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Final Rules on Evaluation of Medical Evidence

Today SSA published final rules on the evaluation of medical evidence. 82 Fed. Reg. 5844 (Jan. 18, 2017). These rules become effective on March 27, 2017, though many aspects of the new rules will only apply to claims filed on or after that date. Under the new rules:

  •  Adjudicators will give no special weight to the medical opinions of a claimant’s treating sources. Instead, medical opinions and prior administrative medical findings will be evaluated equally for “persuasiveness” based most importantly on consistency and supportability
    • A prior administrative medical finding is made by a state agency medical consultant (MC) or psychological consultant (PC) and is defined as “A finding, other than the ultimate determination about whether the individual is disabled, about a medical issue made by an MC or PC at a prior administrative level in the current claim”
  • Physicians Assistants (PAs) and Advance Practice Registered Nurses (APRNs) will be included in the list of Acceptable Medical Sources (AMSs). Licensed audiologists and optometrists can also be AMSs for certain purposes within the scopes of their practices
  • Chiropractors, LCSWs and registered nurses (RN) are still not AMSs
  • Adjudicators will give no special weight to the disability decisions of other governmental agencies, including the VA, but will consider and evaluate the medical evidence that was submitted to that agency in support of that decision

According to SSA, “Because of these revisions, these final rules retain only two programmatic distinctions between AMSs and medical sources who are not AMSs in our regulations for claims filed on or after March 27, 2017. First, we need objective medical evidence from an AMS to establish the existence of a medically determinable impairment(s) at step 2 of the sequential evaluation process. Second, in a few instances, we need specific evidence from an AMS to establish that an individual’s impairment meets a Listing.”  So, for these reasons, it is still important to have medical evidence from an AMS, even though no special weight will be given to a treating source or AMS. SSA will also rescind the following SSRs that would be inconsistent or duplicative of these final rules:

  • SSR 96-2p: Titles II and XVI: Giving Controlling Weight to Treating Source Medical Opinions
  • SSR 96-5p: Titles II and XVI: Medical Source Opinions on Issues Reserved to the Commissioner
  • SSR 96-6p: Titles II and XVI: Consideration of Administrative Findings of Fact by State Agency Medical and Psychological Consultants and Other Program Physicians and Psychologists at the Administrative Law Judge and Appeals Council Levels of Administrative Review; Medical Equivalence
    • Because SSR 96-6p is rescinded, SSA will publish a new SSR that will discuss certain aspects of how ALJs and the Appeals Council must obtain evidence sufficient to make a finding of medical equivalence
  • SSR 06-03p: Titles II and XVI: Considering Opinions and Other Evidence from Sources Who Are Not “Acceptable Medical Sources” in Disability Claims; Considering Decisions on Disability by Other Governmental and Nongovernmental Agencies

Additional information about these new rules, and how they will affect your practice, will be provided in the January NOSSCR Forum, and NOSSCR’s January 24 live webinar (sold out) and on-demand video (available in early February). We will also have a session after these rules are effective during our spring conference in Washington, DC.

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