This week, the Social Security Administration revised several important rules. The changes affect how Administrative Law Judges (ALJs) evaluate medical evidence in support of your disability claim.
Published on January 18, 2017, the new rules will affect Social Security Disability claims filed on or after March 27, 2017.
How Will this Affect Your Disability Claim?
As you may know, “medical evidence’ is a critical part of disability claims under the Social Security disability program. SSA calls medical evidence “the cornerstone of the disability determination.”
As Texas disability lawyers practicing Social Security Disability, Veterans Disability and long term disability insurance law, we represent hundreds of disabled workers and veterans across the nation, at all levels of the disability process.
For our clients and visitors, we offer the following explanation of the new rules affecting how SSA will evaluate medical evidence in the near future. Please contact our law firm if you have questions or need further information.
What SSA Medical Evidence Rules Will Be Different?
Here is what you can expect on claims filed on or after March 27, 2017:
Weight of Medical Opinion as Evidence Is Redefined
Social Security No Longer Gives Special Weight to Your Treating Physician’s Medical Opinion:
When you file a Social Security Disability claim, Administrative Law Judges and claim reviewers evaluate medical evidence in order to reach conclusions about your impairment. Medical evidence often includes professional opinions about your case from your treating physician, treating psychologist and other medical specialists.
Historically, Social Security has given more weight to opinions from treating sources. The “Treating Physician rule” was first published in the Federal Register in 1991.
For example, SSA existing rules express the likelihood that treating sources will be the “medical professionals most able to provide a detailed, longitudinal picture of your medical impairment(s) and may bring a unique perspective to the medical evidence…” otherwise unavailable through objective data or from brief or consultative medical exams. (1)
(1) Code of Federal Regulations § 404.1527. Evaluating opinion evidence.
Under the new SSA final rule on evaluating medical evidence, an ALJ is no longer able to give special weight to medical opinions from your treating doctors. In other words, no deference or controlling weight is to be given to your doctor’s opinion about your case.
The final rule focuses only on the substance of medical opinions – not the source of the opinion. All medical opinions and prior medical findings are to be viewed equally, and will be based on “consistency and supportability” factors.
This rule change recognizes that today’s disability claimants are often treated by many healthcare providers.
The new vision of SSA is that our healthcare delivery has changed dramatically, making the “Treating Physician rule” outdated. It no longer portrays the reality of which healthcare providers have the most knowledge of a patient’s physical and mental impairments.
The occurrence of multiple treating physicians in a disability claim has given rise to certain “adjudicative issues” as a consequence. These issues include
- ALJs having to make multiple findings due to multiple treating doctors’ opinions,
- ALJs’ failure to identify and dismiss invalid opinions given by treating physicians, and
- Although many doctors are designated as “treating” physicians, no truly continual and prolonged doctor-patient relationship is established.
However, SSA also makes the determination here that your treating doctor of many years is to be viewed on equal footing with an SSA consulting doctor – who may only review your paper claim file (with no personal examination). Or they might spend 30 minutes evaluating your residual functional capacity and base their decision upon that.
Prior Administrative Medical Findings:
SSA further defines prior administrative medical findings. These are findings that have previously been made on a specific medical issue regarding your active claim (other than a final award of disability) by either a medical consultant (MC) or a psychological consultant (PC) hired by SSA.
SSA No Longer Gives Special Weight to Decisions by Other Governmental Agencies
The new rules to evaluate medical evidence will put an end to an ALJ or a court giving special weight to disability claim decisions made by another governmental agency with regards to your SSA claim. This includes the VA.
This is another big switch from existing Social Security Disability rules. In the past, ALJs have been able to weigh an outside agency’s medical evidence. When doing so, the ALJ has a duty to outline whatever evidence was considered and the weight allotted to each piece of evidence, in support of the SSDI claim under review.
In fact, courts have found in some SSDI cases that a VA disability rating, while not binding on Social Security, is evidence that should be given great weight.
