluation process now in effect, the committee reports on the 1967 amendments describe three distinct showings the claimant must make, the first of which is that "he has a severe medically determinable physical or mental impairment or impairments" (S. Rep. 744, 90th Cong., 1st Sess. 48-49 (1967); H.R. Rep. 544, 90th Cong., 1st Sess. 30 (1967)). After the 1967 amendments were enacted, the Secretary revised the disability regulations to take account of those amendments, and he retained the provision in the 1960 regulations that permitted benefits to be denied on medical grounds alone. This retention reflects a contemporaneous and manifestly reasonable understanding by the Secretary that Congress did not intend in 1967 to overturn the Secretary's formal and longstanding administrative intepretation. The severity regulation at issue in this case, which was promulgated in 1978 as part of the formal sequential evaluation process, carries forward this prior administrative interpretation and practice under the disability program. Congress again declined to disturb this regulation and the statutory interpretation it embodies when it amended the disability provisions in 1980 and 1982, and the legislative history of the 1980 amendments in fact reiterates the intent of the 1967 amendments that the claimant must demonstrate that he has a "severe medically determinable" impairment. Any remaining doubt regarding the validity of the severity regulation is dispelled by the Social Security Disability Benefits Reform Act of 1984. As we have said, amendments made by that Act expressly refer to the determination of whether the claimant's impairment is "medically severe." But in addition, the committee reports and floor debates make clear that Congress fully understood that a claim can be denied as "non-severe" at step 2 of the sequential evaluation process on the basis of medical evidence alone, without consideration of the claimant's age, education, and work experience; and the House, Senate, and Conference reports all expressly state that no departure from that process was intended (except to the extent of requiring consideration of the combined effect of multiple impairments). That unambiguous ratification of the severity regulation is controlling here. ARGUMENT THE SEVERITY REGULATION CONSTITUTES A VALID EXERCISE OF THE SECRETARY'S AUTHORITY UNDER 42 U.S.C. 405(a) TO ISSUE RULES REGULATING THE RECEIPT OF EVIDENCE AND MANNER OF PROOF IN DISABILITY CASES AND TO GIVE CONTENT TO THE STATUTORY DEFINITION IN 42 U.S.C. 423(d)(1)(A) OF THE TERM "DISABILITY" The severity regulation invalidated by the court of appeals in this case is an integral part of the five-step sequential evaluation process established by the Secretary of Health and Human Services of facilitate the fair, efficient, and uniform adjudication of the more than two million claims for disability benefits that are filed each year under the Social Security Act. The principle reflected in the regulation -- that in appropriate circumstances a persom may be denied disability benefits on the basis of medical evidence alone -- has been a feature of the disability program since its inception in 1954, and that principle has been endorsed by Congress on a number of occasions since that time. The requirement that the claimant make a showing on the basis of medical evidence that his impairment meets a specified threshold level of severity serves to insure that disability benefits are paid only where the claimant's physical or mental impairment is found to be a substantial cause of his inability to work, and thereby to distinguish the Social Security disability program from unemployment compensation and similar systems that are not primarily premised on medical incapacity. The severity regulation also serves an important screening function in the processing of scores of thousands of applications each month. The regulation makes it unnecessary for the decision-maker to engage in an individualized vocational evaluation where a medical assessment establishes that the claimant's impairment is sufficiently insubstantial that it reasonably could be expected not to preclude all substantial gainful activity, irrespective of the claimant's age, education, and work experience. "The need for efficiency is self-evident." Heckler v. Campbell, 461 U.S. at 461 n.2. In accordance with this premise, a number of courts of appeals have held that the severity regulation constitutes a valid administrative implementation of the statutory standard of disability. McDonald v. Secretary of Health & Human Services, No. 86-1288 (1st Cir. July 17, 1986), slip op. 10-20; Hampton v. Bowen, 785 F.2d 1308, 1311 (5th Cir. 1986); Garza v. Heckler, 771 F.2d 871, 873 (5th Cir. 1985); Stone v. Heckler, 752 F.2d 1099, 1101-1103 (5th Cir. 1985); Farmer v. Secretary of Health & Human Services, No. 85-5619 (6th Cir. July 11, 1986); Salmi v. Secretary of Health & Human Services, 774 F.2d 685, 691-692 (6th Cir. 1985); Farris v. Secretary of Health & Human Services, 773 F.2d 85, 89-90 (6th Cir. 1985); Flynn v. Heckler, 768 F.2d 1273, 1274-1275 (11th Cir. 1985); Brady v. Heckler, 724 F.2d 914, 918-920 (11th Cir. 1984); but cf. McCruter v. Bowen, 791 F.2d 1544 (11th Cir. 1986). /9/ These decisions of