Evidence Legally Accepted in Social Security Disability Claims
The Social Security Administration broadly defines evidence in a claim for disability benefits as anything that it receives from the claimant or someone else that is related to their claim. A person seeking benefits generally has the burden of proving that they have a disability, but Disability Determination Services also has certain responsibilities during this process. (DDS is a network of state agencies funded by the federal government that make the initial decision on whether a claimant is disabled.)
For example, DDS must make every reasonable effort to develop the complete medical history of the claimant before deciding that they are not disabled. This involves requesting medical records from the claimant’s medical sources or entities that maintain this evidence, making a follow-up request 10 to 20 days later, and giving the medical source or entity at least 10 days after that request to reply. The complete medical history generally consists of the records from the claimant’s medical sources that cover at least the last 12 months before the month when they filed the application.
Types of Evidence in Disability Claims
The SSA divides evidence in a claim into several categories. The first category is objective medical evidence, which includes signs or laboratory findings but not symptoms or diagnoses. A claimant cannot establish the existence of a medically determinable impairment supporting their claim unless they have this type of evidence from an acceptable medical source, as defined by the SSA. A medical opinion or a description of symptoms by the claimant cannot substitute for objective medical evidence.
Another category of evidence consists of medical opinions, which are statements from a medical source about the functional abilities and limitations of a claimant. Specifically, the opinion must describe what the claimant can still do despite their impairment and whether the impairment has caused limitations or restrictions that affect the claimant’s ability to perform the physical or mental demands of work activities, their ability to perform other demands of work, and their ability to adapt to environmental conditions. A claimant also may provide other evidence from medical sources, such as a diagnosis or prognosis, prescribed treatment, medical history, clinical findings, or information about the nature and severity of their impairment.
The SSA recognizes two further categories of evidence. One of these comprises evidence from a non-medical source about the impairments, restrictions, daily activities, or work history of the claimant, as well as any other relevant statement from a non-medical source. (The SSA notes that evidence from a person who meets the definition of a medical source should be considered evidence from a non-medical source when this person provides evidence in their capacity as a friend or family member of the claimant.) In addition, prior administrative medical findings may be considered. These are factual findings by a medical or psychological consultant about a medical issue that were made at a prior administrative level in the claim.
Exclusions From Evidence in Disability Claims
Although the SSA defines evidence broadly, it excludes certain types of information from evidence. For example, communications covered by the attorney-client privilege or the attorney work product doctrine generally will not be considered unless the attorney or the claimant submits the information. The attorney-client privilege covers confidential communications between the claimant and the attorney that are related to legal advice. The work product doctrine covers the attorney’s analysis of the claim, including their impressions and ideas as well as tangible notes.
In addition, the SSA excludes evidence from medical sources who have been convicted of certain felonies under the Social Security Act. A medical source also cannot provide evidence if they have received a civil penalty or assessment for providing false evidence under the Act, or if they have been excluded from participating in a federal health care program under the Act.
