Medical Evidence Requirements for the SSA

Posted by Scott Flexer on Mar 10 2015

Medical documentation lays the entire foundation for most disability claims.In making official determinations for disability or SSI claims, the Social Security Administration will use medical evidence as the primary deciding factor for awarding or denying benefits. Without full documentation of your condition, receiving benefits from the SSA becomes extremely difficult; this is why it’s so important for disability applicants to understand how the SSA views medical evidence, and what factors the SSA considers in making determinations.

In this article, we break down all pieces of medical evidence the SSA uses to approve or deny SSDI and SSI claims.

Standards for Medical Evidence: Diagnosis Sources

As the SSA states itself, “medical evidence is the cornerstone of the disability determination under both the title II (Social Security Disability Insurance) and title XVI (Supplementary Security Income) programs.” For evidentiaryl purposes, the administration accepts evidence from a short list of acceptable sources. These are licensed, recognized professionals in the healthcare sector that are qualified to provide judgment concerning a person’s disability or blindness:

  • Licensed physicians; this includes both medical and osteopathic doctors

  • Licensed optometrists; essential for evidence of blindness

  • Licensed podiatrists; necessary for disabilities and conditions related to the foot/ankle

  • Licensed psychologists; for evidence of intellectual, learning or cognitive disability (for a child’s disability, this includes licensed school psychologists)

  • Licensed speech-language pathologists; to establish speech disorders and/or disability

An official medical report from a licensed professional source such as these is the foundation for establishing that a medical condition exists. All other forms of medical evidence are used, for SSDI and SSI purposes, to assess the severity of an individual’s condition; how extensively their disability or blindness hinders their ability to work and earn sustainable income.

Standards for Medical Evidence: Treatment Sources

Beyond diagnosis from a licensed professional healthcare professional, evidence provided by medical treatment providers can be essential in proving the progression of an individual’s condition. As sources of medical evidence for SSI/SSDI, the Social Security Administration states the following about treatment sources:

Timely, accurate, and adequate medical reports from treating sources accelerate the processing of the claim because they can greatly reduce or eliminate the need for additional medical evidence to complete the claim.”

Additionally, medical documentation collected from clinics, hospitals or other treatment facilities during ongoing treatment can prove essential as evidence that impairment/disability persists.

Standards for Medical Evidence: Reports and Documentation

When reviewing applicant claims and appeals, the SSA will typically contact medical facilities or physicians familiar with your condition for medical reports. 

During review, the SSA will look at:

  • Your medical history

  • Official diagnosis reports

  • Any treatment or medications prescribed

  • Medical statements about what you are able to do (such as tasks in the workplace) despite your condition; this includes sitting, walking, lifting, hearing, speaking, working with objects and traveling

  • Laboratory findings, including x-rays and blood reports

  • Physical and mental clinical evaluations

Standards for Medical Evidence: Consultative Examinations

If medical documentation from a licensed physician or care facility proves insufficient as evidence of your condition, the SSA will likely schedule a consultative examination to assess your impairment.

This is the case if you have received treatment from an unlicensed professional, there are filing inconsistencies with your medical history or your physician lacked the proper equipment to provide accurate medical evaluation or if the records in your file are simply not sufficient for SSA to make a fair determination on your case..

Standards for Medical  Evidence: Condition Symptoms

In making SSI/SSDI determinations in which symptomatic evidence is used, the SSA investigates all potential complaints on the claimant’s behalf. This includes:

  • The frequency or duration of the symptoms felt (pain, fatigue, etc.)

  • The intensity or physical location of the symptoms

  • The claimant’s day-to-day activities, such as at work, in addition to any potential aggravating factors related to the symptoms

  • Any medication used during symptom prevalence; this includes dosage, effects and potential side-effects

  • Other, non-medication treatments intended to reduce symptoms

For a clearer understanding of how the SSA perceives disability and uses medical evidence in making SSI/SSDI determinations, don’t hesitate to contact a disability consultant in your state. These professionals can help you gather all necessary medical documentation related to your disability claim, and streamline the application process in a way that strengthens your chances for benefits.

Download the Florida Disability Guide

Topics: Disability Medical Requirements, SSDI Benefits, SSI benefits

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