Acceptable Medical Sources: Who is considered acceptable and how are unacceptable medical sources treated?

When you apply for social security disability benefits, the Social Security Administration (SSA) uses medical and other evidence to determine whether an individual’s impairment(s) meet the SSA requirements for disability. When making a determination of disability, SSA will consider ALL available evidence in the individual’s case record. This includes medical evidence from acceptable medical sources, other evidence from medical sources, statements by the individual and others about the impairment(s), information from other non-medical sources and decisions by other governmental and nongovernmental agencies. However, not all forms of evidence are given the same weight by SSA when determining whether to award benefits.

Acceptable Medical Sources

SSA makes a distinction between acceptable medical sources and other health care providers who are not acceptable medical sources. Acceptable medical sources are licensed physicians, licensed or certified psychologists, licensed optometrists, licensed podiatrists and qualified speech-language pathologists.

Evidence from acceptable medical sources is needed to establish the existence of a medically determinable impairment. Acceptable medical sources can give medical evidence and can be considered treating sources whose medical opinions may be entitled to controlling weight. Only acceptable medical sources can give medical opinions, which are statements from an acceptable medical source that reflects judgments about the nature and severity of an individual’s impairment. This includes symptoms, diagnosis and prognosis, and what an individual can and cannot do despite their impairments.

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Social Security Disability: Why is this taking so long?

I’ve been working all my life and paying taxes. Now that I’m not able to work and need help, SSA keeps denying my claim for disability benefits. Why is this taking so long?

It’s hard to be patient when you can’t afford to go the doctor and you don’t have money for medicine food, rent or utilities. But if you think about it logically, you can begin to at least understand why this process is necessary.

Think back to when you were working. Your employer would hand you your paystub, and you’d look to find that a chunk of your pay was taken out before they even gave it to you. You were paying toward the Social Security System. But you know that the government wasn’t holding your money in an account for you in case you should one day need it. The government was giving your money to the elderly and people who could no longer work.

So suppose that some government official approached you on payday and said, “Here’s your check, but before I give it to you, I’m going to take back three hundred bucks and give it to someone who can no longer work.” Your initial reaction might initially be a negative one, but you are human, and you at least to some extent agree that humans must take care of their elderly and sick – or you would not be applying for benefits now.

But this is the tradeoff - as a member of the workforce, I’ll contribute now to those who can no longer work so that I can be treated the same when I become unable to work. With one condition: before you take my money away from me and give it to those who can no longer work, at least make them prove they can no longer work. I surely do not want to give my hard-earned money to everyone who merely claims they can no longer work.

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What Can I Do to Win My Social Security Disability Case?

There are several things claimants can do to improve their chances of winning their Social Security Disability or Supplemental Security Income case. The key is in the presentation of the evidence that comes to comprise your file - the documents upon which the decision will be based.

Your file contains several types of documents, pertaining to everything from timeliness of filing, to jurisdiction, to vocational assessments, to earnings records, to medical records. Many of these you have no control over. But there are many that you do. So it is vital that you exercise some level of control over those documents that you can. This is where the advice of your attorney can be critical.

One aspect of the case over which you have a good deal of control is your medical treatment. It is crucial to maintain consistent medical treatment. Remember that the standard of disability that SSA uses as a bar is very high. It means not only that you are no longer able to do the work you've done in the past, but that you can't do any other work that exists in throughout the national economy.

It is up to the claimant to prove the fact of disability, and this can only be accomplished through clinical medical evidence. Your subjective complaints are considered, but are not given very much weight. The opinion of your doctor is given some little weight as well, but it will not make the difference. What is vital is clinical medical evidence - fact as opposed to opinion.
Be aware that your doctors make notes in your records of their observations, as well as your complaints. This is not the time or place to be brave. Many an unfavorable decision makes note of the fact that the claimant said he was "feeling better," whatever that means.

But from the SSA point of view, a person who cannot do any work at all is, for whatever reason, in pretty bad shape, and should be seeking consistent treatment and relief. It is logical, for example, for a claimant who alleges significant levels of pain to seek relief by whatever means is available, including pain-killers, therapy, injections, or even surgery.

It is also important that you comply with the instructions and recommendations of your doctors. If an adjudicator or judge wants a reason to deny your claim, they will glom onto whatever they can. So if your doctor prescribes you medicine and you don't take it, it can be held against you.
Cooperate with your attorney in making sure all relevant records are known about and submitted to SSA. Keep in mind that a disabling impairment for SSA purposes is one expected to last at least twelve months or result in death. Not every condition for which you've sought treatment is relevant. The time you cut your finger or had the flu five years ago will not have much bearing on your case, but it is best to let your attorney review your records and present your case in the most favorable light possible.

