New rules regarding medical evidence change the manner in which disability claims are reviewed and approved. Claimants and their Social Security Disability attorney must understand the impact of these changes or face the possibility of delays and denial of disability claims.
How the New Rules Affect Disability Claims
According to the Social Security Administration, the intent of the rules changes is to eliminate duplication and bring clarity to the claims determination process. As a result, several long-standing practices have been modified or discontinued.
Treating Physician Opinion is no Longer the Primary Claim Determination Factor
For several decades, the medical opinion of the treating physician had controlling weight in deciding the validity of SSDI claims. Going forward, a consulting physician’s medical opinion is medically equivalent to other medical evidence provided.
This change may have a significant impact on disability claims decisions. Evidence from consulting doctors and other medical personnel, who may have only reviewed a patient file, now carry the same weight as the opinion of the treating physician.
Rulings of Other Government Agencies Receive no Weight
Previously, disability rulings by other government agencies were also given weight in approving a disability claim. For example, a ruling of disability by the Veterans Administration could be considered and given weight in approving a SSDI claim.
The new rules discontinue that practice. Disability rulings by other agencies are now medically equivalent to any other source and add no weight to a disability claim approval.
The List of Acceptable Medical Sources is Expanded
A positive aspect of the new rules is the expansion of the list of Acceptable Medical Sources (AMS) to include:
- Advance Practice Registered Nurses (APRNs)
- Physician’s Assistants (PAs)
Unfortunately, some key medical sources, like chiropractors, clinical social workers, and registered nurses are still missing even though many claimants would be more likely to have evidence from a chiropractor or registered nurse than a Physician’s Assistant or APRN.
Establishing a Disability Claim
Under the new rules, establishing a disability claim requires careful preparation. Claimants can no longer rely solely on the weight of their treating physician’s medical opinion.
It is imperative that Social Security disability claimants present comprehensive documentation. A qualified Social Security disability attorney can help work through the new rules and assist in making the best case for the disability claim.