Social Security Administration Revises Its Medical Evidence Rules
Earlier this year the Social Security Administration (SSA) announced the revision of its final rules regarding disability claims. These changes in policy took effect March 27, 2017 and the SSA had this to say about the changes made:
We are revising our medical evidence rules. The revisions include redefining several key terms related to evidence, revising our rules about acceptable medical sources (AMS), revising how we consider and articulate our consideration of medical opinions and prior administrative medical findings, revising our rules about medical consultants (MC) and psychological consultants (PC), revising our rules about treating sources, and reorganizing our evidence regulations for ease of use. These revisions conform our rules to the requirements of the Bipartisan Budget Act of 2015 (BBA), reflect changes in the national healthcare workforce and in the manner that individuals receive medical care, and emphasize the need for objective medical evidence in disability and blindness claims. We expect that these changes will simplify our rules to make them easier to understand and apply, and allow us to continue to make accurate and consistent disability determinations and decisions.
Here is a List of the revisions made by the Social Security Administration:
- We revised the definitions of “signs” and “laboratory findings” to clarify that “one or more” signs, “one or more” laboratory findings, or both constitute objective medical evidence in final 404.1502 and 416.902.
- We revised the proposed regulatory text for AMS optometrists in final 404.1502 and 416.902 to refer to the scope of practice in the State in which the optometrist practices.
- We revised the proposed regulatory text for AMS audiologists in final 404.1502 and 416.902 to state that licensed audiologists are AMSs for impairments of hearing loss, auditory processing disorders, and balance disorders within the licensed scope of practice only.
- We recognized physician assistants as AMSs for claims filed on or after March 27, 2017, in final 404.1502 and 416.902.
- We revised the title and definition of the category of “evidence from nonmedical sources” in final 404.1513 and 416.913. We changed the title from “statements from nonmedical sources” as proposed to “evidence from nonmedical sources” for clarity. We revised the definition for brevity and to explain that we may receive evidence from nonmedical sources either directly from the nonmedical source or indirectly, such as from forms and our administrative records.
- We clarified that a statement(s) about whether or not an individual has a severe impairment(s) is a statement on an issue reserved to the Commissioner in final 404.1520b(c)(3) and 416.920b(c)(3).
- We revised final 404.1520c(a)-(b) and 416.920c(a)-(b) to clarify that, while we consider all evidence we receive, we have specific articulation requirements about how we consider medical opinions and prior administrative medical findings.
- For claims filed on or after March 27, 2017, we are revising our rules to state that our adjudicators will articulate how they consider medical opinions from all medical sources, regardless of whether or not the medical source is an AMS, in final 404.1520c and 416.920c.
- We revised the factors for considering medical opinions and prior administrative medical findings in final 404.1520c and 416.920c to both emphasize that there is not an inherent persuasiveness to evidence from MCs, PCs, or CE sources over an individual’s own medical source(s), and vice versa, and to highlight that we continue to consider a medical source’s longstanding treatment relationship with the individual.
- We added regulatory text in final 404.1520c(d) and 416.920c(d) for claims filed on or after March 27, 2017, that there is no requirement to articulate how we considered evidence from nonmedical sources about an individual’s functional abilities and limitations using the rules for considering and articulating our consideration of medical opinions found in final 404.1520c and 416.920c.
- We clarified the section headings and introductory text in final 404.1520c, 404.1527, 416.920c, and 416.927 about the implementation process.
- We added regulatory text in final 404.1527(f) and 416.927(f) for claims filed before March 27, 2017, about how we consider and articulate our consideration of opinions from medical sources who are not AMSs, and from nonmedical sources. We are adding our current policies found in SSR 06-03p, which explains how we consider and when we articulate our consideration of opinions from medical sources who are not AMSs and from nonmedical sources Start Printed Page 5845under our current rules, into the final rules for these claims.
- We revised the criteria for which audiologists may perform audiometric testing in sections 2.00B and 102.00B of the Listings  to be consistent with our revision to recognize licensed audiologists as AMSs. We now state that audiometric testing must be performed by, or under the direct supervision of, a licensed audiologist or otolaryngologist.
- We did not adopt our proposal to recognize independently practicing psychologists with masters-level education as qualified to be PCs. Instead, we will continue to follow our current policies about who is qualified to be a PC, which generally requires a doctorate-level education degree, in final 404.1616 and 416.1016.
- We made a number of nonsubstantive revisions relating to the revisions listed above, as part of our effort to reorganize our regulations for ease of use, to use consistent terminology throughout our rules, to reflect revisions to the regulatory text made by other rules since publication of the NPRM, and for clarity.
Because of these revisions, these final rules retain only two programmatic distinctions between AMSs and medical sources who are not AMSs in our regulations for claims filed on or after March 27, 2017. First, we need objective medical evidence from an AMS to establish the existence of a medically determinable impairment(s) at step 2 of the sequential evaluation process. Second, in a few instances, we need specific evidence from an AMS to establish that an individual’s impairment meets a Listing.
Treating Physician Rule
Since the 1990s, additional weight has been given by administrative law judges, when making disability determinations, to the opinion provided by a disability claimant’s treating physician. This has been often referred to as the “Treating Physician Rule.” The Treating Physician Rule meant that most of the time, the administrative law judge would go with a treating doctor’s opinion at a disability hearing. The Treating Physician Rule has been eliminated with the SSA’s 2017 disability determination rule changes.
Who Are Treating Physicians?
Who are considered treating physicians? Doctors who provide ongoing care to a disability claimant are considered treating physicians, and their opinions with regards to their patient’s claim of a disability were, prior to May 27, 2017, given special weight by the claim adjudicator. The number of visits a claimant had made to a physician and the length of time a claimant had been seeing a physician were considerations that would be taken into account when determining the weight that was given to the physician’s opinion.
The rationale behind the Treating Physician Rule was, of course, that a physician who had seen a patient many times would be quite familiar with the patient’s case and condition.
Claims for Disability Benefits Filed on or After May 27, 2017
Under the new rules, the opinions of treating physicians and those of the SSA’s consultative examiners are treated equally, with medical opinions that are most supported by medical tests (e.g. blood tests, MRIs, and X-Rays) being given the most weight. Another factor that is given heightened importance by a disability claims adjudicator is whether a physician’s opinion is consistent with other evidence in the claimant’s file.
If the medical opinions of more than one doctor are considered equal in both consistency and supportability, additional weight will be afforded to the opinion of physicians who have a long history with the claimant and physicians who are specialists in the field in which they rendered a medical opinion.
With less deference given to the medical opinion of one’s treating physician, it is now more important than a claimant’s doctor provide supportive evidence in the form of lab tests that provide results consistent with the doctor’s stated opinion.
If evidence exists in a claimant’s file that could be considered inconsistent with a physician’s stated medical opinion, it is important that the physician provides an explanation for the apparent inconsistency.
Contact Eric Brown
Eric Brown is a Social Security Lawyer based in Tulsa, Oklahoma. Eric is here to help make the Social Security process understandable, easier, and as fast as possible. If you have additional questions or wonder if you qualify for Social Security Benefits, contact Eric or fill out our free evaluation form and Eric will get back with you to discuss your specific situation.