the various courts of appeals that have sustained the severity regulation are clearly correct. Heckler v. Campbell, 461 U.S. 458 (1983), establishes the governing framework for evaluating the validity of regulations promulgated by the Secretary to regulate the manner of proof in disability cases and to give content to the statutory definition of the term "disability." In Heckler v. Campbell, the Court considered the validity of the medical-vocational guidelines that are applied at step 5 of the sequential evaluation process. The Court observed that 42 U.S.C. 405(a) directs the Secretary to "adopt reasonable and proper rules and regulations to regulate and provide for the nature and extent of the proofs and evidence and the method of taking and furnishing the same" in disability cases. See 461 U.S. at 466. In the Court's view, Congress, through this directive, has "'conferred on the Secretary exceptionally broad authority to prescribe standards'" for applying the statutory definition of the term "disability." Ibid., quoting Schweiker v. Gray Panthers, 453 U.S. 34, 43 (1981). "Where, as here, the statute expressly entrusts the Secretary with the responsibility for implementing a provision by regulation," a court's review "is limited to determining whether the regulations promulgated exceeded the Secretary's statutory authority and whether they are arbitrary and capricious." 461 U.S. at 466. The severity regulation plainly suffers from neither defect. To the contrary, the text of the Act and the legislative and administrative history of the relevant statutory and regulatory provisions lend overwhelming support to the regulation -- far more so even than was the case with the medical-vocational guidelines that were unanimously sustained in Heckler v. Campbell. A. THE VALIDITY OF THE SEVERITY REGULATION IS SUPPORTED BY THE STATUTORY DEFINITION OS THE TERM "DISABILITY" IN 42 U.S.C. 423(d)(1)(A), AS WELL AS OTHER PROVISIONS OF THE ACT, AND IS EXPRESSLY SANCTIONED BY THE SOCIAL SECURITY DISABILITY BENEFITS REFORM ACT OF 1984 The severity step of the sequential evaluation process is affirmatively supported by the text of a number of the provisions of the Social Security Act that govern the disability program. The court of appeals failed to discuss those provisions, much less to consider their cumulative effect. 1. In the first place, the severity regulation employed at step 2 of the sequential evaluation process is directly tied to and faithfully implements the basic statutory definition of the term "disability" that applies in the Social Security disability program. That definition, which was enacted in the Social Security Amendments of 1954 (ch. 1206, Section 106(d), 68 Stat. 1080), provides that the term "disability" shall mean -- (the) inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months(.) 42 U.S.C. 423(d)(1)(A). /10/ The corresponding definition under the SSI program is identical. See 42 U.S.C. 1382c(a)(3)(A). Nothing in this generally worded definition casts any doubt on the validity of the severity regulation. The severity regulation informs the claimant: If you do not have an impairment or combination of impairments which significantly limits your physical or mental ability to do basic work activities, we will find that you do not have a severe impairment and are, therefore, not disabled. We will not consider your age, education, and work experience. 20 C.F.R. 404.1520(c), 416.920(c). The term "basic work activities" is defined by regulation for these purposes to mean "the abilities and aptitudes necessary to do most jobs." 20 C.F.R. 404.1521(b), 416.921(b). By way of amplification, the regulations include examples of such aptitudes and abilities: "(p)hysical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling;" "(c)apacities for seeing, hearing, and speaking;" "(u)nderstading, carrying out, and remembering simple instructions;" etc. 20 C.F.R. 404.1521(b), 416.921(b). Although the regulations at issue here thus prescribe a threshold showing of severity that the claimant's impairment must satisfy based solely on the medical evidence of the claimant's condition (i.e., without specific consideration of his age, education, and work experience), that severity is measured essentially in vocational terms -- the impact that the impairment has on the claimant's ability to perform the "basic work activities" that are "necessary to do most jobs." The regulations therefore adhere and give content to the statutory definition: if the claimant has not shown that his impairment is so severe as to "significantly limit" his ability to perform the basic work functions necessary for most jobs, then he plainly has not demonstrated, for purposes of the statutory definition, an "inability to engage in any substantial gainful activity by reason of (the) impairment" (42 U.S.C. 423(d)(1)(A)). See Brown v. Heckler, 786 F.2d at 873 (Bowman, J., concurring and dissenting). In other words, as the Secretary explained in the clarifying guidance contained in SSR 85-28 (discussed at page 10, supra), "(i)nherent in a finding of a medically not severe impairment or combination of impairments is the conclusion that the individual's ability to engage in SGA (substantial gainful activity) is not seriously affected" (Pet. App. 42a). 