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What medical evidence do I need to win my SSDI claim?

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Q:

What medical evidence do I need to win my SSDI claim?

A:

Winning Social Security Disability Insurance (SSDI) can take weeks, months or years. However, providing medical evidence to the Social Security Administration (SSA), which proves that the claimant has a severe health condition that is expected to last at least 12 continuous months and that does not allow them to perform work, is the key to winning Social Security Disability Insurance benefits.

Who provides the medical evidence to the Social Security Administration?

Disability applicants are not required to contact their doctors and request copies of their medical information to send to the SSA (although if they have recent medical information, it can be given to the SSA and is likely to expedite the claims process). Instead, the SSA will request the contact information from each of the claimant’s treating sources, including the doctor’s names, addresses, phone numbers and dates of treatment.

What are considered acceptable medical sources?

As mentioned above, to win an SSDI case, a disability applicant must provide medical evidence. Medical evidence, however, can only be obtained from a doctor that the SSA considers to be an acceptable medical source.

Acceptable medical sources are defined by the SSA as including the following:

  • Licensed physicians (medical or osteopathic doctors)
  • Licensed or certified psychologists
  • Licensed optometrists
  • Licensed podiatrists
  • Qualified speech-language pathologists

Depending on the claimant’s health condition, the SSA will expect that the claimant has seen the appropriate doctor. For example, if you claim to have a severe heart condition, the SSA would expect that you would be receiving medical treatment from a cardiologist.

It’s important to note that while information provided by acceptable medical sources is used to substantiate a claimant’s claim of disability, this does not mean that the SSA discounts information from all other sources. In fact, information from other sources such as employers, social workers and chiropractors may also provide important information about the extent of the claimant’s physical and mental functional limitations.

What type of medical information should I provide to the SSA?

To make the disability determination, the SSA will request all recent medical information from the medical sources provided by the disability applicant. Medical records contain a variety of reports that can be used by the SSA to make their disability determination. The SSA will specifically evaluate the following types of reports:

  • Medical history reports
  • Laboratory reports
  • Diagnostic reports
  • Clinical reports
  • Treatment information including diagnosis, treatment and prognosis

Claimants can also bolster their disability claims by ensuring that their doctor provides information about their mental and physical limitations to work. For example, claimants with a physical disability should ask their doctors to provide a functional limitation report, which specifically addresses the claimant’s ability to stand, sit, walk, speak, lift, carry and manipulate objects.

Claimants with a mental disability should ask their doctor to include information about their mental limitations that limit their ability to work. Limitations can include the inability to work an eight-hour day, 40 hours per week; understand and carry out tasks; get along with co-workers; and remember detailed instructions.

Remember, the goal of all medical evidence provided by the claimant to the SSA is to prove that the claimant no longer has the ability to perform what the SSA terms substantial gainful activity (SGA). Any evidence that suggests a claimant has the capability to work a full-time job will hurt their claim (i.e. a doctor’s note in a claimant’s medical file that the claimant can work).

What if I do not have any medical evidence?

Every disability applicant should make sure that they have solid, convincing medical evidence from acceptable medical sources before they apply for SSDI benefits. The SSA regulations require the SSA to place special emphasis on evidence provided by acceptable medical sources.

According to the SSA, “Acceptable treating sources are likely to be the medical professionals most able to provide a detailed longitudinal picture of the claimant's impairment(s) and may bring a unique perspective to the medical evidence that cannot be obtained from the medical findings alone.” With this in mind, it is critical to get good medical care.

Unfortunately, due to the current health care system and the high cost of medical care, this may not always be possible. If a claimant does not have medical records to substantiate their claim, there is another option: a consultative examination.

Medical Evidence Obtained from a Consultative Examination

Claimants may be required to attend a consultative examination if they do not have sufficient medical evidence, their doctor fails to provide their medical records to the SSA, there are inconsistencies in the claimant’s medical records, or the SSA has determined the claimant’s treating source is not a “productive source.”

After the consultative examination, the consultative examiner will provide a report to the SSA documenting their findings. The consultative examiner does not make a disability determination. The SSA will review the report and determine if the claimant is disabled. Unfortunately, the consultative examination generally does not provide enough medical evidence to win SSDI.

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