What Medical Evidence Is Needed to Support Social Security Disability Claims?

by | Published on Apr 20, 2020 | Social Security Disability

Disability cases rely heavily on medical evidence that is obtained from the applicant’s medical records. The SSA (Social Security Administration) will use this evidence to determine whether or not the applicant is unable to work because of a severe physical or mental disability. Reliable medical evidence is vital to support a disability claim and this makes medical records services a very useful solution. Disability attorneys utilize these services to ensure that they have all the medical documentation ready to support their clients’ claims. The relevant medical records will have to be collected from all providers that have treated or evaluated the claimant for his or her impairment. Medical record review firms collect these records and review them, which lightens the disability claim processing for attorneys.

As any experienced provider of medical review services would endorse, to increase the possibility of approval, the medical evidence provided to the SSA must be adequate, timely, and correct.

  • Ideally, the claimant’s medical records should be no older than 6 months. However, older records are also important because the SSA may want to check the claimant’s medical history when determining disability. Such “longitudinal” medical records are needed for approval of retroactive disability back pay in SSDI (Social Security Disability Insurance) cases. Older records help provide a broader view of the applicant’s underlying conditions.
  • The medical records must clearly and accurately describe the applicant’s condition. The SSA will not accept inconsistencies in the medical record. The medical records must also be sufficient for the SSA to come to the correct medical conclusion regarding the claimant’s functional limitations and the severity of his/her disability.

What Are SSA’s Acceptable Medical Sources?

  • Licensed physicians, medical or osteopathic doctors
  • Licensed or certified psychologists
  • Licensed optometrists (for visual disorders only)
  • Qualified speech-language pathologists (for speech/language impairments only)
  • Licensed podiatrists (for foot and/or ankle problems only)

The SSA doesn’t accept medical records from:

  • Chiropractors (Notes and records made by the chiropractor are not considered, but x-rays taken at a chiropractor’s office can be submitted as evidence because they are considered as objective evidence)
  • Massage therapists
  • Acupuncture
  • New age medicine

Medical Reports from Treating Physicians

Medical reports from the claimant’s healthcare providers have to be submitted along with the initial application. Otherwise the SSA will ask for these from time to time, and this could delay the application processing. The reports from the doctors should contain the following information.

  • Prescribed treatment with the applicant’s response
  • Clinical and lab findings
  • Diagnosis
  • Prognosis
  • Detailed medical history
  • List of applicant’s functional limitations caused by the condition
  • The applicant’s ability to perform work-related activities despite their condition (if 18 years old or older)
  • The applicant’s functional limitations compared to children his/her age (if the applicant is younger than 18)

When applying for disability, the medical opinion from the claimant’s treating doctor is given more weight by the SSA. ALJs (Administrative Law Judges) are also required to give more weight to the claimant’s treating doctor’s opinion during an appeals hearing. A statement from the treating physician about what the claimant is still able to do in spite of being disabled, should describe the claimant’s work-related physical ability and work-related mental ability. This would include:

  • The applicant’s ability to perform basic physical activities such as standing, walking, lifting, carrying, handling objects, sitting for long periods, hearing, speaking, and traveling
  • The applicant’s ability to understand and carry out instructions, to concentrate, to adapt to changes, and to respond appropriately to supervision, co-workers and work pressures in a work environment

Consultative Exam If the Medical Documentation Is Insufficient

When considering the claim, if the SSA finds that the medical documentation provided is insufficient, they may request the claimant to attend a consultative medical exam. In this exam, the SSA may request something specific such as blood work or an X-ray. The preferred source for such an exam is the claimant’s treating physician, however, the SSA could call for an independent physician to perform the exam in the following instances.

  • The claimant’s treating doctor refuses to perform the exam
  • There are inconsistencies with the documentation the treating physician has provided
  • The treating physician doesn’t have the necessary equipment to perform the exam
  • The claimant has another doctor whom he/she prefers to perform the exam. The claimant must justify why he or she wants another doctor
  • The SSA finds that the treating doctor is not a productive source of medical information

Retrieving the necessary medical records and reviewing them for the required evidence are time-intensive activities that are best performed by medical records services, and many social security disability attorneys rely on these solutions. Professional medical reviewers will ensure that the complete set of medical records relevant to the claim are obtained from diverse sources, organized and reviewed carefully to ensure that the claimant’s application is granted at the earliest.

Discover our medical record review solutions and partner with us for your next case.

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