2. The court of appeals believed, however, that benefits cannot be denied in this manner on the basis of medical evidence alone and that the claimant's age, education, and work experience (which the court apparently regarded as the only "vocational" considerations) must be specifically considered in connection with every application for disability benefits. See Pet. App. 9a. This reasoning is seriously flawed for several reasons. In the first place, as we have just explained, the severity test at step 2 of the sequential evaluation process in fact does take vocationally related considerations into account, because the severity of an impairment must be measured in terms of its impact on the claimant's ability to perform basic work activities. Furthermore, a number of provisions of the Act make clear that the claimant must demonstrate, on the basis of medical evidence, that he has a physical or mental impairment to which his alleged inability to work may properly be attributed. Only then has the claimant established the necessary predicate for the finding, required by 42 U.S.C. 423(d)(1)(A), that his alleged inability to engage in any substantial gainful activity is "by reason of" his impairment. As an initial matter, Section 423(d)(1)(A) itself requires that the alleged impairment be "medically determinable." Moreover, 42 U.S.C. 423(d)(3) provides that for purposes of the basic statutory definition of "disability," a "physical or mental impairment" is "an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques." An applicant for disability benefits, such as respondent, bears the burden of establishing the existence of his impairment by such acceptable medical evidence. See Mathews v. Eldridge, 424 U.S. 319, 336 (1976). This burden is confirmed by 42 U.S.C. (Supp. II) 423(d)(5)(A), which provides that "(a)n individual shall not be considered to be under a disability unless he furnishes such medical and other evidence of the existence thereof as the Secretary may require." See Eldridge, 424 U.S. at 336. All of these provisions support the propriety of the Secretary's requirement that the claimant establish through medical evidence that his impairment meets a certain threshold level of severity. /11/ 3. The court of appeals did not discuss the authority for the severity regulation contained in the basic definition of "disability" in 42 U.S.C. 423(d)(1)(A) and the additional statutory provisions, just quoted, that pertain to the claimant's burden of producing medical evidence of his impairment. Instead, in its brief discussion of the statutory text, the court of appeals looked only to 42 U.S.C. (Supp. II) 423(d)(2)(A), which it believed rendered the severity regulation invalid on its face. Section 423(d)(2)(A), which was enacted in the Social Security Amendments of 1967 (Pub. L. No. 90-248, Section 158(b), 81 Stat. 868), provides in relevant part: an individual * * * shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy * * *. See also 42 U.S.C. 1382c(a)(3)(B). In the court of appeals' view, the reference in this provision to the claimant's "age, education, and work experience" requires a particularized consideration of those three factors in every disability determination, and benefits therefore cannot be denied solely on the basis of the medical evidence regarding the severity of the claimant's impairment. See Pet. App. 5a, 9a. The court of appeals erred in believing that the language of Section 423(d)(2)(A) compels a specific consideration of the claimant's age, education, and work experience in every disability determination, irrespective of the nature of the medical evidence of the claimant's alleged impairment. /12/ On its face, Section 423(d)(2)(A) merely states further conditions of eligibility that the claimant must satisfy in order for his application for benefits to be granted: Not only must he satisfy the requirements of the basic definition of "disability" in 42 U.S.C. 423(d)(1)(A); in addition, he will be found to be under a disability "only if" he is unable to do his previous work and any other kind of substantial gainful work which exists in the national economy. Conversely, however, Section 423(d)(2)(A) does not by its terms impose any conditions that must be satisfied in order for the claimant's application for benefits to be denied, at least where the Secretary has determined that the claimant has failed to satisfy the requirements of the basic definition of "disability" in Section 423(d)(1)(A) and implementing regulations. In this case, the Secretary has determined that respondent failed to satisfy the requirement in the regulations implementing Section 423(d)(1)(A) that her impairment must meet a threshold standard of severity. It therefore was unnecessary for the Secretary to proceed to the additional conditions of eligibility under Section 423(d)(2)(A), including an assessment of respondent's ability to perform her own past work and a specific consideration of respondent's age, education, and work experience for purposes of deciding whether she could perform any other substantial gainful work that exists in the national economy. /13/ Moreover, as SSR 85-28 makes clear, the severity regulation is fully consistent with 42 U.S.C. (Supp. II) 