Under Social Security regulations, the term “medical sources” refers to both “acceptable medical sources” and “non-acceptable medical sources.” See Social Security Ruling 06-03p.
“Acceptable medical sources” are: licensed physicians (medical and osteopathic doctors), licensed and certified psychologists, school psychologists or similar school personnel who perform the same functions (but only for purposes of establishing certain impairments such as learning disabilities and borderline intellectual functioning), licensed optometrists for purposes of measuring visual acuity and visual fields (for Title II claims, an underlying medically determinable visual impairment must be diagnosed by an MD), licensed podiatrists for purposes of establishing a foot or ankle disorder only, depending on whether the state in which he or she practices allows podiatrists to work on both ankle and feet, or feet only, and qualified speech pathologists, for purposes of establishing speech or language impairments only.
There are three reasons for the distinction between acceptable and non-acceptable medical sources. First, only an acceptable medical source can diagnose a medically determinable impairment. Second, only acceptable medical sources can give medical opinions. Third, only acceptable medical sources may be considered treating sources whose opinions may be entitled to controlling weight.
However, evidence from non-acceptable medical sources may still be used to establish the severity of an impairment, and how it affects the person’s ability to function. Non-acceptable medical sources are sources such as naturopaths, chiropractors, licensed clinical social workers, nurse practitioners, physician’s assistants, audiologists and therapists.
Other, non-medical sources of evidence may include, educational personnel, daycare providers, welfare agency personnel, rehab counselors, family, friends, employers, neighbors and others who have a knowledge of the person’s medical conditions. Evidence from other sources cannot establish a medical impairment, but may impart insight into the person’s conditions and daily activities, and thus may be used to determine the severity of the person’s impairments and their impact on the person’s functioning.
Social Security’s regulations set forth criteria for evaluating opinions from acceptable medical sources. These factors include, among other things: the nature of an examining relationship between the person and medical source; the nature of any treatment relationship between patient and provider including length, duration and frequency; whether the provider is a specialist in the particular field her or she is given an opinion about; how consistent the opinion is with the record as a whole; whether the provider gives an explanation supported by medical signs and laboratory findings; and any other important factors that are brought to the adjudicator’s attention, such as whether or not the provider or examiner is familiar with social security’s programs and other evidence in the file.
Given the increasingly prominent role of medical sources such as nurse practitioners, licensed clinical social workers and physician’s assistants in providing much of the primary care for individuals, social security promulgated this ruling in order to give guidance on how to evaluate the opinions of “other sources”, whether medical or non-medical.
Similar criteria apply to evaluating these opinions as apply in evaluating opinions from “acceptable medical sources.” These include factors such as: the length of time and frequency the other source has seen the individual; whether the opinion is consistent with other evidence in the file; how well the source explains his or her opinion; whether the source has any kind of expertise in the field in which he or she gives an opinion about; and any other factors that tend to support or refute the opinion.
Although generally speaking, an opinion from an “acceptable medical source” may be given more weight than one from a “non-acceptable medical source” due to the former’s qualifications, it does not necessarily follow that such must always be the case. An opinion from a “non-acceptable medical source” may be given more weight under certain circumstances, such as where the source has seen the patient much more often and/or longer than the “acceptable medical source” and thus has more knowledge of the individual’s functioning over time.
These same principles are generally applicable to the opinions of other sources who are not medical sources.
Only an authorized state agency (such as Disability Determination Services, in Utah) or the Commissioner of Social Security (and his or her agents such as administrative law judges) are authorized to make disability determinations for Social Security. Thus, the disability decisions of other agencies, such as Worker’s Compensation or the Department of Veteran’s Affairs, are not binding upon Social Security. Their decisions are made based upon their own set of rules.
However, this does not mean that social security adjudicators can ignore such decisions. They may be useful in determining and individual’s functioning over time. The medical evidence used to make the decisions may be particularly valuable. But their relevance may be somewhat limited by the different standards they apply for determining disability. Adjudicators should document the consideration given to these disability decisions from other agencies.
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.