Social Security Disability Insurance (SSDI) – SSA Publishes Final Rules on Evaluation of Medical Evidence

The Social Security Administration (SSA) recently published final rules regarding the evaluation of medical evidence in Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims. These rules become effective March 27, 2017. A very important change under the new rules is that adjudicators of Social Security Disability Insurance (SSDI) or SSI claims no longer have to give special weight to the medical opinions of a claimant’s treating source, i.e, a treating primary care physician, psychiatrist, or psychologist. The medical opinions now will be evaluated equally for “persuasiveness” based supposedly on consistency and supportability.

On a positive note, the opinions of Physicians Assistants (PAs) and Advance Practice Registered Nurses (APRNs) are now included in the list of acceptable medical sources, as well as licensed audiologists and optometrists for issues within their specific scopes of practice. The rule change involving Pas and APRNs is well overdue and is an acknowledgment of the changing healthcare landscape in America where many people primary care is not delivered by medical doctors (MDs).

Chiropractors, Licensed Clinical Social Workers (LCSWs) and Registered Nurses are still not acceptable medical sources and are considered “other sources.”

Additionally, adjudicators will give no special weight to the disability decisions of other governmental agencies, such as Department of Veterans Affairs (VA). The SSA adjudicators will still consider and evaluate the medical evidence submitted to that agency in support of that decision.

These new evidence rules will cause the SSA to rescind certain Social Security Rulings (SSRs) that are now inconsistent or duplicative with the new rules. Those SSRs include:

· SSR 96-2p: Titles II and XVI: Giving Controlling Weight to Treating Source Medical Opinions;

· SSR 96-5p: Titles II and XVI: Medical Source Opinions on Issues Reserved to the Commissioner;

· SSR 96-6p: Titles II and XVI: Consideration of Administrative Findings of Fact by State Agency Medical and Psychological Consultants, and Other Program Physicians and Psychologists at the Administrative Law Judge and Appeals Council Levels of Administrative Review; Medical Equivalence; and

· SSR 06-03p: Titles II and XVI: Considering Opinions and Other Evidence from Sources who are not “Acceptable Medical Sources” in Disability Claims; Considering Decisions on Disability by other Governmental and Non-governmental Agencies.

If you need more information about a Social Security Disability/SSI, personal injury, EEOICPA, long or short-term disability, Railroad Retirement Board disability, or a workers compensation matter, please contact the Law Offices of Tony Farmer and John Dreiser for a free case evaluation. We can be reached at (865) 584-1211 or (800) 806-4611 or through our website.




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