Nearly two years ago Social Security published revisions to the rule regarding the evaluation of medical evidence in a disability case, which relied less on the opinion of a claimant’s medical provider, so that the persuasiveness of medical evidence is considered rather than the opinion of the doctor who treats and knows the claimant best. Below, you can see the previous rule and how the rule has changed, which now seems to give as much weight to medical opinions provider by a doctor who only sees the claimant one time.
Medical opinions and prior administrative medical findings: Claims filed before 3/27/17: Factors to consider
- Examining relationship: Generally, we give more weight to the medical opinion of a source who has examined a claimant
- Treatment relationship:
– Generally, we give more weight to medical opinions from treating sources
– Consider
* Length of the treatment relationship and frequency of examination
* Nature of the treatment relationship and extent of the treatment relationship
- Supportability:
– The more a medical source presents relevant evidence to support a medical opinion, particularly objective medical evidence, the more weight we will give that medical opinion.
– The better an explanation a source provides for a medical opinion, the more weight we will give that medical opinion.
- Consistency: Generally, the more consistent a medical opinion is with the record as a whole, the more weight we will give to that medical opinion.
- Specialization: Generally, we give more weight to the medical opinion of a specialist about medical issues related to his or her area of specialty than to the medical opinion of a source who is not a specialist.
- Other factors: Consider any other factors which tend to support or contradict the medical opinion
– Amount of understanding of our disability programs and their evidentiary requirements
– The extent to which a medical source is familiar with the other information in a case record
Medical opinions and prior administrative medical findings: Claims filed on or after 3/27/17: Policies
- Consider the persuasiveness of the quality of the evidence
- Do not assign any “weight”
- There is a new definition of “medical opinion” focusing on functional abilities and limitations
- There are 5 factors to consider
- Most important factors are supportability and consistency
- Articulation requirements
- We must include an explanation about how persuasive we find all medical opinions from all medical sources and all prior administrative medical findings
– We may include an explanation about all of a medical source’s medical opinions together
– We must include an explanation about the supportability and consistency factors
– Remaining 3 factors
We must discuss when two or more medical opinions or prior administrative medical findings about the same issue are both equally well-supported and consistent but are not exactly the same
It is discretionary whether to discuss them in other situations
