Section 6: Evidence and Medical Records-Advance Flashcards
Scenario:
Michael submits medical records from his general practitioner, but SSA denies his claim, stating the evidence is insufficient to establish disability.
Question:
What type of evidence does SSA require to establish a disability?
Answer:
SSA requires objective medical evidence from acceptable medical sources, such as licensed physicians, psychologists, or specialists, to establish a medically determinable impairment.
Explanation:
General statements or subjective complaints are insufficient. Evidence must include diagnostic tests, clinical findings, and other objective data.
Key Resource: CFR §404.1513(a) – Acceptable medical sources.
Key Takeaway:
SSA requires objective medical evidence from acceptable medical sources to establish a disability.
Scenario:
Lisa fails to submit her complete medical records by the ALJ hearing date. She argues the ALJ must still consider the evidence if she provides it after the hearing.
Question:
Can the ALJ consider late-submitted evidence?
Answer:
Yes, but only if Lisa demonstrates good cause for the delay under SSA’s Five-Day Rule.
Explanation:
Under the Five-Day Rule, claimants must submit evidence at least five business days before the hearing. Exceptions are granted only with good cause, such as unexpected delays from medical providers.
Key Resource: CFR §404.935 – Five-Day Rule for evidence submission.
Key Takeaway:
Evidence submitted after the Five-Day Rule deadline is considered only if good cause for the delay is demonstrated.
Scenario:
Tom submits an RFC form completed by a nurse practitioner, claiming it supports his inability to work. SSA states the form lacks weight because it is not from an acceptable medical source.
Question:
Can evidence from a nurse practitioner be considered?
Answer:
Yes, evidence from a nurse practitioner may be considered, but it does not carry the same weight as evidence from an acceptable medical source.
Explanation:
SSA evaluates evidence from non-acceptable medical sources as “other evidence,” which can support claims but does not establish a medically determinable impairment.
Key Resource: CFR §404.1527(f) – Weight of evidence from other medical sources.
Key Takeaway:
Evidence from non-acceptable medical sources can support claims but does not establish a medically determinable impairment.
Scenario:
Sarah provides conflicting medical records from two different specialists regarding the severity of her condition. The ALJ gives more weight to the treating physician’s opinion.
Question:
Why might the ALJ give more weight to the treating physician’s opinion?
Answer:
The treating physician’s opinion may be given more weight if it is well-supported by medical evidence and consistent with the overall record.
Explanation:
SSA gives controlling weight to treating source opinions when they are well-supported and not inconsistent with other evidence.
Key Resource: CFR §404.1527(c)(2) – Treating physician rule.
Key Takeaway:
Treating source opinions receive controlling weight when well-supported and consistent with the record.
Scenario:
What is required for evidence to establish a medically determinable impairment?
Question:
What type of evidence is necessary to establish a medically determinable impairment?
Answer:
Objective medical evidence from acceptable medical sources, such as diagnostic tests and clinical findings.
Explanation:
Subjective complaints are insufficient to establish an impairment. Evidence must demonstrate the existence of a medically determinable condition.
Key Resource: CFR §404.1513(a) – Acceptable medical sources.
Key Takeaway:
Objective evidence from acceptable medical sources is required to establish a medically determinable impairment.
Scenario:
When must evidence be submitted for an ALJ hearing?
Question:
What is the deadline for submitting evidence to an ALJ?
Answer:
At least five business days before the hearing, unless there is good cause for late submission.
Explanation:
The Five-Day Rule ensures the ALJ has adequate time to review all evidence. Exceptions require good cause, such as provider delays.
Key Resource: CFR §404.935 – Five-Day Rule.
Key Takeaway:
Evidence must be submitted at least five business days before the ALJ hearing unless good cause is shown.
Scenario:
David submits evidence of his disability that includes diagnostic tests and a vocational assessment. SSA denies his claim, stating the vocational evidence is insufficient.
Question:
Can vocational evidence alone establish disability?
Answer:
No, vocational evidence alone cannot establish disability. SSA requires medical evidence to establish a medically determinable impairment.
Explanation:
Vocational evidence may support claims of functional limitations but cannot substitute for medical evidence of a medically determinable impairment.
Key Resource: CFR §404.1520(c) – Evidence of severity.
Key Takeaway:
Vocational evidence cannot establish disability without supporting medical evidence.
Scenario:
Emma’s medical records indicate inconsistent findings from multiple providers regarding her functional capacity. The ALJ relies on a consultative examiner’s opinion for the decision.
Question:
Can the ALJ give more weight to a consultative examiner’s opinion over treating physicians?
Answer:
Yes, the ALJ can give more weight to a consultative examiner’s opinion if it is more consistent with the overall evidence.
Explanation:
When treating source opinions are inconsistent or unsupported, SSA may rely on consultative examinations or other evidence to make a determination.
Key Resource: CFR §404.1527(c) – Evaluating conflicting evidence.
Key Takeaway:
The ALJ may give more weight to consultative opinions if they are better supported by the record.
