Medical Evidence for Social Security Disability

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Medical evidence of your disability is one of the most important aspects of your application. Many claims for benefits have been decided or denied on the strength of the medical evidence. It is important to be as complete as possible.

Your Medical Records and Disclosure Laws

The Privacy Act requires that Social Security cannot release or obtain your medical records without your consent. You will be asked to sign medical release forms as part of your application packet. Information you submit to Social Security can only be released for referring you to community or other agencies for services they cannot provide.

Acceptable SSA Sources of Medical Evidence?

Social Security will review evidence from an acceptable medical source. These sources are:

Licensed physicians (medical or osteopathic doctor);
Licensed or certified psychologists - Included are school psychologists, or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing mental retardation, learning disabilities, and borderline intellectual functioning only;
Licensed optometrists, for purposes of establishing visual disorders only (except, in the U.S. Virgin Islands, licensed optometrists, for the measurement of visual acuity and visual fields only);
Licensed podiatrists, for impairment(s) of the foot, or foot and ankle only, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle; and
Qualified speech-language pathologists, for purposes of establishing speech or language impairments only.

Social security will also accept medical evidence from other medical sources such as such as nurse practitioners, physician assistants, chiropractors, and therapists.

Obtaining Evidence from your Doctor and the Hospital

If you do not have the evidence, you need from your doctor or hospital, Social Security will assist you in getting that evidence. Social Security will pay for the cost of obtaining medical records from hospitals, doctors or other medical providers.

Medical records – the more recent and thorough the better

What does the SSA look for in your medical records?

Social Security looks for the following information in your medical records:

Medical history
Clinical findings (such as the results of physical or mental status examinations)
Laboratory findings (such as blood pressure, X-rays)
Treatment prescribed with response
Diagnosis
Prognosis

Additionally, they will look for a statement from the acceptable medical source, based on the above elements, about what you can still do despite your condition. A statement from an acceptable medical source is not needed in blindness claims.

Consultative Examinations

Who needs a Consultative Examination?

Social Security may need a consultative examination in several situations. Some of them are as follows:

To gather more evidence because the evidence obtained is not enough to make a disability determination;
To obtain more detailed medical findings about your impairment(s);
To obtain technical or specialized medical information;
To resolve conflicts or differences in medical findings in the evidence already in file; or
To resolve the issue of your ability to do substantial gainful activity, if you are an adult; or, if you are a child under age 18, your ability to function like other children your age who do not have impairments.

Who Will Perform your Consultative Examination?

The doctor, hospital or other medical professional or institution is the preferred source for a consultative examination. There are situations where Social Security could send you to someone other than your regular doctor or clinic.

Who Will Pay for the Consultative Examination?

Social Security is responsible for the cost of the consultative examination and any travel related expenses that may be necessary.

[Note that Social Security regulations require that your treating physicians medical opinion should be given more weight than that of a consultative examination if the consultative is completed by someone other than your regular medical professional. This is recognition that the treating source that sees you on a regular basis would have more knowledge of your abilities than someone who may only see you for a few minutes.]

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