The Evidentiary Requirements Of A Disability Claim

At the beginning of this year Social Security made a number of changes to its Adult Listings, know as Part A in determining the severity of disabilities for the purposes of disability claims, but it also made significant changes to the listings of impairments the impact children. The two major changes deal with Mental Disorders (112.00) and Immune System Disorders (114.00). The new listings can be found here. These listings are quite extensive, but Social Security considers evidence of impairments similarly for adults and children. Here is exactly what Social Security’s evidentiary requirements are.

Medical Evidence

Medical evidence is the cornerstone of the disability determination under both the title II (SSDI) and title XVI (SSI) programs.

Each person who files a disability claim is responsible for providing medical evidence showing he or she has an impairment(s) and the severity of the impairment(s). However, the Social Security Administration (SSA), with the claimant’s permission, will help the claimant get medical evidence from his or her own medical sources who have evaluated, examined, or treated the claimant for his or her impairment(s). SSA also requests copies of medical evidence from hospitals, clinics, or other health facilities when appropriate.

Claimants who provide SSA with timely, accurate, and complete information and evidence can help accelerate the processing of their claims.

Existence Of An Impairment

By law, SSA needs specific medical evidence to establish that a claimant has an impairment.  SSA regulations require “objective medical evidence” from an “acceptable medical source” to establish that a claimant has a medically determinable impairment.  The regulations define these terms.

Severity

Once the existence of an impairment is established, SSA considers all evidence from all medical and nonmedical sources to assess the extent to which a claimant’s impairment(s) affects his or her ability to function 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.  Nonmedical sources include, but are not limited to: the claimant, educational personnel, public and private social welfare agency personnel, family members, caregivers, friends, neighbors, employers, and clergy.

Evidence Relating To Symptoms

In developing evidence of the effects of symptoms, such as pain, shortness of breath, or fatigue, on a claimant’s ability to function, SSA investigates all avenues presented that relate to the complaints. These include evidence about:

  • the claimant’s daily activities;
  • the location, duration, frequency, and intensity of the pain or other symptom;
  • precipitating and aggravating factors;
  • the type, dosage, effectiveness, and side effects of any medication;
  • treatments, other than medications, for the relief of pain or other symptoms;
  • any measures the claimant uses or has used to relieve pain or other symptoms; and
  • other factors concerning the claimant’s functional limitations due to pain or other symptoms.

In assessing the claimant’s pain or other symptoms, SSA considers all of the above-mentioned factors. It is important that medical sources address these factors in the reports they provide.