What is Acceptable Medical Evidence?

Social Security issued a ruling about ten years ago about “acceptable medical evidence,” considerably broadening the scope of proof allowed in a disability case claim. This has always been a problematic area in Social Security law – particularly for the many patients who receive much of their care from nurse practitioners or physicians’ assistants or chiropractors.

It is essential to remember that your doctor can’t just say you’re “disabled.” In fact, the record needs to show the reasons for Social Security to reach that conclusion. A simple statement from your doctor without underlying documentation is pretty worthless.

In the past, treatment notes from these licensed sources and others – such as chiropractors and counselors – were not given “substantial weight” in a disability determination. Only records from physicians, licensed psychologists or other certain “acceptable” medical sources having an “ongoing treatment relationship” with the claimant were considered valid.

Ruling SSR 6-03p1 requires that the underlying diagnosis be provided by a physician and the existence of the impairment must be certified in this way. But the severity and ongoing functional limitations may now be demonstrated by treatment notes and letters from other professionals and lay witnesses. Before this ruling, Social Security was free to disregard anything but physician evidence. Sometimes that meant that the only evidence in the file might be a consultative examination provided by Social Security, performed by a doctor who only saw the patient once.

The new ruling recognizes that these non-physician treatment sources have “increasingly assumed a greater percentage of the treatment and evaluation functions previously handled by physicians and psychologists.” These highly trained professionals are providing most of the treatment and care for Americans, and Social Security has finally recognized this fact. This regulatory change may open doors long-closed to our clients who receive health care in clinic settings, where treatment by a physician can be rare.

The “other sources” which are now acceptable for providing legitimate and binding evidence are nurse practitioners, physicians’ assistants, psychiatric social workers and some therapists. Next in evidentiary importance are teachers, counselors or social welfare agency staff, non-medical people acting in their professional capacities. Of lesser importance, but still valued, would be information from lay witnesses such as spouses, clergy, friends and employers. Any opinion evidence provided is judged by its consistency with other evidence, length of relationship, and degree to which the opinion is supported by other medical records.

All information submitted has a cumulative effect. If, for example, there are numerous letters from friends and neighbors observing a person’s daily actions reflecting a psychiatric problem, it adds detail that may be missing from the professional treatment notes. The medical record still must provide an impairment diagnosis from a doctor, but these details are like brush strokes that allow the decision-maker to paint a picture of the real, whole person. Now all of these sources are seen as “very valuable sources of evidence for assessing impairment severity and functioning.”