I have a friend who often says to me, "I have to go see Dr. Amanda today." I know who he is talking about. Amanda works in a doctor's office, wears a white lab coat and hangs a stethoscope around her neck. She even writes prescriptions. But she is not a doctor. She is a nurse practitioner or CRNP.
While nurse practitioners are becoming more and more common and may offer quality healthcare, they are not considered "acceptable medical sources" for purposes of medical evidence by Social Security under 20 CFR 404.1527.
What does this mean to you when you file a disability claim and all or most of your medical records are from a nurse practitioner? Social Security may not give the records the same weight they would give if you had been treated by an MD or DO. They may argue that you have not been diagnosed and treated by an "acceptable medical source." This may be unfair, illogical or disagreeable--but it's the law.
Who does Social Security consider to be "acceptable medical sources" for purposes of evidence under 20 CFR 404.1527? Any of the following:
- a Doctor of Medicine (MD)
- a Doctor of Osteopathy (DO)
- a licensed clinical psychologist (Ph.D. or Psy.D)
- a licensed Physician's Assistant (PA), as of 2017
- a podiatrist (for disorders of the feet)
- an optometrist (for vision or certain eye disorders)
- Note that chiropractors also fall under the category of not being acceptable medical sources at Social Security.
Medical professionals are given "pecking order" by Social Security. Specialists are at the top of the order, followed by primary care providers (MD or DO). If you have a heart condition, for example, a treating cardiologist's evidence will normally be given the most weight. So, if possible, see a specialist.
We are not suggesting that nurse practitioners or chiropractors don't offer quality care. But Social Security may not give them much weight when it comes to considering their medical evidence.
When a claimant appears at a hearing on a Social Security disability appeal, his or her testimony at the hearing is crucial. Here are the crucial issues:
Credibility - The judge must believe everything you say, whether or not it has anything to do with your case. For example, if a claimant lies about smoking or drinking, it may not have anything material to do with disability, but credibility is lost and the judge believes nothing else that is said.
Severity of Conditions - The claimant should always speak of terms of symptoms, not medical terms. Instead of saying, "I have degenerative disc disease in my lumbar spine," the claimant should discuss pain level, stiffness, trouble standing, sitting or bending, etc. Specific examples can be used. For instance, "I can't stoop without a lot of pain and I need help unloading my dryer."
Longevity of Conditions. How long have you had these severe conditions? This will largely determine how much back pay you may receive. You may receive disability payments for up to 12 months before you filed your application. So, finding the correct onset date is important. You want to show that you are disabled now, but you also want to show when you first became disabled.
Be Specific. In your testimony, try to avoid very general phrases that have no defined meaning: "sometimes, occasionally, pretty bad, not long, a short distance, not very far," etc. Frame your testimony in terms of well defined words: minutes, hours, days, weeks, feet or yards. For example, "I get out of my house about twice a week." Or, "I can only stand for about 20 minutes at a time."
You should understand the kind of questions you will be answering at your disability hearing. It is, most of all, a fact finding process. The judge will press you to give specific facts that allow him or her to decide whether you meet the rules for a Social Security disability benefit.
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Mental health disorders account for a lot of disability in the United States. These disorders may make a person unable to work and, therefore, qualify for Social Security disability.
Being diagnosed with a particular mental illness, however, is usually not enough to qualify for benefits. The questions are: what are your symptoms, how severe are they, and how do they prevent you from working?
Concentration, persistence and pace may be a problem. Perhaps you aren't able to focus on a task long enough to complete it. Maybe there are times you can focus and complete tasks but other times when you cannot.
Memory issues may cause problems with your ability to remember, understand and carry out simple instructions or tasks.
Social skills may be degraded. Are you able to appropriately respond to co-workers, supervisors or members of the public? Can you accept instruction from your supervisor? Are you able to adapt to the usual work pressures of a job?
Mental health issues are best addressed by a clinical psychologist or a psychiatrist. The opinion of these professionals carry a lot of weight with Social Security decision makers. Consider asking your family doctor or primary care doctor to refer you to a psychiatrist.
I think it is also important to comply with medical treatment.
