Health professionals play a vital role in the disability determination process and participate in the process in a variety of ways: As treating sources or other medical sources who provide medical evidence on behalf of their patients; As Consultative Examining sources to perform, for a fee, examinations and/or tests that are needed; As full-time or part-time medical or psychological consultants reviewing claims in a DDS, in one of SSA's regional offices, or in SSA central office; or As medical experts who testify at administrative law judge hearings.
Treating Sources: A treating source is a claimant's own physician, psychologist, or other acceptable medical source that has provided the claimant with medical treatment or evaluation and has or has had an ongoing treatment relationship with the claimant. The treating source is usually the best source of medical evidence about the nature and severity of an individual's impairment (s). If an additional examination or testing is needed, SSA usually considers a treating source to be the preferred source for performing the examination or test for his or her own patient. The treating source is neither asked nor expected to make a decision whether the claimant is disabled. However, a treating source will usually be asked to provide a statement about the claimant's ability, despite his or her impairments, to do work-related physical or mental activities.
Program Medical Professionals: Physicians of virtually all specialties and psychologists at the State, regional or national levels review claims for disability benefits. The review work is performed in the State DDSs or SSA's regional office or headquarters. It is strictly a paper review in which the program physician or psychologist usually has no contact with the claimant.
Medical Experts: Because there is no direct involvement of medical professionals in the disability decisions made by administrative law judges in the Office of Disability Adjudication and Review, administrative law judges sometimes request expert testimony on complex medical issues. Each hearing office maintains a roster of medical experts who are called to testify as expert witnesses at hearings. The experts are paid a fee for their services.
Confidentiality of Records: Two separate laws, the Freedom of Information Act and the Privacy Act, have special significance for Federal agencies. Under the Freedom of Information Act, Federal agencies are required to provide the public with access to their files and records. This means the public has the right, with certain exceptions, to examine records pertaining to the functions, procedures, final opinions, and policy of these Federal agencies. The Privacy Act permits an individual or his or her authorized representative to examine records pertaining to him or her in a Federal agency. For disability applicants, this means that an individual may request to see the medical or other evidence used to evaluate his or her application for disability benefits under the Social Security or the SSI programs. (This evidence, however, is not available to the general public.) SSA screens all requests to see medical evidence in a claim file to determine if release of the evidence directly to the individual might have an adverse effect on that individual. If so, the report will be released only to an authorized representative designated by the individual.