423(d)(2)(A) even if that provision were construed to limit the Secretary's power to deny an application where the claimant has failed to satisfy the eligibility requirements in Section 423(d)(1)(A) and implementing regulations. In SSR 85-28, the Secretary explained that an impairment is found to be "not severe" only when the medical evidence establishes that the impairment "would have no more than a minimal effect on (the) individual's ability to work even if the individual's age, education, or work experience were specifically considered" (Pet. App. 41a). "Thus, even if an individual were of advanced age, had minimal education, and a limited work experience, an impairment found to be not severe would not prevent him or her from engaging in SGA" (ibid.). As a result, the severity regulation operates to screen out those claimants who it may reasonably be presumed would be found not to be disabled if the sequential evaluation process were to proceed to a specific consideration at step 5 of their age, education, and work experience. See 43 Fed. Reg. 9296 (1978); McDonald v. Secretary of Health & Human Services, slip op. 11, 16-17; Hampton v. Bowen, 785 F.2d at 1311; Farris v. Secretary of Health & Human Services, 773 F.2d at 90; Brady v. Heckler, 724 F.2d 914, 920 (11th Cir. 1984) (quoting Appeals Council Review of Sequential Evaluation Under Expanded Vocational Regulations (1980)). 4. The validity of the severity step of the disability determination process is in any event expressly confirmed by 42 U.S.C. (Supp. II) 423(d)(2)(C). That paragraph, which was added by Section 4(b) of the Social Security Disability Benefits Reform Act of 1984 (98 Stat. 1800), provides (emphasis added): In determining whether an individual's physical or mental impairment or impairments are of a sufficient medical severity that such impairment or impairments could be the basis of eligibility under this section, the Secretary shall consider the combined effect of all of the individual's impairments without regard to whether any such impairment, if considered separately, would be of such severity. If the Secretary does find a medically severe combination of impairments, the combined effect of the impairments shall be considered throughout the disability determination process. /14/ The first sentence of this new paragraph clearly refers to the threshold determination of "medical severity" that is made at step 2 of the sequential evaluation process. And the second sentence just as clearly contemplates that the subsequent steps of the "disability determination process" (which include steps 4 and 5, at which the decision-maker would consider the claimant's ability to perform his past work and his age, education, and work experience) will be reached only "(i)f the Secretary does find a medically severe combination of impairments" (98 Stat. 1800 (emphasis added)). See Johnson v. Heckler, 776 F.2d at 170 (Easterbrook, J., dissenting from denial of rehearing en banc). In this case, because the Secretary found at step 2 that respondent did not have a medically severe impairment or impairments (Pet. App. 28a), it was unnecessary for the Secretary to proceed to the subsequent steps of the disability determination process. 5. In sum, the severity step of the sequential evaluation process is affirmatively supported by the text of the basic definition of the term "disability" in 42 U.S.C. 423(d)(1)(A) and by the other provisions of the Act that underscore the importance of medical evidence in the disability determination process. The regulation also is fully consistent with the further limitations on eligibility in 42 U.S.C. (Supp. II) 423(d)(2)(A), and it is expressly ratified by the new provision in 42 U.S.C. (Supp. II) 423(d)(2)(C) concerning the consideration of multiple impairments. The court of appeals' conclusion that the severity regulation conflicts with the text of the Act -- which was reached in a two-sentence discussion of 42 U.S.C. (Supp. II) 423(d)(2)(A) alone (Pet. App. 9a) -- therefore is completely without merit. /15/ B. THE LEGISLATIVE HISTORY OF THE RELEVANT AMENDMENTS TO THE SOCIAL SECURITY ACT AND THE ADMINISTRATIVE HISTORY OF THE DISABILITY PROGRAM CONFIRM THE VALIDITY OF THE SEVERITY REGULATION The validity of the severity step of the sequential evaluation process is further confirmed by the legislative history of the relevant amendments to the Social Security Act and the administrative history of the disability program since 1954. At virtually every turn, there is strong support for the regulation, and literally millions of claims have been tested against the threshold severity standard since the sequential evaluation process was formally adopted in 1978. It is far too late in the experience of the disability program for a court to hold that the severity regulation is beyond the Secretary's statutory authority. Yet there is no indication that the court of appeals gave any weight to these considerations in its almost casual invalidation of one of the most broadly applicable administrative measures on the books. 