Learn About Social Security’s Criteria for Acceptable Medical Evidence for Your Disability Claim
The successful approval of your Social Security Disability Insurance (SSDI) application hinges on the quality and completeness of the medical evidence you provide. The Social Security Administration (SSA) has developed rigorous standards for acceptable medical sources and medically determinable impairments.
It’s essential when you apply for disability benefits that you understand and meet these requirements for evidence. The SSA typically looks for at least 12 months of recorded medical history. Carefully compile your medical documentation with the SSDI lawyers of Keefe Disability Law and bolster your chances of approval.
Why the SSA Denies Most SSDI Applications
The Social Security Administration denies nearly two-thirds of SSDI applications at the initial evaluation stage. There are several possible reasons for this. Some claimants simply do not qualify for disability. Others may be denied based on a technical error, like exceeding the limit for substantial gainful activity.
By far, the most common reason why the SSA denies most SSDI claims is a lack of sufficient medical evidence. They require specific, objective proof of the existence and severity of a medically determinable impairment (MDI). The impairment must also be expected to last at least 12 months or end in death.
Medically Determinable Impairment Definition
To be eligible to receive SSDI benefits, you must have a medically determinable impairment (MDI). This physical or mental impairment must result from anatomical, physiological, or psychological abnormalities. Furthermore, these abnormalities must be supported by medically acceptable clinical or laboratory diagnostic techniques.
Crucially, a statement of symptoms, a medical opinion, or a simple diagnosis is insufficient proof of an MDI. The SSA is looking for evidence consisting of signs and laboratory findings to support the claim. The MDI must be objectively verifiable. To qualify for benefits, it must also be sufficiently severe to prevent the claimant from working.
The SSA Blue Book lists qualifying impairments, though SSDI applicants can still be approved for benefits if they do not meet the criteria for a specific Blue Book listing.
SSA Acceptable Medical Sources for SSDI Claims
MDI evidence must come from what the SSA considers acceptable medical sources (AMS). Not all health care providers meet the SSA’s evidentiary requirements for objective medical evidence. While the definition is quite broad, the SSA names several specific examples of acceptable medical sources. These include:
- Licensed medical physicians or osteopathic doctors
- Licensed or certified psychologists at the independent practice level
- School psychologist for impairments of intellectual disability, learning disability, and borderline intellectual functioning
- Licensed optometrists for claims relating to visual disorders and acuity impairments
- Licensed podiatrists for impairments of the feet and ankles
- Qualified speech-language pathologists (SLPs) for speech and language impairments
- Licensed physician assistants within their licensed scope of practice
- Licensed audiologists for claims relating to hearing loss, auditory processing, and balance disorders
- Licensed advanced practice registered nurses (APRN) and advanced registered nurse practitioners (ARNP) within their licensed scope of practice
Helpful Medical Evidence for Your SSDI Application
Medical records and test results from acceptable medical sources are the backbone of your SSDI claim application. These types of medical evidence can take on several different forms.
Diagnostic Imaging Reports
One example of objective medical evidence is diagnostic imaging, like MRIs, CT scans, and X-rays. A licensed radiologist can provide medical reports with objective evidence of physical conditions, like joint degeneration or the presence of tumors.
Laboratory Test Results
Accredited medical laboratories can offer a variety of diagnostic test results, like blood work and urinalysis. These can indicate diabetes, kidney disease, or hormonal imbalances, offering specific measurements and reference ranges. The physician can offer their professional interpretation of the test results. Auditory and visual acuity testing are relevant to disorders affecting hearing and sight.
Detailed Doctor’s Notes
A medical opinion or a formal diagnosis from a doctor is not enough on its own for SSDI approval. However, detailed notes from your doctor can greatly strengthen your application. They can describe how your disability impairs or limits your ability to meet the demands of working. Doctor’s reports substantiate claims of the severity of your disability.
Treatment Records and Results
To provide a more complete picture of your medical history, provide the SSA with treatment records and results. You can demonstrate to the SSA that you are doing everything you can to address your disability and reduce its impact on your ability to work. By showing that your symptoms are not improving enough, you further support your claim of disability.
Residual Functional Capacity Assessment
You may ask your doctor to complete a more formal evaluation of your abilities by completing a residual functional capacity (RFC) assessment. The resulting report outlines what you can and cannot do in light of your medical impairment and related symptoms, like chronic pain or fatigue. It gives context to the SSA of whether you can perform past work or pivot to other work. An RFC assessment considers both physical and mental abilities.
Consultative Examinations
During your SSDI application process, the SSA may request a consultative examination (CE). The SSA generally prefers your own medical sources, but sometimes it may ask for an impartial, independent opinion. This can occur if your own sources cannot perform the examination or there are inconsistencies in your file.
Additional Supporting Evidence You Should Provide
Credible, objective evidence from acceptable medical sources is a major part of your SSDI application. To provide a more comprehensive picture, it’s beneficial to provide the SSA with additional supporting evidence from other sources.
Other Healthcare Providers
According to the SSA, not all health care providers qualify as acceptable medical sources, but they can still provide valuable context and information about your disability. Evidence of chiropractic care is one such example. You can also supply information provided by a naturopath, physical therapist, or other practitioners who are legally permitted to provide health care.
Activities of Daily Living Questionnaire
The Activities of Daily Living questionnaire (ADL) is an optional but beneficial component of a successful SSDI application. The self-report questionnaire covers how your condition affects your ability to perform everyday tasks, ranging from personal care and household tasks to mobility and social activities.
Personal Disability Journal
Although informal, a disability journal can be a valuable element of your SSDI claim application. Like the ADL questionnaire, a disability journal provides context for how your disability affects your daily life and the steps you take to manage it. Describing your subjective experience reinforces the evidence you provide from medical sources.
Third-Party Function Report
Whereas the ADL questionnaire and disability journal come from your point of view, a third-party function report offers an outside perspective. To be completed by coworkers, family members, neighbors, caregivers, or other people who know you well, the report can further substantiate your claim for benefits.
A third-party function report asks them to assess how your disability may impair your physical functioning, social functioning, sleep, work, and leisure activities. The volunteer must complete the report independently without any of your direct input.
The Value of an Experienced Disability Lawyer’s Help
Applying for Social Security Disability Insurance can feel daunting, as it has numerous stringent requirements. It can be difficult for the average person to manage, especially when faced with significant paperwork and confusing terminology. To improve your chances of success, it’s advisable to consult with an experienced disability lawyer.
The skilled team at Keefe Disability Law specializes in helping clients with their disability claims. We will help you complete your application, gather extensive supporting evidence, and navigate the SSDI process, including filing an appeal if necessary. We are determined to help you secure the benefits you deserve.
“I am extremely satisfied with the lawyer I had,” writes Roxanne of Salem, Massachusetts. “He did a fantastic job helping me with my case. If need be, I will use your office again in the future.”
