Social Security Ruling (SSR) 96-2p sets out Social Security’s rules for giving controlling weight to medical source opinions.
Only a medical opinion from an acceptable treating source may be afforded controlling weight. A medical opinion is an opinion from a medical source regarding a person’s diagnoses, prognoses, and/or the nature and severity of a person’s impairments. Medical opinions on ultimate issues reserved for the Commissioner are never entitled to controlling weight or special significance. These issues include a person’s residual functional capacity (RFC), or the most the person can do despite his or her impairments, whether a person’s impairment(s) meet or medically equal one of Social Security’s listed impairments, whether the person’s RFC prevents her from doing her prior work, how the vocational factors of age, education, and prior work experience apply, and whether or not the person is disabled. See SSR 96-5p.
An “acceptable” medical source refers to a medical provider’s credentials; i.e., an MD, a DO, a licensed clinical psychologist (PhD), and in some instances a podiatrist, an optometrist, and a speech pathologist. Examples of “non-acceptable” medical sources are: licensed clinical social workers (LCSW), physician’s assistants (PA-C), chiropractors, naturopath’s, acupuncturists, holistic health providers, physical therapists, and nurse practitioners. Though such sources’ opinions are never entitled to controlling weight, they cannot be ignored and must be weighed along with all of the other evidence in the file.
Similarly, opinions from acceptable medical sources who have not treated the person are never entitled to controlling weight, although in certain circumstances they may be entitled to greater weight than a treating source opinion. Such medical sources may be consultative examiners or non-examining consultants. See SSR 96-6p.
An acceptable treating source medical opinion must be given controlling weight if it is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with other substantial evidence in the file.
The requirement for a treating source opinion to be given controlling weight only if it is well supported by medically acceptable clinical and laboratory diagnostic techniques ensures that there is a sound medical basis for a treating source opinion. In order to make this determination, an adjudicator must have an understanding of what the clinical and laboratory evidence signifies. There may be circumstances in which an adjudicator at the administrative hearing and Appeals Council levels of adjudication need to consult a medical expert in order to gain a clear understanding of what the clinical signs and laboratory findings signify.
A treating source opinion does not need to be completed supported by the clinical signs and laboratory findings in order to be afforded controlling weight.
In addition to the requirement that a treating source opinion must be well supported by medically acceptable clinical signs and laboratory findings in order to be assigned controlling weight, it must also be “not inconsistent” with other substantial evidence in the case record.
Such substantial evidence need not necessarily be medical evidence. For example, it could be a spouse’s description of the person’s actual daily activities being greater than is described in a treating source opinion. It could be a conflicting opinion from a different medical source.
Substantial evidence is defined as “more than a scintilla…” It is such evidence as a reasonable mind might accept as adequate to support a conclusion. Such evidence does not need to be a preponderance of evidence.
When the test for controlling weight is met, the adjudicator must not substitute his or her judgment for that of the treating source.
It is important to remember that the fact that a treating source opinion may not be entitled to controlling weight does not mean it must be rejected. Pursuant to 20 CFR 404.1527 and 416.927, opinions from acceptable treating sources are entitled to deference. The criteria set out in those sections will often lead to s treating source opinion being assigned “greatest weight”, even if it is not entitled to controlling weight.
It is critical for a claimant in any disability case to obtain treating source opinions from his or her doctors and/or psychologists. These opinions are an integral part of any disability case. No one knows the claimant’s medical condition better than his or her ling-time treating doctors.
This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.