| Under both the Title II and Title XVI programs, | | | | birth to age 1, responsiveness to stimuli). |
| medical evidence is the cornerstone for the | | | | |
| determination of disability. Each person who files | | | | |
| a disability claim is responsible for providing medical | | | | Consultative Examinations |
| evidence showing that he or she has an | | | | If the evidence provided by the claimant’s |
| impairment(s) and how severe the impairment(s) | | | | own medical sources is inadequate to determine if |
| may be. However, the Social Security | | | | he or she is disabled, additional medical information |
| Administration (SSA) will help claimants get | | | | may be sought by recontacting the treating |
| medical reports from their own medical sources | | | | source for additional information or clarification, or |
| when the claimants give SSA permission to do so. | | | | by arranging for a CE. The treating source is the |
| This medical evidence generally comes from | | | | preferred source for a CE if he or she is qualified, |
| sources who have treated or evaluated the | | | | equipped, and willing to perform the examination |
| claimant for his or her impairment(s). | | | | for the authorized fee. Even if only a supplemental |
| Acceptable Medical Sources | | | | test is required, the treating source is ordinarily |
| Documentation of the existence of a | | | | the preferred source for this service. However, |
| claimant’s impairment must come from | | | | SSA’s rules provide for using an independent |
| medical professionals defined by SSA regulations | | | | source (other than the treating source) for a CE |
| as “acceptable medical sources.” Once | | | | or diagnostic study if: |
| the existence of an impairment is established, all | | | | - the treating source prefers not to perform the |
| the medical and non-medical evidence is | | | | examination; |
| considered in assessing impairment severity. | | | | |
| ”Acceptable medical sources” are: | | | | |
| - licensed physicians (medical or osteopathic | | | | - the treating source does not have the |
| doctors); | | | | equipment to provide the specific data needed; |
| | | | | |
| | | | | |
| - licensed or certified psychologists. Included are | | | | - there are conflicts or inconsistencies in the file |
| school psychologists, or other licensed or certified | | | | that cannot be resolved by going back to the |
| individuals with other titles who perform the same | | | | treating source; |
| function as a school psychologist in a school | | | | |
| setting, for purposes of establishing mental | | | | |
| retardation, learning disabilities, and borderline | | | | - the claimant prefers another source and has |
| intellectual functioning only ; | | | | good reason for doing so; or prior experience |
| | | | | indicates that the treating source may not be a |
| | | | | productive source. |
| - licensed optometrists, for purposes of | | | | |
| establishing visual disorders only (except, in the | | | | |
| U.S. Virgin Islands, licensed optometrists, for the | | | | Consultative Examination Report Content |
| measurement of visual acuity and visual fields | | | | A complete CE is one which involves all the |
| only); | | | | elements of a standard examination in the |
| | | | | applicable medical specialty. A complete |
| | | | | consultative examination report should include the |
| - licensed podiatrists, for purposes of establishing | | | | following elements: |
| impairments of the foot, or foot and ankle, | | | | - the claimant’s major or chief complaint(s); |
| depending on whether the State in which the | | | | |
| podiatrist practices permits the practice of | | | | |
| podiatry on the foot only, or the foot and ankle; | | | | - a detailed description, within the area of specialty |
| and | | | | of the examination, of the history of the major |
| | | | | complaint(s); |
| | | | | |
| - qualified speech-language pathologists, for | | | | |
| purposes of establishing speech or language | | | | - a description, and disposition, of pertinent |
| impairments only. For this source, | | | | “positive” and “negative” detailed |
| “qualified” means that the speech-language | | | | findings based on the history, examination, and |
| pathologist must be licensed by the State | | | | laboratory tests related to the major complaint(s), |
| professional licensing agency, or be fully certified | | | | and any other abnormalities or lack thereof |
| by the State education agency in the State in | | | | reported or found during examination or |
| which he or she practices, or hold a Certificate of | | | | laboratory testing; |
| Clinical Competence from the American | | | | |
| Speech-Language-Hearing Association. | | | | |
| | | | | - results of laboratory and other tests (e.g., |
| | | | | X-rays) performed according to the requirements |
| Medical Evidence from Treating Sources | | | | stated in the Listing of Impairments; |
| Currently, many disability claims are decided on | | | | |
| the basis of medical evidence from treating | | | | |
| sources. SSA regulations place special emphasis on | | | | - the diagnosis and prognosis for the |
| evidence from treating sources because they are | | | | claimant’s impairment(s); |
| likely to be the medical professionals most able to | | | | |
| provide a detailed longitudinal picture of the | | | | |
| claimant’s impairments and may bring a | | | | - a statement about what the claimant can still do |
| unique perspective to the medical evidence that | | | | despite his or her impairment(s), unless the claim |
