Because the Social Security Administration (SSA) mainly uses medical evidence to determine eligibility for disability benefits, accurate records are key. You must prove that your impairment prevents you from working for at least one year, or should result in death. But which healthcare providers are acceptable medical sources for a disability evaluation, according to the SSA’s own internal guidelines? Should you list each of your specialists (i.e., chiropractor, neurologist and physical therapist) as well as your primary care provider? Many applicants find the claims paperwork confusing, and knowing which doctor matters most can make a difference in getting approved.
Acceptable Medical Sources for Your Disability Evaluation
Fortunately, the SSA lists several different acceptable medical sources who can submit evidence required for your Social Security disability evaluation. As long the documents they submit meet certain requirements, the SSA lists the following as acceptable medical sources for your disability evaluation:
The SSA considers both medical and osteopathic doctors to be credible sources. Your state’s Disability Determination Services (DDS) examiner will consider any documentation they provide when conducting your Social Security disability evaluation.
Licensed or Certified Psychologists
Any licensed or certified individuals in the psychology field (even those with titles other than “psychologist”) are credible medical sources. This includes school psychologists, private practice therapists and those who help establish intellectual or learning disabilities, or borderline intellectual functioning.
If you have a diagnosed visual disorder, ask a licensed optometrist to provide medical evidence that proves your disabling condition.
To establish foot or ankle-related impairments, you need evidence from a licensed podiatrist that clearly documents your diagnosis. Ask whether your podiatrist’s certified to make proper foot or foot and ankle diagnoses, since every state has different guidelines.
Qualified Speech-Language Pathologists
A speech-language pathologist must submit medical evidence that establishes your speech or language impairment meets the SSA’s definition of disability. “Qualified” means your state’s professional licensing agency issued a license to your speech-language pathologist to practice according to their guidelines. A state education agency may also certify your pathologist. The SSA also considers any pathologist that holds a Certificate of Clinical Competence from the American-Speech-Language-Hearing Association to be qualified.
What Documents Provide the Most Convincing Evidence for Your Disability Evaluation?
Medical claims from all treating physicians provide the most convincing evidence to the SSA during your Social Security disability evaluation. Each one should give his or her accurate and unique perspective about your diagnosis, treatment and your condition’s progress outlook. Any medical professional who doesn’t regularly treat or see you most likely won’t have a clear opinion about your disability. The more viable evidence you can get from licensed, treating sources, the better your chances are for getting disability benefits. Convincing records typically include:
- Laboratory test results
- X-rays, CT scans or MRIs
- Doctor’s treatment notes and other records that detail your condition’s initial diagnosis, progress and expected improvements or functional declines
- Hospital admission and release records, if applicable
- Medications you take for managing your condition’s symptoms, if applicable
- Surgical procedures or medical devices needed as a result of your condition (for example: limb amputation, tumor removal, insulin pump, pacemaker, stent, IVC filter, lumbar decompression, artificial knee or hip joint replacement, etc.)
Occasionally, the SSA pulls records and other evidence directly from medical treatment centers and hospitals that treated you. The DDS may also consult non-medical sources, including schools, parents, caregivers, social workers, employers, and non-licensed medical personnel. However, these sources won’t carry as much weight as medical evidence from licensed professionals will in determining your disability evaluation.
When Does the SSA Require Applicants to Undergo A Consultative Exam?
Occasionally, a DDS claim examiner feels there isn’t enough medical evidence to demonstrate your disability fits within the SSA’s guidelines. Then, your claim examiner will either contact your treating physicians for additional records and documentation, or schedule a consultative examination. During your CE, the SSA’s chosen medical professional (typically your doctor, if qualified and willing) completes an additional disability evaluation. He or she must then submit a complete and detailed report about your disability, including:
- Major complaints and symptoms
- How your disability affects your everyday life
- Any other evidence that the SSA requires to complete your disability evaluation
If the SSA sends you a letter telling you to attend an upcoming consultative exam, don’t panic! That doesn’t mean the SSA plans to automatically deny your disability benefits claim. Often, it means the SSA needs clarification or additional information before reaching a disability evaluation determination. Here are some reasons why you might need to attend a consultative examination (CE):
- Your medical records are inconsistent or show unusual changes in progress/conflicting diagnoses
- The SSA can only accept specialized medical evidence or highly technical proof, such as specific lab tests you have not yet completed
- Your doctor submitted outdated or incomplete medical records
- Your records indicate your condition could sufficiently improve enough that you could return to work in less than 12 months
How Long Does A Consultative Exam Usually Take and What Should You Bring?
Before your consultative exam, write down all of the following information and bring it with you to your appointment:
- Your symptoms (specifically, the ones caused by your disabling condition)
- Medications (include both prescription and over-the-counter drugs, plus your usual dosage and frequency)
- Treatment history (names, phone numbers and addresses of all doctors and other healthcare providers treating your condition)
- Primary reasons your disability keeps you from working (i.e., back pain keeps you from lifting packages for UPS; cannot work retail due to peripheral neuropathy)
The consultative exam typically lasts 20-60 minutes for claimants with one disability, but could take longer for assessing multiple conditions. Federal law states your CE must meet the following time requirements for completing your disability evaluation:
- General medical conditions: no less than 30 minutes
- Musculoskeletal and neurological impairments: no less than 20 minutes
- Psychiatric impairments: 40 minutes or longer
- Psychological issues: at least one hour (60 minutes), but can last longer if multiple tests are needed
- All other impairment types and associated exams: no less than 30 minutes (provided it fits within the accepted medical practices for your state)
Get Free Help Preparing for Your Disability Evaluation
Have questions about your medical records or not sure whether your doctor’s an acceptable medical source for your disability evaluation? Schedule your free legal consultation now with a local resource in our network of Social Security lawyers and disability advocates. You can get help filing your claim, get personalized advice in private or secure representation for your appeal, if needed. Our disability advocates work on contingency, which means you’ll pay nothing for professional help unless we help you win benefits.
The best way to get the most benefits you’re rightfully owed faster is to ask a lawyer to help you. Less than 1 in 4 applicants get their claims approved on the first try, and another 11% win benefits during the appeals process. In fact, nearly 6 in 10 eligible applicants have their claims rejected for basic errors they made completing their forms. If that happens, it could delay your claim’s disability evaluation another 12-18 months — or longer before you hear a decision.
To see if you may qualify for legal assistance, click the button below to start your free benefits evaluation now.