One example is the case of Brady v. M Heckler. In this case, SSA denied a claim for disability benefits. The claimant was also a veteran who was receiving an award of disability benefits for pericarditis and hypoglycemia from the Veteran’s Administration (100% disabled).
The VA records were highly informative. Medical evidence showed that the claimant’s impairments severely limited his ability to perform basic work-related functions, and for at least one year.
The administrative law judge reviewing the case decided not to consider this evidence in the SSDI claim. The court overturned the ALJ’s decision for not giving significant weight to VA’s medical evidence and disability rating. (2)
(2)Olson v. Schweiker, 663 F.2d 593 (5th Cir.1981), citing to Rodriguez v. Schweiker, 640 F.2d 682, 686 (5th Cir.1981). “Although the V.A.’s disability rating is not binding on the Secretary of Health and Human Services, it is evidence that should be given great weight.“
As of March 27, 2017, if you file a VA claim for disability compensation, this option will no longer be available in association with your Social Security disability claim. Under the new rules, an Administrative Law Judge will only view and evaluate the medical evidence submitted in a VA claim as it pertains to that VA claim.
Social Security expands its list of Acceptable Medical Sources (AMS)
Medical evidence supporting your disability claim comes from medical service providers. These are the doctors and healthcare professionals who have treated or evaluated you regarding your condition.
SSA publishes in their rules who they view as Acceptable Medical Sources (AMS). Historically this list includes:
- Licensed physicians
- Licensed or certified psychologists
- Licensed optometrists
- Licensed podiatrists
- Qualified speech-language pathologists
With the new rules, SSA broadens the existing list to be more in sync with the treatment many disability claimants receive under our current national healthcare system.
SSA now includes the following professionals in the list of Acceptable Medical Sources:
- Physicians Assistants (PAs)
- Advance Practice Registered Nurses (APRNs)
- Licensed audiologists and optometrists (when circumstances are specific to their specialty practices)
Yet did the expansion reach far enough? Some healthcare professionals still do not meet SSA’s criteria of Acceptable Medical Sources. These include:
- Registered Nurses
- Licensed Clinical Social Workers (LCSW)
Why did SSA change their rule on evaluating medical evidence in Social Security Disability claims?
These changes come largely as the result of measures taken by the Senate. The final rules conform to requirements set forth in the Bipartisan Budget Act of 2015 (BBA).
The BBA amends the Balanced Budget and Emergency Deficit Control Act of 1985:
- The Balanced Budget Act was enacted to avert a government default and set forth some measure of certainty for federal discretionary programs.
- The purpose of the BBA is to increase the discretionary spending limits for Fiscal Years 2016 & 2017.
Prior to making the rules final, SSA invited comments on the proposed changes to how they evaluate medical evidence in disability claims. The rules have been under review and discussion since September 2016.
SSA announced that these changes also reflect the current landscape of the national healthcare labor force, and how many disabled people receive primary medical care.
Finally, SSA states the new rule changes will enable them to make accurate and consistent decisions, and to stress the need for objective medical evidence in disability and blindness claims.
Our Disability Attorneys Will Help You Win the Benefits You Have Earned
As Board Certified Social Security Disability attorneys, we navigate this complicated area of law each day.
The importance of medical documentation cannot be underestimated, old rules or new. The most compelling medical evidence is that which offers solid reasoning rather than persuasion.
When you file a claim for disability benefits, you are responsible for providing medical evidence proving that (1) you are disabled, and (2) the severity of your condition. We know what the SSA needs and wants in order to evaluate a claim. Our dedicated team will help you in this and every area of your claim, from initial application to appeals in Federal Court.
Experienced disability attorneys can make the difference between losing all you have worked for and ensuring the medical and financial resources you need are provided via Social Security disability benefits.
If you need help with your initial application, our Social Security disability lawyers can help you make a compelling case for benefits. If your claim is denied, your lawyer becomes even more critical to your success. Call us today for a free case evaluation at 713-929-2664.
Source: Federal Register: 82 Fed. Reg. 5844 (Jan. 18, 2017). Revisions to Rules Regarding the Evaluation of Medical Evidence.