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The inability to use one or both hands to perform fine and gross movements can very seriously impact an individual’s ability to perform substantial work activity. To be able to use the upper extremities effectively, an individual must be able to reach, push, pull, grasp and finger. Difficulty in performing activities such as preparing a simple meal, sort and handle papers or files on a consistent basis are a couple of indicators of a severe problem. In addition, the presence of pain at an occasional and severe level that limits this type of activity must also be considered by SSA.