6.4 Weight of Evidence Flashcards
“What factors determine the weight of medical opinions?”
Answer:
“1. Supportability: How well the opinion is supported by objective medical evidence.”
“2. Consistency: How consistent the opinion is with other evidence in the record.”
“3. Specialization: Whether the provider is a specialist in the relevant field.”
Explanation: “These factors ensure that SSA considers the quality and reliability of medical evidence.”
Source: CFR §404.1520c.
“What is the hierarchy of medical opinions in SSA determinations?”
Answer:
“1. Opinions from acceptable medical sources.”
“2. Opinions from non-acceptable sources (e.g., nurse practitioners).”
“3. Other evidence, such as non-medical statements.”
Explanation: “SSA prioritizes evidence from AMS but considers all relevant information.”
“Does SSA still apply the treating physician rule?”
Answer: “No, SSA evaluates medical opinions based on supportability and consistency rather than giving deference to treating sources.”
Explanation: “This change promotes an objective analysis of the evidence.”
Case Scenario: Dr. Smith, a treating physician, provides a statement that Alex cannot work due to chronic pain. Dr. Smith’s opinion conflicts with other evidence in the record, including consultative examination findings.
Question: Will SSA give controlling weight to Dr. Smith’s opinion?
Answer: No, SSA will not give controlling weight to Dr. Smith’s opinion because it conflicts with other evidence and lacks sufficient supportability.
Legal Explanation: Under SSA rules, medical opinions are evaluated for supportability (evidence backing the opinion) and consistency (agreement with the record). Treating source opinions are no longer given automatic controlling weight.
Key Resource: CFR §404.1520c – Factors for evaluating medical opinions.
Case Scenario: Dr. Smith, a treating physician, provides a statement that Alex cannot work due to chronic pain. Dr. Smith’s opinion conflicts with other evidence in the record, including consultative examination findings.
Question: Will SSA give controlling weight to Dr. Smith’s opinion?
Answer: No, SSA will not give controlling weight to Dr. Smith’s opinion because it conflicts with other evidence and lacks sufficient supportability.
Legal Explanation: Under SSA rules, medical opinions are evaluated for supportability (evidence backing the opinion) and consistency (agreement with the record). Treating source opinions are no longer given automatic controlling weight.
Key Resource: CFR §404.1520c – Factors for evaluating medical opinions.
Case Scenario: Maria’s medical record includes an RFC assessment from her treating neurologist. The neurologist’s opinion is detailed and consistent with imaging studies and clinical findings.
Question: Will SSA assign significant weight to the neurologist’s opinion?
Answer: Yes, SSA is likely to assign significant weight to the neurologist’s opinion because it is well-supported and consistent with the evidence.
Legal Explanation: SSA gives greater weight to medical opinions that are supported by objective evidence and consistent with the overall record, regardless of the source’s role as a treating physician.
Key Resource: CFR §404.1520c – Evaluation of supportability and consistency of medical opinions.
Weight of Evidence:
Opinions are evaluated for supportability and consistency with the record.
