Earlier this year the Social Security Administration (SSA) published new rules in the Federal Register (82 FR 5844) regarding the evaluation of medical evidence in disability claims. All Social Security disability claims, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims, filed on or after March 27, 2017, will be assessed according to these new rules.
The following rules have been revised:
- Rules about acceptable medical sources;
- How the SSA considers and articulates their consideration of medical opinions and prior administrative medical findings;
- The SSA’s articulation requirements for other kinds of evidence;
- The rules about medical and psychological consultants; and
- The rules about treating sources.
The new rules were instituted in an effort by the SSA to fight fraud and streamline the application process, but for many individuals these new rules have created a fog of uncertainty about moving through a lengthy process that, even before the new rules, seemed complicated and difficult. In fact, according to the National Organization of Claimants’ Representatives, less than half of all people who apply for disability benefits in the United States are actually accepted into the benefits program.
As such, an understanding of and compliance with the rules is more critical than ever when submitting a disability claim.
Here’s a guide to help you navigate the changes.
Opinion of Treating Physician no Longer Given Extra Weight
Previously, when you filed a Social Security disability claim, the Administrative Law Judges and claim reviewers evaluating the medical evidence in your claim could give more weight to the opinions of your treating physician. A treating physician or treating source is the medical doctor, osteopath or Ph.D.-level psychologist with whom you have an ongoing relationship, who sees and treats you on a regular basis.
In the new rules, the SSA removed the term “treating source” from the regulations entirely and replaced it with “your medical source.” Now, while
your treating physician’s opinion can still be included as evidence in your claim, it can no longer be given any special weight during the review.
The rules do allow for an individual’s own medical source’s opinion to be considered the most persuasive if the opinion is consistent with other evidence and supported by that of relevant objective medical evidence.
What it all means: In short, under the new SSA rules, evidence from your treating physician, with whom you likely have an ongoing relationship and who likely has the most in-depth information about your condition, will be given the same weight as evidence from a medical consultant hired to conduct a one-time evaluation or to simply review your paperwork. This may make it more difficult to get a claim approved, especially for those suffering from conditions like lupus where symptoms aren’t always obvious.
No Special Weight Given to Decisions by Other Governmental Agencies
In addition to no longer giving extra weight to the opinion of the treating source, the SSA will no longer give any special weight to decisions made regarding disability by other governmental and nongovernmental agencies. The SSA states that those decisions “are inherently neither valuable nor persuasive to us.”
This rule includes decisions about disability ratings by the Department of Veterans Affairs (VA). This means, for example, that disability ratings given by the VA will no longer be given weight in SSDI or SSI case evaluations. The medical evidence submitted in a VA claim, however, will continue to be viewed and evaluated.
What it all means: Previously, a disability rating from another governmental agency like the VA was given extra weight by those reviewing SSDI and SSI claims. These ratings will now no longer be considered, which could also make it more difficult to get a claim approved. The good news is that claim reviewers can still consider the medical information that led to the previous disability rating when reviewing a SSDI or SSI claim.
Expanded List of Acceptable Medical Sources
With the new rules, the SSA has expanded the list of Acceptable Medical Sources (AMS) whose opinion may be included as medical evidence in your claim. AMSs are doctors and other health care professionals who have evaluated you and treated you for your condition.
Previously that list included:
- Licensed physicians,
- Licensed or certified psychologists,
- Licensed optometrists,
- Licensed podiatrists and
- Qualified speech-language pathologists.
The SSA has expanded that list to now also include:
- Physician Assistants,
- Advance Practice Registered Nurses and
- Licensed audiologists.
The following categories of health care professionals are not on the list of AMSs:
- Registered Nurses,
- Chiropractors and
- Licensed Clinical Social Workers.
Don’t Go it Alone
If you have questions about the new SSA rules, call our office; the attorneys in Robinson & Henry’s disability practice can answer them and others you may have about your SSDI or SSI claim.