| cannot be obtained from the medical findings | | | | is based on statutory blindness. This statement |
| alone or from reports of individual examinations or | | | | should describe the opinion of the consultant about |
| brief hospitalizations. Therefore, timely, accurate, | | | | the claimant’s ability, despite his or her |
| and adequate medical reports from treating | | | | impairment(s), to do work related activities such |
| sources accelerate the processing of the claim | | | | as sitting, standing, walking, lifting, carrying, handling |
| because they can greatly reduce or eliminate the | | | | objects, hearing, speaking, and traveling; and, in |
| need for additional medical evidence to complete | | | | cases of mental impairment(s), the opinion of the |
| the claim. | | | | consultant about the individual’s ability to |
| Medical Evidence From Health Facilities | | | | understand, to carry out and remember |
| Social Security also requests copies of medical | | | | instructions, and to respond appropriately to |
| evidence from hospitals, clinics, or other health | | | | supervision, coworkers, and work pressures in a |
| facilities where a claimant has been treated. All | | | | work setting. For a child, the statement should |
| medical reports received are considered during | | | | describe the child’s functional limitations in |
| the disability determination process. | | | | learning, motor functioning, performing self-care |
| Other Evidence | | | | activities, communicating, socializing, and |
| Information from other sources may also help | | | | completing tasks (and, if the child is a newborn or |
| show the extent to which a person’s | | | | young infant from birth to age 1, responsiveness |
| impairment(s) affects his or her ability to function | | | | to stimuli); and |
| in a work setting; or in the case of a child, the | | | | |
| ability to function compared to that of children the | | | | |
| same age who do not have impairments. Other | | | | - the consultant ’s consideration, and some |
| sources include public and private agencies, | | | | explanation or comment on, the claimant’s |
| non?medical sources such as schools, parents and | | | | major complaint(s) and any other abnormalities |
| caregivers, social workers and employers, and | | | | found during the history and examination or |
| other practitioners such as naturopaths, | | | | reported from the laboratory tests. The history, |
| chiropractors, and audiologists. | | | | examination, evaluation of laboratory test results, |
| Medical Reports | | | | and the conclusions will represent the information |
| Physicians, psychologists, and other health | | | | provided by the consultant who signs the report. |
| professionals are frequently asked by SSA to | | | | |
| submit reports about an individual’s | | | | |
| impairment. Therefore, it is important to know | | | | Evidence Relating to Symptoms |
| what evidence SSA needs. Medical reports should | | | | In developing evidence of the effects of |
| include: | | | | symptoms, such as pain, shortness of breath, or |
| - medical history; | | | | fatigue, on a claimant’s ability to function, |
| | | | | SSA investigates all avenues presented that relate |
| | | | | to the complaints. These include information |
| - clinical findings (such as the results of physical or | | | | provided by treating and other sources regarding: |
| mental status examinations); | | | | - the claimant’s daily activities; |
| | | | | |
| | | | | |
| - laboratory findings (such as blood pressure, | | | | - the location, duration, frequency, and intensity of |
| x-rays); | | | | the pain or other symptom; |
| | | | | |
| | | | | |
| - diagnosis; | | | | - precipitating and aggravating factors; |
| | | | | |
| | | | | |
| - treatment prescribed with response and | | | | - the type, dosage, effectiveness, and side |
| prognosis; | | | | effects of any medication; |
| | | | | |
| | | | | |
| - a statement providing an opinion about what the | | | | - treatments, other than medications, for the |
| claimant can still do despite his or her | | | | relief of pain or other symptoms; |
| impairment(s), based on the medical source’s | | | | |
| findings on the above factors. This statement | | | | |
| should describe, but is not limited to, the | | | | - any measures the claimant uses or has used to |
| individual’s ability to perform work-related | | | | relieve pain or other symptoms; and |
| activities, such as sitting, standing, walking, lifting, | | | | |
| carrying, handling objects, hearing, speaking, and | | | | |
| traveling. In cases involving mental impairments, it | | | | - other factors concerning the claimant’s |
| should describe the individual’s ability to | | | | functional limitations due to pain or other |
| understand, to carry out and remember | | | | symptoms. |
| instructions, and to respond appropriately to | | | | |
| supervision, coworkers, and work pressures in a | | | | |
| work setting. For a child, the statement should | | | | In assessing the claimant’s pain or other |
| describe his or her functional limitations in learning, | | | | symptoms, the decision maker must give full |
| motor functioning, performing self-care activities, | | | | consideration to all of the above-mentioned |
| communicating, socializing, and completing tasks | | | | factors. It is important that medical sources |
| (and, if a child is a newborn or young infant from | | | | address these factors in the reports they provide. |