615.Categories of Evidence

615.1What types of evidence are from medical sources?

Evidence from medical sources include objective medical evidence, medical opinions, and other medical evidence.

1. Objective medical evidence is medical signs, laboratory findings, or both.We need objective medical evidence from an acceptable medical source to establish whether you have a medically determinable impairment. Acceptable medical sources are:

   • Licensed physicians (medical or osteopathic doctor);

   • Licensed psychologists, which include:

     • A licensed or certified psychologist at the independent practice level; or

     • A licensed or certified school psychologist, or other licensed or certified individual with another title who performs the same function as a school psychologist in a school setting, for impairments of intellectual disability, learning disabilities, and borderline intellectual functioning only;

   • Licensed optometrists, for purposes of establishing visual disorders, or measurement of visual acuity and visual fields only, depending on the scope of practice in the State in which the optometrist practices;

   • Licensed podiatrists, for impairment(s) of the foot, or foot and ankle only, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle;

   • Qualified speech-language pathologists, for purposes of establishing speech or language impairments only;

   • Licensed audiologists for impairments of hearing loss, auditory processing disorders, and balance disorders within the licensed scope of practice only (on or after March 27, 2017);

   • Licensed Advanced Practice Registered Nurses, or other licensed advanced practice nurses with another title, for impairments within his or her licensed scope of practice (on or after March 27, 2017); and

   • Licensed Physician Assistants for impairments within his or her licensed scope of practice (on or after March 27, 2017).

2. Medical opinions

   The definition we use for medical opinion depends on whether the claim is for an adult or a child and the filing date of the claim.

   1. Medical opinion – adult claim – filing date on or after March 27, 2017

      • The ability to perform physical demands of work activities, such as sitting, standing, walking, lifting, carrying, pushing, pulling, or other physical functions (including manipulative or postural functions, such as reaching, handling, stooping, or crouching)

      • The ability to perform mental demands of work activities, such as understanding; remembering; maintaining concentration, persistence, and pace; carrying out instructions; and responding appropriately to supervision, co-workers, and work pressures in a work setting;

      • The ability to perform other demands of work, such as seeing, hearing, and using other senses

      • The ability to adapt to environmental conditions, such as temperature extremes and fumes

   2. Medical opinion – child claim – filing date on or after March 27, 2017

      A medical opinion is a statement from a medical source about what you can still do despite your impairments and whether you have one or more impairment-related limitations or restrictions in the six domains of functioning:

      • Acquiring and using information

      • Attending and completing tasks

      • Interacting and relating with others

      • Moving about and manipulating objects

      • Caring for yourself

      • Health and physical well-being

   3. Medical opinion – adult or child claim - filing date before March 27, 2017

      A medical opinion is a statement from an acceptable medical source (AMS) that reflects judgments about the nature and severity of your impairments, including symptoms, diagnosis and prognosis, what you can still do despite impairments, and your physical or mental restrictions.

3. Other medical evidence

   Other medical evidence is all other evidence from a medical source that is not objective medical evidence or medical opinion.

   1. Claims with a filing date on or after March 27, 2017

      Other medical evidence includes judgments about the nature and severity of your impairments, medical history, clinical findings, diagnosis, treatment prescribed with response, or prognosis.

   2. Claims with a filing date before March 27, 2017

      Other medical evidence includes medical history, clinical findings, prescribed treatment and response.

615.2Evidence from nonmedical sources

In addition to medical evidence from medical sources (§615.1), we use evidence from nonmedical sources to show the severity of your impairment and how it affects your ability to work; or, if you are a child, your ability to perform age-appropriate activities compared to that of other children the same age who do not have impairments. Evidence from a nonmedical source means any information or statements from a nonmedical source about any issue in a claim. Nonmedical sources include but are not limited to: you; educational personnel (e.g., school teachers, counselors, early intervention team members, developmental center workers, and daycare center workers); public and private social welfare agency personnel; and family members, caregivers, friends, neighbors, employers, and clergy.

615.3Prior administrative medical findings

A prior administrative medical finding is a finding of fact about a medical issue made by a medical consultant (MC) or psychological consultant (PC) at a prior administrative level in the current claim, such as:

• The existence and severity of an impairments

• The existence and severity of a symptoms

• A statement about whether an impairment(s) meets or medically equals any listing in the Listing of Impairments (Listings)

• If you are a child, a statement about whether the impairment(s) functionally equals the Listings

• If you are an adult, the residual functional capacity (RFC)

• Whether the impairment(s) meets the duration requirement

• How failure to follow prescribed treatment relates to the claim

• How drug addiction and alcoholism relates to the claim

We will include a written analysis or rationale about how we consider prior administrative medical findings in the determination or decision. We use the same standard for consideration as applied to medical opinion evidence (§604.3).