6.1 Medical Evidence Flashcards
“What is the role of medical evidence in SSA disability determinations?”
“Medical evidence is the primary basis for determining whether a claimant meets the SSA’s definition of disability.”
Explanation: “SSA requires objective medical documentation to establish the existence, severity, and duration of a claimant’s impairment.”
Source: CFR §404.1512.
What are acceptable medical sources (AMS) for SSA claims?”
Answer:
“1. Licensed physicians.”
“2. Licensed psychologists.”
“3. Licensed optometrists (for visual disorders).”
“4. Licensed podiatrists (for foot/ankle disorders).”
“5. Qualified speech-language pathologists (for speech or language impairments).”
Explanation: “SSA relies on AMS to provide diagnoses, opinions, and medical records.”
Source: CFR §404.1502.
“What is the role of a treating physician in SSA determinations?”
Answer: “The treating physician provides longitudinal medical evidence, often given significant weight in assessing a claimant’s functional limitations.”
Explanation: “Although SSA no longer applies the ‘treating physician rule,’ consistency and supportability of evidence are key factors.”
Source: SSA Rulings on Medical Evidence.
“What is a consultative examination (CE)?”
Answer: “A medical examination ordered by SSA to obtain additional evidence when the claimant’s records are insufficient.”
Explanation: “CAs are performed by independent medical professionals, and their findings are considered with other evidence.”
Source: CFR §404.1519.
Case Scenario: Alex applies for SSDI benefits, citing severe chronic migraines. His medical records include a diagnosis from his family doctor but lack treatment notes or specialist evaluations.
Question: Does Alex have sufficient medical evidence to support his disability claim?
Answer: No, Alex’s medical evidence is insufficient because SSA requires detailed documentation, including objective findings and treatment history, ideally from specialists.
Legal Explanation: SSA relies on objective medical evidence from acceptable medical sources to establish the existence and severity of impairments. A mere diagnosis without supporting treatment notes or specialist input may not meet SSA’s evidence standards.
Key Resource: CFR §404.1513 – Rules on acceptable medical sources and evidence requirements.
Case Scenario: Tina submits medical records from her chiropractor to substantiate her claim for back pain-related disability. The records show regular treatments but no imaging studies or physician evaluations.
Question: Can SSA rely on the chiropractor’s records to determine Tina’s eligibility?
Answer: No, SSA cannot rely solely on the chiropractor’s records because chiropractors are not considered acceptable medical sources for establishing a medically determinable impairment.
Legal Explanation: SSA considers evidence from acceptable medical sources, such as licensed physicians or specialists, to establish impairments. Non-acceptable sources, like chiropractors, can only provide supplementary information.
Key Resource: CFR §404.1502 – Definitions of acceptable medical sources.
Medical Evidence:
Must come from acceptable medical sources and include objective findings.
