Nurse and therapist records in Social Security cases
Social Security has regulations on which medical providers can provide evidence and opinions about an individual’s diagnosis and limitations. For a long time, evidence from nurses, chiropractors, therapists, and psychologists was not considered by Social Security because these professionals were not considered “acceptable medical sources.”
The term “medical sources” refers to both “acceptable medical sources” and other health care providers who are not “acceptable medical sources.” See 20 CFR 404.1502 and 416.902.
Under our current regulations, “acceptable medical sources” are:
Licensed physicians (medical or osteopathic doctors);
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 the measurement of visual acuity and visual fields (for claims under title II, we may need a report from a physician to determine other aspects of eye disease);
Licensed podiatrists, for purposes of establishing impairments 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.
See 20 CFR 404.1513(a) and 416.913(a).
Basically, a medical provider had to have MD (or DO, or PhD) after their name to qualify as a medical source. This left nurses, therapists, chiropractors, teachers, counselors, among other providers out in the cold as far as having their evidence conisidered by Social Security.
Social Security Ruling (SSR) 06-03p changed that by creating a new class: “other sources.”
SSR 11-1p: can’t appeal and reapply for Social Security disability
A number of attorneys suggest that if you are denied at your Social Security disability hearing, you should do two things:
Appeal the Administrative Law Judge’s (ALJ’s) decision to the Social Security Appeals Council, and
File a new claim for Social Security disability benefits.
The idea was that the new claim would be evaluated by Social Security until it got to the hearing level, the the old claim was pending on appeal. There were pros and cons to this approach.
Since cases often take in excess of 18 months at the Appeals Council, some advised to start the ball rolling on a new claim (which might get approved sooner).
The problem was that a denial on the new claim might reinforced the correctness of the prior hearing denial which is being appealed.
Also, if the new claim got to the hearing level, it was put on hold until the Appeals Council decided on the appeal of the prior hearing decision.
If the Appeals Council denied the appeal, it might have a chilling effect on the new claim’s chances waiting to be heard at the hearing office.
Well, all this is a thing of the past.
With SSR 11-01p, Social Security now effectively makes you pick whether to appeal OR start a new claim.
Social Security Rulings – an inside look at Social Security’s thought process
Gordon Gates has a great post tackling Social Security Rulings and how they can be used in a Social Security disability case:
Social Security Rulings are policy interpretations issued by the SSA. Social Security Rulings are binding on all components of the SSA, and are to be relied upon as precedents when adjudicating other cases. See 20 CFR 402.35(b)(1).
The value of the Rulings is that they explain how Social Security is supposed to interpret and apply its own regulations.
These are especially useful when you are writing an appeal and disagree with the Judge on a point of law. If you have a Ruling on your side showing that your interpretation is correct, you are much closer to winning your appeal.
Chronic Fatigue Syndrome and Social Security
A caller told me he considers Chronic Fatigue Syndrome (CFS) the Rodney Dangerfield of medical conditions: you get you no respect.
I could see his point. The condition is often misdiagnosed, treatment options may be limited, and it can often be difficult to get Social Security to approve a CFS claim.
But there is hope. The symptoms of CFS can be disabling:
Postexertional malaise (relapse of symptoms after physical or mental exertion);
Unrefreshing sleep;
Substantial impairment in memory/concentration;
Muscle pain;
Pain in multiple joints;
Headaches of a new type, pattern or severity;
Sore throat; and
Tender neck or armpit lymph nodes.
Fatigue and muscle pain can reduce exertional abilities (how much you can still lift/carry, & how long you can sit, stand, and walk). However, this may not be enough to find you disabled.
