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!

If your work is performed at a Substantial Gainful Activity (SGA) level you may be denied Social Security disability benefits.  However, you may be able to reduce the amount Social Security considers to bring your gross income below SGA levels.

One way to do this is through Impairment Related Work Expenses (IRWEs). Here is what Social Security describes IRWEs:

An IRWE means an expense for an item or service which is directly related to enabling an impaired individual to work and which is necessarily incurred by that individual because of a physical or mental impairment. Such an expense may involve payment for the purchase, installation, maintenance and repair of an impairment-related item or payment for an impairment-related service. Any medically necessary expenses related to your impairment which are necessary to allow you to work are deducted from your gross income.

If you are disabled, but some type of medical care or service allows you to be able to work, the cost of that care or services may be deducted from your gross income.

This might make you eligible to continue receiving Social Security benefits even though you are working, and your work is a substantial gainful activity (SGA).

One critical element of IRWEs is that you, the disabled individual, have to be paying for the medical care or service.  If insurance or another person is paying for the care, Social Security will not deduct it from your gross income as IRWE.

Here are some examples of IRWEs:

1. Routine drugs and routine medical services.
2. Some diagnostic procedures.
3. Attendant care services.
4. Medical devices.
5. Prosthesis.
6. Other equipment.
7. Guide dogs.

For many people, the most relevant potential IRWE will be “routine drugs and medical services.”  Here is what Social Security says about this:

The costs of routine drugs and routine medical services are not deductible unless the drugs or services are necessary to control the disabling condition so as to enable the individual to work. The amount of IRWE that may be deducted is subject to reasonable limits, and deductions for needed items and services will be made only if the cost is paid by the impaired individual.

In short, the reasonable cost of medications can be deducted from your gross income if the medications are necessary, they enable you to work, and you pay for the medications.

There are a lot of limits on IRWEs and this is only a brief overview.  For more information check out Social Security Ruling 84-26 and 20 CRF 404.1576.