Eligibility for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits often depends on the quality of a claimant’s medical evidence. You must have a severe “medically determinable” physical or mental impairment that has lasted or is expected to last for at least one year or is expected to result in death. An impairment is medically determinable if it is adequately documented by evidence from medical professionals. Thus, it is essential that you obtain continuous medical treatment to show that you have an ongoing physical or mental impairment.
What Is a Physical or Mental Impairment?
A physical or mental impairment is one that results from anatomical, physiological, or psychological abnormalities.
A physical impairment is an anatomical or physiological disorder or condition affecting one or more body systems, such as the neurological, musculoskeletal, respiratory, cardiovascular, digestive, lymphatic, and endocrine systems.
A mental impairment is a psychological disorder such as mental retardation, emotional or mental illness, and organic brain syndrome.
How Can You Prove that You Have a Severe Medically Determinable Impairment?
The only way to prove that you have a severe medically determinable impairment is with acceptable medical treatment. Physical and mental impairments can be shown through signs (clinical observations by your doctor), symptoms (what you experience), and laboratory findings. The existence of symptoms alone cannot be the basis for an impairment. Medically acceptable clinical and laboratory diagnostic techniques performed by medical professionals are necessary.
A disability examiner deciding a claim cannot make medical determinations because he or she is not a trained medical professional. The examiner must see verifiable medical evidence that your impairments are severe.
Licensed physicians, psychiatrists, and psychologists are acceptable sources of information. Chiropractors, acupuncturists, massage therapists, and other service providers without a medical license do not carry any weight with a disability examiner.
Medical specialists will provide the most acceptable medical opinions of your impairment. For example, if you have an impairment related to your feet, a podiatrist is the best source of information.
Clinical and laboratory tests are the most effective type of medical information. Valid tests may include MRIs, CAT scans, X-rays, biopsies, blood screening, and mental exams performed by licensed psychiatrists or psychologists.
Physician’s notes from office visits and ER treatment are also acceptable; however, those notes must provide more information than just a description of your symptoms.
What Information Should Be Included in Medical Evidence?
If your medical provider is willing to support your SSDI/SSI claim, then you should ask him or her to be sure your records include the following information:
Your date of onset. The disability claims examiner will want to know when your symptoms first began and when they became disabling.
Your level of disability. Your physician can evaluate whether or not you are able to perform work-related activities. Your physician can fill out a form that details your residual functional capacity, which describes what you can and cannot do due to your impairment. If he or she is not familiar with the criteria considered by the SSA, you may consider finding a medical provider who specializes in SSDI/SSI claims.
Your prognosis. You must show that your condition has lasted or is expected to last at least one year, or is expected to result in death. Your medical provider should be able to assess whether your impairment is expected to improve, stay the same, or worsen over time.
Does the Age of Medical Evidence Matter?
A claims examiner will consider all medical evidence that you provide. When determining the onset of your disability, a claims examiner will review when your doctor first made a diagnosis and when your symptoms became disabling. However, it is essential that you have current medical treatment records as well. Do not make the mistake of stopping medical treatment after you have been diagnosed. If you prove that you were disabled five years ago, but have not sought treatment recently, a claims examiner has no acceptable medical treatment to consider your current level of disability and prognosis. In order to be eligible for SSDI/SSI currently, you must prove that you are currently disabled. Your statements, no matter how genuine, cannot be the sole basis of disability. Only a trained medical provider has the knowledge to provide necessary information in a disability claim.
What if You Have Not Obtained Recent Medical Treatment?
Because medical proof is at the core of your success in applying for SSDI/SSI benefits, it is essential that you obtain acceptable medical treatment. If you have not recently received medical care for your impairment, the SSA will not be able to make a decision about your current level of disability. In such an event, the SSA may ask you to complete a Consultative Exam by an appointed doctor. Such a medical provider will only help the SSA determine the extent of your disability and will not provide you with ongoing treatment and care. It is important to be as honest and compliant as possible with an SSA doctor because their opinions are highly influential in determining your case. However, the best thing for you to do is to see your own doctor so that you can get both treatment and medical evidence. Evidence from your own doctor will likely be more thorough and helpful to your claim than a report from a consultative examiner who sees you briefly only once.
To find out about your eligibility for Social Security disability or SSI benefits, call Adams & Associates Disability Inc. at 1-888-551-1190.
Title: MEDICAL TREATMENT IS CRUCIAL TO THE SUCCESS OF YOUR CLAIM
Meta description: Role of medical evidence in proving your claim; medical evidence you need; acceptable sources of medical evidence; importance of recent treatment.
Keyword: Eligibility for Social Security Disability