LAW FIRM BLOG
Medical Source Statements
November 08, 2020
One of the most important items of medical evidence you can submit to the Social Security Administration (SSA) when applying for disability benefits (SSDI/SSI) is a “Medical Source Statement” from healthcare providers who treat you on a regular basis for a disabling condition. With credible, supportive medical source statements, your odds of being approved for benefits can increase significantly. Despite this fact, the SSA does not attempt to obtain these statements from providers. Therefore, claimants who wish to have the written opinions of their healthcare professionals considered must obtain such statements themselves.
A medical source statement is a letter from your provider that describes your physical and/or mental health conditions and the impact they have on what the SSA refers to as your “Residual Functional Capacity.” That is, work-related activities you may or may not be able to engage in and your ability to participate in and maintain “Substantial Gainful Employment”.
Residual Functional Capacity
Residual functional capacity is what you can do despite your disabling condition and what you cannot do because of your disabling condition. Examples include:
• Physical disability: Your ability to sit, stand, walk, lift certain weights, carry, reach, handle objects, hear, speak, write, stoop, crouch, balance, kneel, grasp and travel.
• Mental disability: Your ability to understand, follow and remember instructions; communicate with and respond appropriately to supervision, co-workers, customers and work pressures; complete routine or repetitive tasks.
It is important that these statements be through and detailed. Unfortunately, it is often the fact that the healthcare provider, who likely has no understanding of how the SSA disability system works, simply supplies a brief statement indicating that their patient is disabled and unable to work, with no mention of functional limitations, thus rendering it practically useless. A letter saying you are disabled is not enough. It must describe your medical problem(s) and explain how your disability makes you unable to work.
Whether the SSA will rely on your provider’s opinion depends on their credentials, how he or she writes his or her opinion, whether it is consistent with medical evidence in your file, and the length of your treatment history with your provider.
Often medical professionals are hesitant to write medical source statements. It is important to explain to your provider that they are simply being asked for their opinions about your physical and mental conditions; they are not being asked to determine whether you are disabled or not. In some cases, it may be that the provider does not consider the patient to be disabled, regardless of whatever contrary statements they have made to the patient. In other situations, the provider may not want to devote their limited time to a claimant’s SSDI or SSI case and may decline, or instead request a fee to write this letter. If your provider isn’t willing to write the statement, even if you pay a fee, you should consider switching to one who will.
What Information Should Medical Source Statements Contain?
A letter from your provider should summarize the information in your medical records into a easily digestible format and provide a detailed examination of your overall medical condition, including:
• A formal diagnosis, onset date and description of all the disabling condition(s) for which the provider has treated you.
• Medical findings. The procedures undertaken to diagnose your condition. Your provider should attach materials from your medical file (such as laboratory results, blood work, MRIs, CT scans, x-rays) that support the opinions expressed in the letter.
• The condition’s effect upon you. The symptoms from which you suffer and how they affect your everyday life, including how each limits your ability to do various work and non-work activities. Does the provider think you can return to any previous jobs, or do any other type of work?
• Medication and treatment. List drugs, doses, side effects and a statement as to whether the medication itself interferes with your ability to work. Also, what kind of prescribed treatment you are undergoing (surgery, physical therapy, etc.) including frequency and duration, and responses to each treatment, positive or negative on your everyday ability to function, including your ability to perform normal job tasks. You need to show that you are unable to work despite treatments and medications.
• Prognosis. Will you improve? Stay the same? Get worse? How long will the condition last? The outlook for your disability, including the overall timeframe of its progression or regression and any changes which have already occurred, particularly if they have made it more difficult for you to perform work. Only individuals who have been or will be unable to work for at least l2 months are eligible for disability benefits.
Unless your medical source statement describes your diagnosis, your symptoms, your treatment history, the limitations imposed by your condition, and prognosis, you may not win your case even though your provider states you are disabled.
The Importance of a Medical Source Statement to Your Social Security Disability Claim
A patient’s medical file is often filled with laboratory reports, X-rays, MRIs, statements of diagnosis, treatment plans, and physician notes, all which document your medical condition and indicate that you are disabled. So why do you need a medical source statement to supplement your SSDI application? Shouldn’t this evidence be enough to prove that the disability prohibits the claimant from earning a substantial wage? The answer is no, and the reason is that effective medical source statements elicit information from the claimant’s provider not routinely included in medical records.
The existence of a disabling condition, in itself, is only part of the equation for getting approved for SSDI/SSI benefits. While medical records can prove that you have a disability, they do not ordinarily include information regarding an applicant’s functional residual capacity--what they can and cannot do because of their disability--and any insight into your ability to work. There are people who have a disability but are still able to work. In order to receive benefits, the claimant must also demonstrate that his or her disability makes him or her unable to participate in substantial gainful activity, either of the type the applicant was previously engaged in, or some other work.
For example, if the claimant is a construction worker who applies for benefits due to a back injury, an X-ray or MRI will likely prove or disprove the injury. But such tests cannot prove whether he/she still has the ability to lift and/or carry heavy objects, a requirement of working in the construction trade. In this case, the medical evidence shows the injury, but not the effect of that injury.
Acceptable Medical Sources and their Credentials
The SSA will review everything that you submit for your case, but all diagnoses, tests, and medical source statements must be provided by “Licensed Medical Professionals.” Acceptable medical sources are:
• Licensed medical or osteopathic doctors,
• Licensed optometrists (for purposes of establishing visual disorders only),
• Licensed podiatrists (for purposes of establishing impairments of the foot and/or ankle only),
• Qualified speech language pathologists (for purposes of establishing speech or language impairments only),
• Licensed or certified psychologists (including unlicensed school psychologists when the claimant alleges intellectual disorder, learning disabilities, and borderline intellectual functioning),
• Physician assistants (PAs),
• Advance registered nurse practitioners (ARNPs) (also known as advanced practice registered nurses, or APRNs), and
• Licensed audiologists.
Many people today receive medical treatment from non-physicians, such as nurses, or nurse practitioners and physician’s assistants. And while a statement completed by one of these sources is helpful, it will be given greater weight by the SSA if it is signed or co-signed by a medical doctor.
Non-Licensed Medical Professional Statements
If your treating provider is not an acceptable medical source, the SSA may either disregard their opinion or it may just use the provider’s information only to establish the severity of your impairment. For example, you may submit a letter from your chiropractor stating that you have degenerative disc disease, but the SSA will disregard that opinion. However, if the chiropractor also writes that he or she has been treating you for years and that you cannot sit or stand for more than 30 minutes at a time, the SSA could use that information to decide how severe your condition is.
Your Treatment History With Your Medical Professional
Social Security gives more weight to the opinion of those medical professionals who are actively engaged in the treatment of your condition over a long period of time, rather than those who have seen you on a limited basis, such as during a brief hospitalization or a one-time examination. If the provider whose opinion you are offering has only reviewed your records and never examined you in person, or if you have only seen the provider for the purpose of getting an evaluation for your disability case, then the SSA may give the opinion less weight, all other factors being equal. This is because a long-term relationship allows the treating professional to give medical evidence that tracks the development and course of your disability over time.
The Timeliness of Medical Source Statements
In order to be considered current, a medical source statement should be no older than 60 days for mental health conditions or six months for physical conditions. The more recent your statement, the better for your Social Security Disability claim.