1. The basic statutory definition of the term "disability," which was enacted by Congress in 1954 and carried forward in 42 U.S.C. 423(d)(1)(A) in 1956 (see page 20 & note 10, supra), is the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment." The Senate and House reports on the 1954 amendments both stress that this definition limits the program's protection to "(o)nly those individuals who are totally disabled by illness, injury, or other physical or mental impairment" (H.R. Rep. 1698, supra, at 23; S. Rep. 1987, supra, at 20. This emphasis on "total" disability obviously supports the Secretary's adoption of a mechanism for screening out those claimants who impairments are relatively insignificant from a medical perspective and who therefore are, at most, only partially disabled. /16/ Moreover, the Senate and House Reports on the 1954 amendments contain a detailed explanation of the statutory definition of "disability" that is directly relevant to the issue in this case: There are two aspects of disability evaluation: (1) There must be a medically determinable impairment of serious proportions which is expected to be of long-continued and indefinite duration or to result in death, and (2) there must be a present inability to engage in substantial gainful work by reason of such impairment * * *. The physical or mental impairment must be of a nature and degree of severity sufficient to justify its consideration as the cause of failure to obtain any substantial gainful work. Standards for evaluating the severity of disabling conditions will be worked out in consultation with the State agencies. H.R. Rep. 1698, supra, at 23 (emphasis added); S. Rep. 1987, supra, at 21 (emphasis added). The first of the two "aspects" of the disability determination articulated by the congressional reports strongly supports the Secretary's adoption of an independent threshold requirement that the impairment be of "serious proportions" from a medical perspective alone. Only if that condition is met should it be necessary for the decision-maker to consider the second "aspect" of the disability determination: whether the claimant is unable to work by reason of "such impairment" -- i.e., by reason of an impairment found to be of "serious proportions." /17/ The second sentence quoted from the committee reports likewise makes clear Congress's intent that the impairment must rise to a certain threshold level of severity before it may even be considered as the cause of the claimant's alleged inability to work. This principle affords some measure of assurance that the claimant's alleged inability to work is actually "by reason of" his impairment, as the Act requires, and not merely coincidental with the existence of a relatively minor ailment. /18/ Finally, the third sentence in the passage supports the Secretary's decision to promulgate standards for "evaluating the severity" of impairments that, inter alia, require the claimant to make a threshold showing that his impairment significantly limits his ability to do basic work functions. /19/ 2. The congressional intent that a finding of non-disability may be based on medical factors alone -- where the claimant has failed to produce medical evidence that he has an impairment of serious proportions -- was reflected in the Disability Freeze State Manual, which HEW issued on March 16, 1955, to guide the state agencies in making disability determinations under the 1954 Act. The Manual stated by way of introduction (id. Section 304.B (emphasis added)): In the great majority of cases the State agency will be able to evaluate the applicant's impairment or combination of impairments on the basis that it meets or does not meet the level of severity presented in the listing of (presumptively disabling) impairments. (See Sections 321-323, 382-393.) Where a realistic evaluation cannot be made on the basis of the medical factors plus cessation of work, the State agency should consider non-medical factors described in the following sections. (See Sections 324-328, discussing age, education, and experience.) This passage makes clear that, in appropriate circumstances, a person could be found not to be disabled on "medical factors" alone (if his impairment "does not meet the level of severity" in the listings) and that consideration of the "non-medical" factors of age, education, and experience would be required only if a "realistic evaluation" could not be made on the basis of medical factors alone. See also id. Section 314.A ("The impairment must be sufficiently severe to be the cause of inability to work."); id. Section 321.A. ("great emphasis should be placed on the nature and severity of the medical impairment"). /20/ This contemporaneous interpretation of the statutory standard of disability was subsequently incorporated into the formal disability regulations promulgated by the Secretary in 1960. 