It is also important to avoid alcohol, illicit drug use, and in some cases, even tobacco. If it is determined that something you are doing is contributing to your disability, and if you stopped doing it your condition would improve, this will be held against you. So if you can't walk a block without shortness of breath, but continue to smoke two packs a day, or are depressed but continue drinking alcohol, or are bipolar but on cocaine, it may be determined that if you stopped doing these things you would get better, and your claim denied.

There are other documents in your file over which you can exercise control. SSA will have you complete adult function reports, stating how you spend your day, and your activities of daily living. Once you have completed these forms and submitted them, they become a permanent part of your record. Any contradiction of them later will have to be explained, and may go to credibility. If a judge doesn't believe that your impairments are as limiting as you say they are, your case is sunk.

Your earnings record is a vital piece of evidence in your file. Be aware that if you have worked for an employer or filed taxes, SSA will have a record of it. If you have earned income after the date you alleged you became disabled, it will have to be explained to the adjudicator's satisfaction. If you have engaged in substantial gainful activity ($940 per month in 2008), your case may not progress beyond the first step of the process. This is also vital for SSI cases, because if you have too much income or too many resources, you will not qualify for benefits.

One other thing you can do to win your case: do not give up! SSA has become notoriously slow. Cases can sometimes linger for three years or more. In the meantime, claimants have not been able to work, have long ago exhausted their savings, have sold their belongings, lost their homes, etc. It is frustrating. But do what you can. Write your congressman. Believe it or not, they do respond, and SSA has a special process they follow when they receive congressional inquiries. Just don't give up.

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Proving a Lumbar Spine Disability

What it Takes to Prove a Lumbar Spine Disability Case

Degenerative disc disease is one of the most likely causes of low back pain, effecting approximately 65 million Americans a year. However, it is also one of the most misunderstood conditions and often people are left unsure on what the diagnosis actually means. Much of the confusion centers around the idea that because it’s called “degenerative,” the condition will progress and get worse over time. But actually, while disc degeneration is likely to progress over time, the resulting lower back pain usually gets better over time. Disc degeneration is a natural part of aging so everyone will have changes in their discs; however, not all people will develop symptoms because degenerative disc disease is quite variable in its severity. Therefore, when assessing an alleged back condition, Social Security looks for certain markers that indicate an individual’s condition is truly disabling. This article will explore these markers and provide tips on how to strengthen a disability case which involves degenerative disc disease of the lumbar spine.

What Social Security is Looking For?

MRI’s are a great way to prove the severity of a disc disease. Most doctors will order this imaging test when a patient consistently complains of low back pain. The MRI offers a more detailed image of the spine than an x-ray, and can tell the doctor how much degeneration exists and whether the disease is affecting a nerve or the spinal cord. A procedure that offers an even more detailed image of the spine is called a discography. A patient’s disc is injected with a special contrast dye which outlines the damaged areas on x-rays taken following the injection. This procedure is often suggested for patients who are considering lumbar surgery.

After a patient undergoes an MRI imaging exam, a one to two page report is generated. On the bottom of this report, a doctor who has analyzed the MRI lists the diagnoses in the “impressions” section. Words like “mild, moderate, or severe” are used to describe the severity of the disease. Social Security often looks for moderate to severe degeneration described on the imaging study. Additionally, Social Security looks for nerve root or spinal cord implication. When a disc is displaced or degenerating to a significant degree, it may “abut, efface, irritate or compress” a nerve root or cord. When a nerve is involved, there is significant pain not only in the lower back, but radiating pain down one or both legs. Lastly, Social Security looks for how the disc disease affects an individual’s ability to ambulate. Specifically, the Administration checks to see if the disease results in “ineffective ambulation,” which is defined by an inability to walk without the use of 2 canes, crutches or a walker.

Though not all the markers need to be present to win a Social Security case, having these markers makes the case strong because the medical evidence points to a severely disabling condition. An individual with an MRI showing severe degeneration of disc L4-5, with nerve root compression and a prescribed walker will probably meet one of Social Security’s Listings, resulting in an automatic win. However, an individual with a mild degeneration at L4-5, no nerve root or spinal cord implication, and no assistive devices for ambulation will have a more difficult time proving their disability.

