Opinions from medical providers who are not "acceptable medical sources" in Social Security claims
by
Glen Cook on Jul. 24, 2013
Government Social Security Health Care Health Care Other
Summary: Administrative Law Judges often reject opinions from providers who are not doctorates because the opinion does not come from "an acceptable medical source." However, the regulations clearly indicate these records can be used for some purposes.
Administrative Law judges try to deny cases from any number of reasons. One excuse they use is that the opinion is not from an "acceptable medical source", that is, from a PhD or M.D.
However, the regulations specifically provide that evidence from other sources, including chiropractors and therapists, is used “to show the severity of your impairment(s) and how it affects your ability to work.” 20 CFR 404.1513(d). Social Security Ruling 06-3p clarifies how SSA considers evidence from individuals who are not “acceptable medical sources.” This ruling explains that with the growth of managed care in recent years on the emphasis in containing medical cost, medical sources who are not “acceptable medical sources” have increasingly assumed a greater percentage of the treatment and evaluation functions previously handled primarily by physicians and psychologists. Opinions from these medical sources are “important and should be evaluated on key issues such as impairments, severity, and functional effects along with the other relevant in the file.” The Ruling further explains that non-medical sources who have had contact with the individual or valuable sources of evidence for assessing impairment, severity, and functioning.
Indeed, SSR 06-03p recognizes that under some circumstances, an opinion from a “non-medical source” who has seen the claimant in his or her professional capacity, may “properly be determined to outweigh the opinion from a medical source, including a treating source.” This ruling further provides that opinions from non-medical sources who have seen the individual in their professional capacity should be evaluated by using the factors set forth in 20 CFR 416.927(d). Further, the ALJ should generally explain the weight given to opinions from these other sources, or otherwise ensure that the discussion of the evidence in the determination or decision allows a claimant or subsequent reviewer to follow the adjudicator’s reasoning, when such opinions may have an effect on the outcome of the case. Id. One of the relevant factors in deciding the weight to give to a medical opinion is “the extent to which an acceptable medical source that’s familiar with the other information in your case record.” 20 CFR 404.1527(d)(6).
This ruling has been utilized in the in the Tenth Circuit. Bowman v. Astrue, 511 F.3d 1271 (2008).
Copyright 2013. Glen Cook www.cooklaw.org