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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Evaluating Severity of Mental Impairments

John M. FitzGerald

When evaluating the severity of mental impairments in a Social Security Disability or SSI claim, The Social Security Administration (SSA) must follow a specific technique at each level in the administrative review process.

The technique is meant to identify the need for additional evidence to determine impairment severity, consider and evaluate functional consequences of the mental disorder as relating to ability to work, and to present findings in a clear and consistent manner.

SSA first evaluates pertinent symptoms, signs, and laboratory findings to determine whether a medically determinable mental impairment is present. If determined that a medically determinable mental impairment exists, SSA must specify the symptoms, signs, and laboratory findings that substantiate the presence of the impairment and document findings.

The degree of functional limitation resulting from the impairment is then rated.
Assessment of functional limitations is a “highly individualized process” that requires consideration of all relevant evidence to obtain a picture of overall degree of functional limitation. All relevant clinical signs and laboratory findings are considered, along with the effects of symptoms, and how ability to function may be affected by factors such as chronic mental disorders, structured settings, medication, and other treatment.

The degree of functional limitation is based on the extent to which one’s impairment interferes with ability to function independently, appropriately, effectively, and on a sustained basis. Thus, such factors as the quality and level of overall functional performance, recurrence of episodes, the amount of supervision or assistance one requires, and the settings in which one is able to function must all be considered.

SSA has identified four broad functional areas in which to rate the degree of functional limitation: Activities of daily living, social functioning concentration, persistence, or pace, and episodes of decompensation.

The first three functional areas are rated using a five-point scale:
None, mild, moderate, marked, and extreme.

The degree of limitation in the fourth functional area is rated using a four-point scale: None, one or two, three, four or more.

The last point on each scale represents a degree of limitation that is incompatible with the ability to do any gainful activity.



After rating the degree of functional limitation, the severity of one’s mental impairment must be determined. If the degree of one’s limitation in the first three functional areas is "none" or "mild" and "none" in the fourth area, the conclusion is one’s impairment is “not severe,” unless evidence indicates there is more than a minimal limitation in ability to do basic work activities.

If one’s mental impairment is severe, it is then determine whether it meets or equals a listed mental disorder. This is done by comparing the medical findings and rating the degree of functional limitation to the criteria of the relevant listing. At the initial and reconsideration levels of the administrative review process, the presence or absence of the criteria and the rating of the degree of functional limitation is recorded on a standard document, known as the Psychiatric Review Technique.

At subsequent levels, the presence or absence of the criteria and the rating of the degree of functional limitation is recorded in the decision, and must show the significant history, including examination and laboratory findings, and the functional limitations that were considered in reaching a conclusion about the severity of the mental impairment. The decision must also include a specific finding as to the degree of limitation in each of the functional areas described above.

If determined that a severe mental impairment neither meets nor equals a listing, one’s residual functional capacity is then assessed at step four of the sequential evaluation process, as in any other case.


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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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Social Security Administration Improvements: 2010 Update

Michelle Nevarez, Esq.


The Obama Administration has committed to helping our fellow Americans in need by allocating more of the Nation’s budget to the preservation and improvement of the Social Security disability insurance approval process. In response to increased application in addition to existing backlog of claims, SSA has committed to increasing their processing capacities in a number of ways.


Extended Service Team(EST) are new centralized units that tasked to assist in with hearing backlog in flood areas that experienced increased applications. The purpose of these teams is explained by SSA Commisioner Astrue, “These centralized units have reduced the hearings backlog and improved processing times at some of the hardest-hit hearing offices....”

In FY 2010, SSA plans to place 280 new employees in four States (Virginia, Arkansas, Oklahoma , and Mississippi ) to help staff the teams that will be able to quickly take cases from the hardest hit States.
DDS Federal Units in each of the ten regions are tasked with assisting the DDSs in processing cases. In FY 2010, we plan to provide 237 additional hires in these units. The increases at the DDA level also include more medical consultants in order to prevent expensive and much dreaded consultative examination.

Virtual Screening Units have been erected with senior attorneys tasked to review the disability hearing backlog for potential awards.SSA believes that the screening methodology and the electronic folder to move work to the members of the virtual unit will identify about 14,600 on-the-record, fully favorable awards this year without a hearing.

SSA eligibility and processing requirements are in constant flux, for this reason you should take a moment to update yourself on the changes in 2010 eligibility requirements.

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