What Various Types of Medical Treatment Says About Your Case


Other than tests, Social Security looks for medical treatment. Much in the way of treatment can be offered to individuals suffering from low back pain. Medications are the most common form of treatment, but they can range from over the counter pain relievers to serious narcotic pain management medications such as vicodin, morphine and valium. The stronger medications suggest more severe, unmanageable pain conditions and they are likely to cause debilitating side effects.

Other forms of treatment are physical therapy, pain injections, TENS units and pain patches. These conservative treatments are often exhausted before more invasive procedures are considered. Social Security looks to see if conservative medical management has been tried and inevitably failed to provide relief from the pain. If an individual has found total relief from pain after using medications and undergoing physical therapy, their condition is no longer disabling. However, if despite medications, physical therapy trials and pain injections, an individual’s pain persists, then the case appears much stronger.

A doctor’s recommendation for surgery on the spine reflects a serious condition. Although an individual’s choice to follow through with surgery or not does not effect a disability determination, the fact that it’s even recommended shows that the condition is very serious.

Multiple failed surgeries or other invasive procedures such as surgically inserted pain stimulators, tend to show that the condition is very severe and has probably totally disabled the individual.

What You Can Do to Strengthen Your Case

Though the presence or absence of the markers mentioned above are beyond an individual’s control, there are certain things that claimant’s can personally do to strengthen their case. Social Security looks for consistent pain complaints in order to assess the validity of a disability claim. An individual who never complains about back pain to their doctor, but then alleges it is preventing him/her from working will not be found very credible. Therefore, if your condition causes severe pain, be sure to see your doctor regularly and check that progress notes are being taken which reflect your pain complaints. Also, doctors can perform certain tests on their patients other than medical imaging which can help determine how severe a low back condition is.

For example, a straight leg-raising test can be performed on a patient to determine whether there is disc herniation. Additionally, testing can be performed on range of motion to check how much a patient can bend and move. Muscle strength tests will show whether the disease is causing weakness. Atrophy can be tested to check if the back condition is causing muscle wasting and foot drop. Gait tests can tell how the disease affects a patient’s ability to walk and stand. Make sure you explore these testing procedures with your doctor so that a supportive medical record will be available for Social Security to review.

APPEALING THE SOCIAL SECURITY ADMINISTRATION DECISION

You should not become discouraged if your claim is initially denied. In a recent year roughly 60% of claims were denied. An SSDI attorney will be able to determine what documentation and evidence will strengthen your claim.

LEVEL 1: RECONSIDERATION OF YOUR INITIAL CLAIM
You must request a reconsideration of your claim within sixty days of receipt of the denial letter. Reconsideration is a complete review of your claim by someone who did not take part in the first decision. They will look at all the evidence submitted when the original decision was made, plus any new evidence.
After approximately four to six months a decision will be reached on the reconsideration request. The case will either be granted benefits or denied again. In some states, this process may vary.

LEVEL 2: HEARING BY AN ADMINISTRATIVE LAW JUDGE
If your claim is denied after reconsideration, you have 60 days to request an informal hearing. This will be in front of an administrative law judge who had no part in the first decision or the reconsideration of your case. The judge will listen to witnesses, review medical evidence, and decide your case. An SSDI appeal lawyer will help you prepare for the hearing and represent you at the hearing.
The Judge will not announce a decision at the administrative hearing. It usually takes at least two to three months after the hearing to receive the decision, if not longer. If the decision is favorable, you should receive your first check about eight to twelve weeks after the decision.

LEVEL 3: REVIEW BY THE APPEALS COUNCIL
If the Judge's decision is not in your favor, the next step is to request a review by The Appeals Council. This must be done within sixty days after you have received the hearing decision. You should be represented by an experienced SSI/SSDI lawyer to ensure you have the best chance of winning the appeal.
A failure to appeal by the deadline will result in having to start an entirely new claim unless you can demonstrate good cause for not filing the appeal prior to the deadline. Good cause includes illness, hospitalization, comprehension problems due to mental infirmity, or other circumstances beyond your control.
The Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an administrative law judge for further review.
If the Appeals Council denies your request for review, you will receive a letter explaining the denial. If the Appeals Council reviews your case and makes a decision itself, you will receive a copy of the decision. If the Appeals Council returns your case to an administrative law judge, you will receive a letter and a copy of the order.

LEVEL 4: FEDERAL COURT
If the Appeals Council denies your appeal and/or refuses to review your case, you have 60 days to file a lawsuit in a federal district court. After reviewing the record from your hearing, the Federal judge can (1) award disability benefits, (2) deny disability benefits, or (3) send your case back to a lower court for an additional hearing. It is critical to have good legal representation to give you the best chance of winning the appeal.

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