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.” 

In addition to evidence from “acceptable medical sources,” we may use evidence from “other sources,” as defined in 20 CFR 404.1513(d) and416.913(d), to show the severity of the individual’s impairment(s) and how it affects the individual’s ability to function. These sources include, but are not limited to:

• Medical sources who are not “acceptable medical sources,” such as nurse practitioners, physician assistants, licensed clinical social workers, naturopaths, chiropractors, audiologists, and therapists; and
• “Non-medical Sources” including, but not limited to:
• Educational personnel, such as school teachers, counselors, early intervention team members, developmental center workers, and daycare center workers;
• Public and private social welfare agency personnel, rehabilitation counselors; and
• Spouses, parents and other caregivers, siblings, other relatives, friends, neighbors, clergy, and employers.

Information from these “other sources” cannot establish the existence of a medically determinable impairment. Instead, there must be evidence from an “acceptable medical source” for this purpose. However, information from such “other sources” may be based on special knowledge of the individual and may provide insight into the severity of the impairment(s) and how it affects the individual’s ability to function.

SSA will now consider evidence from other sources. And not only medical sources: SSA also has to consider evidence from rehab counselors, parents and family members, clergy, employers.

If there is a catch, it is that an “acceptable medical source” is still needed for the diagnosis – which is sensible. However, in some cases where the symptoms are clearly disabling, but the cause is unclear, obtaining a clear diagnosis from an acceptable medical source can be difficult.

However, once there is a diagnosis, the extent of the condition and the limitations can be developed through other sources of evidence. Keep in mind though that this Ruling only requires that SSA consider these other sources of evidence. It does not mean that Social Security will find you disabled just because your paper boy said so. Evidence from medical professionals and from acceptable medical sources is still usually better evidence and more likely to convince Social Security. SSR 06-03p just lets you also provide additional other evidence.

How will Social Security consider evidence from other sources? Here are some factors SSA may use in determining the weight given to evidence from other sources:

Although the factors in 20 CFR 404.1527(d)  and  416.927(d)  explicitly apply only to the evaluation of medical opinions from “acceptable medical sources,” these same factors can be applied to opinion evidence from “other sources.” These factors represent basic principles that apply to the consideration of all opinions from medical sources who are not “acceptable medical sources” as well as from “other sources,” such as teachers and school counselors, who have seen the individual in their professional capacity. 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;
• Whether the source has a specialty or area of expertise related to the individual’s impairment(s), and
• Any other factors that tend to support or refute the opinion.

Here is where therapists and nurses records can really shine. Often these providers have had the most frequent and longest contact with patients and can provide the most detailed opinion of how their conditions affect what they can and cannot do.

So go ahead and get those therapists and other records to Social Security. It’s good evidence!

A number of attorneys suggest that if you are denied at your Social Security disability hearing, you should do two things:

1. Appeal the Administrative Law Judge’s (ALJ’s) decision to the Social Security Appeals Council, and
2. 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.

Under the new procedures we are adopting in this Ruling, generally you will no longer be allowed to have two claims for the same type of benefits pending at the same time. If you want to file a new disability claim under the same title and of the same type as a disability claim pending at any level of administrative review, you will have to choose between pursuing your administrative review rights on the pending disability claim or declining to pursue further administrative review and filing a new application.

This applies to pursuing two cases of the same type. That is, both appealing and applying for SSDI benefits, SSI benefits, or a concurrent claim for both SSDI/SSI benefits.

You can still apply for benefits of a different type that those considered on the appeal.

This Ruling does not change the procedure we currently follow when you file a subsequent claim under a different title or for a different benefit type than a pending claim. When a subsequent claim under a different title or for a different benefit type shares a common issue with the pending claim, we will usually consolidate it with the pending claim through the hearing level. When you file a subsequent claim that is under a different title or is for a different benefit type and your prior claim is pending review at the Appeals Council, we will process the subsequent claim in accordance with our current procedures.

In practice, this exception to the “choose only one appeal option” will mostly come up in cases where an individual was applying for Social Security Disability Insurance (SSDI) benefits and the hearing denial deals with disability through the date last insured (DLI).

An appeal is usually the only option (unless there is a previously un-adjudicated period of disability), since the date last insured often precludes a new SSDI claim. However, an individual in this circumstance may still be able to file for Supplemental Security Income (SSI) benefits (which does not have a date last insured issue).

So, if you have a prior hearing denial for SSDI which deals with a date last insured, and can only start a new claim for SSI,  you are still able to apply and appeal. This is because the prior claim (SSDI) is a different type that then new claim (SSI).

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.

As Gordon mentions, it used to be very difficult to find a Ruling on the topic you needed.  But, things have gotten much easier:

Recently, the SSA published a new index of the rulings, grouping them by subject matter.

So for example, if you were looking to see if Social Security has a ruling on Reflex Sympathetic Dystrophy (RSD), you choose “Medical” from the index.  Then scan the new window … and there it is!  SSR 03-02p Evaluating Cases Involving Reflex Sympathetic Dystrophy Syndrome/Complex Regional Pain Syndrome.

Now, you can find out exactly how Social Security is supposed to review this debilitating condition.  

Social Security Disability Lawyer: Social Security Rulings.

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.

However, the memory and concentration impairments can further limit your ability to perform skilled work, or maintain production requirements in unskilled work (in assembly line work, for example).  

The combination of exertional and non-exertional limitation substantially increases your chances of being found disabled.

In any Social Security case, having medical documentation is essential.  This means that if you have stopped seeing a doctor because you were told there was nothing more the doctor could do for you, you have also stopped developing the evidence you will need on your Social Security case — which can be a problem.

If possible, keep up with your doctors visits; if for no other reason than to keep current documentation of the severity of CFS.

If you do not already an attorney, strongly consider working with one to develop the specific limitations CFS causes that keep you from being able to work.  ’

For more information about how Social Security evaluates CFS, see Social Security Ruling (SSR) 99-2p.  But, be warned, the legalese and medical terminology flies fast and furious in the SSRs.  If you already have an attorney, make sure he or she is aware of SSR 99-2p.  

photo credit: peasap