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New Social Security Ruling Should Help Disability Claimants

On August 9, 2006, Social Security Ruling 06-03p became effective. The purpose of the ruling is to clarify how the Social Security Administration evaluates opinions from sources who are not "acceptable medical sources." Here are some questions and answers about this very important ruling.

Q: What is an "acceptable medical source?"
A: The Social Security Administration now considers the following to be acceptable medical sources: Licensed physicians, licensed or certified psychologists, licensed optometrists (in claims involving vision impairments), licensed podiatrists (in claims involving foot and ankle impairments), and qualified speech-language pathologists (in claims involving speech or language impairments).

Q: What is the significance of an acceptable medical source:
A: Acceptable medical sources are important for two main reasons. First, at the second step of the sequential evaluation process the adjudicator or Administrative Law Judge must determine whether a claimant suffers from a medically determinable impairment or combination of impairments that is "severe." Only an acceptable medical source can establish the existence of a medically determinable impairment. Secondly, only an acceptable medical source can give medical opinions and be considered a treating source whose opinion is potentially entitled to controlling weight.

Q: How will opinions from sources who are not acceptable sources be evaluated?
A: Opinions from sources who are not acceptable medical sources may be evaluated to determine the severity of an individual’s impairment, and how it affects the individual’s ability to function only after evidence from an acceptable medical source establishes the existence of a medically determinable impairment.

Q: What are examples of medical sources who are not acceptable medical sources?
A: Nurse practitioners, physician assistants, licensed clinical social workers, naturopaths, chiropractors, audiologists, and therapists are all examples of sources whose opinions should be considered regarding severity and ability to function only if an acceptable medical source has first established the existence of a medically determinable impairment.

Q: What does all this really mean?
A: For example, if your physician (an acceptable medical source) establishes the existence of degenerative disc disease in the lumbar spine, the opinion of the physician assistant (a person who is not a medically acceptable source) can be considered in determining the severity of the degenerative disc disease, as well as how it affects you. The Social Security Administration has acknowledged that "other sources" such as nurse practitioners and physician assistants may have special knowledge of individuals. This is likely due to the fact that many patients rarely see the physician and are routinely examined by a physician assistant or nurse practitioner who has more direct interaction with the patient.

Q: What factors should be considered in evaluating the opinion of a person who is not a medically acceptable source?
A: Opinions from "other sources" should be evaluated under the same factors that apply to opinion evidence from acceptable medical sources. These factors include: how long the source has known and how frequently the source has seen the individual, how consistent the opinion is with other evidence, the degree to which the source presents relevant evidence to support an opinion, how well the source explains the opinion, and whether the source has a specialty or area of expertise related to the impairments.

Q: Will this Ruling help me?
A: Yes. You should still seek to have your treating physician complete a medical opinion form detailing any physical or mental limitations. However, it will now also be essential to have "other sources" complete assessment forms detailing the severity of your impairments and the effect the impairments have on your ability to work. In fact, submitting medical opinions from sources who are not acceptable medical sources (such as nurse practitioners) could possibly provide you with an opportunity to strengthen your claim for benefits.