25 Fed. Reg. 8100. This regulation provided in pertinent part (20 C.F.R. 404.1502(a)(1961) (emphasis added)): Whether or not an impairment in a particular case constitutes a disability * * * is determined from all the facts of that case. Primary consideration is given to the severity of the individual's impairment. Consideration is also given to such other factors as the individual's age, education, training and work experience. However, medical considerations alone may justify a finding that the individual is not under a disability where the only impairment is a slight neurosis, slight impairment of sight or hearing, or similar abnormality or combination of slight abnormalities. This regulation, promulgated pursuant to the Secretary's broad authority under 42 U.S.C. 405(a), gave content to the statutory standard of disability based on the accumulated experience to that date in the administration of the disability program. /21/ It therefore has particular significance here. Moreover, the regulation, which was revised slightly in 1965 (33 Fed. Reg. 11749), remained in effect in essentially identical form until 1978, when the sequential evaluation regulations were formally adopted. See pages 42-43, infra. Thus, the interpretation of the Act reflected in the current severity regulation -- that a claim may be denied on the basis of medical evidence alone if the impairment is relatively minor -- also has been a consistent and longstanding one, and it accordingly is entitled to particular deference by the courts. CFTC v. Schor, No. 85-621 (July 7, 1986), slip op. 10; Pattern Makers v. NLRB, No. 83-1894 (June 27, 1985), slip op. 19-20; Chevron U.S.A. Inc. v. NRDC, Inc., 467 U.S. 837, 844-845 (1984). /22/ 3. In 1967, Congress reexamined the operation of the disability program and added 42 U.S.C. 423(d)(2)(A) to the Act. Section 158(b), 81 Stat. 868. The court of appeals interpreted Section 423(d)(2)(A) essentially as a liberalization of the disability requirements, under which the Secretary is barred from denying benefits based on medical evidence, without also considering the claimant's age, education, and work experience. Pet. App. 5a, 9a. There is no support for this proposition. To the contrary, the legislative history demonstrates that Congress intended in 1967 to establish more stringent standards of disability and to "reemphasize the predominant importance of medical factors in the disability determination." S. Rep. 744, 90th Cong., 1st Sess. 48 (1967). This background obviously does not support the court of appeals' view that the enactment of Section 423(d)(2)(A) was intended to prohibit a policy of denying benefits on the basis of medical evidence alone in appropriate circumstances. Moreover, when the 1967 amendments were enacted, the regulations promulgated by the Secretary in 1960 to implement the basic statutory definition of "disability" were already in effect. Those regulations, quoted above, expressly provided that medical considerations alone would support a finding of no disability. 20 C.F.R. 404.1502(a)(1966). Yet Congress did not amend 42 U.S.C. 423(d)(1)(A) or otherwise disapprove the formal and settled administrative construction of the term "disability" reflected in those regulations. When Congress thoroughly reexamines a statutory program and revises it in certain respects, Congress is generally understood to have approved those aspects of the program that it left unaltered. See CFTC v. Schor, slip op. 11; FDIC v. Philadelphia Gear Corp., No. 84-1972 (May 27, 1986), slip op. 11; Merrill Lynch, Pierce, Fenner & Smith v. Curran, 456 U.S. 353, 381-382(1982). That conclusion is particularly compelling here. As we have explained (see pages 25-26, supra), the new 42 U.S.C. 423(d)(2)(A), by its terms, simply made explicit certain additional conditions of eligibility: Not only must the claimant establish that he has a mental or physical impairment of "serious proportions" and of "a nature and degree of severity" sufficient to justify its consideration as the cause of his failure to obtain work, as the committee reports on the 1954 amendments explained (see H.R. Rep. 1698, supra, at 23; S. Rep. 1987, supra, at 21 (both quoted at pages 31-32, supra)); under Section 423(d)(2)(A), a claimant who meets that requirement also must demonstrate that his "impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy" (42 U.S.C. (Supp. II) 423(d)(2)(A) (emphasis added)). Nothing in this further prerequisite undermines the validity of the preexisting threshold requirement under Section 423(d)(1)(A) that the claimant's impairment be severe from a medical perspective. The legislative history in fact confirms that Congress intended no such departure from settled practice. The House and Senate Reports both explained the method for determining disability that Congress contemplated: The bill would provide that such an individual would be disabled only if it is shown (i) that he has a severe medically determinable physical or mental impairment or impairments; (ii) that if, despite his impairment or impairments, an individual still can do his previous work, he is not under a disability; and (iii) that if, considering the severity of his impairment together with his age, education, and experience, he has the ability to engage in some other type of substantial gainful work that exists in the national economy even though he can no longer do his previous work, he also is not under a disability. S. Rep. 744, supra, at 48-49 (emphasis added); H.R. Rep. 544, 90th Cong., 1st Sess. 30 (1967) (emphasis added). This congressional description is a virtual blueprint for the sequential evaluation process that was formally adopted by the Secretary in 1978. The emphasized passage plainly supports the requirement at step 2 of the current process that a claimant