Adult Listings (Part A)

Childhood Listings (Part B)

General Information

Evidentiary Requirements

Listing of Impairments (overview)

Revisions to Rules Regarding the Evaluation of Medical Evidence

Revisions to Rules Regarding the Evaluation of Medical Evidence

On January 18, 2017, SSA published the final rules “Revisions to Rules Regarding the Evaluation of Medical Evidence” in the Federal Register (82 FR 5844). A correction to the final rules was published on March 27, 2017 (82 FR 15132). The final rules became effective on March 27, 2017. This page provides information for the public to become familiar with the rules.  Additional resources are found at the bottom of this page.

Q1: What revisions did we make?

A1: The revisions to our medical evidence rules include redefining several key terms related to evidence, revising our list of acceptable medical sources (AMS), revising how we consider and articulate our consideration of medical opinions and prior administrative medical findings, revising who can be a medical consultant (MC) and psychological consultant (PC), revising our rules about treating sources, and reorganizing our evidence regulations for ease of use. 

Q2: Why did we make these revisions?

A2: These revisions conform our rules with the requirements of the Bipartisan Budget Act of 2015 (BBA), reflect changes in the national healthcare workforce and in the manner that individuals receive primary medical care, simplify and reorganize our rules to make them easier to understand and apply,  allow us to continue to make accurate and consistent decisions, and emphasize the need for objective medical evidence in disability and blindness claims. 

Q3: How do we determine which set of rules to use?

A3: Some of the rules we use to evaluate evidence will depend on a claim’s filing date.  For a claim filed on or after March 27, 2017, we will adjudicate the claim using the rules in place on or after March 27, 2017 (“current rules”).  For a claim filed before March 27, 2017, we will adjudicate the claim using   the rules in place before March 27, 2017 (“prior rules”).   We maintain subregulatory guidance about how to determine the filing date of a claim and filing date scenarios at POMS DI 24503.050 Determining the Filing Date for Evaluating Evidence.

Q4: What changes did we make to our rules about categorizing evidence?

A4: We reorganized and redefined categories of evidence to make them easier to understand and apply in the disability adjudicative process.  The categories of evidence are: (1) objective medical evidence, (2) medical opinions, (3) other medical evidence, (4) evidence from nonmedical sources, and (5) prior administrative medical findings.  This chart summarizes the categories of evidence:

Q5: What changes did we make to the list of acceptable medical sources (AMS)?

A5: For claims filed on or after March 27, 2017, we recognize three new AMSs.  These include Advanced Practice Registered Nurses (APRN), or other licensed advanced practice nurse with another title, for impairments within his or her scope of practice; audiologists for impairments of hearing loss, auditory processing disorders, and balance disorders within his or her licensed scope of practice; and P hysician A ssistants (PA) for impairments within his or her licensed scope of practice. We also updated rules about existing AMSs to reflect current licensing, scope of practice, and credentialing requirements. 

Q6: Why did we not recognize additional medical sources as AMSs?

A6: Upon investigation of licensing requirements for other medical sources, we did not find a similar level of consistency or rigor in terms of education, training, certification, and scope of practice. However, we will continue to consider evidence from these medical sources when we evaluate the severity of an individual’s impairment(s) and its effect on an individual.   

Q7: What changes did we make to our rules about establishing the existence of an impairment?

A7: We still require objective medical evidence from an AMS to establish the existence of a medically determinable impairment(s) .   We revised the definition of objective medical evidence to clarify that it means signs, laboratory findings, or both.  We now recognize APRNs, audiologists, and PAs as AMSs who can provide us with this objective medical evidence for claims filed on or after March 27, 2017.  We also clarified that we cannot establish an impairment based on a diagnosis, symptoms, or a medical opinion.  Finally, we made clarifying revisions to the existing definitions of signs and laboratory findings.

Q8: What changes did we make to our rules about medical consultants (MC) and psychological consultants (PC)?

A8: We revised our rules to conform with requirements of BBA section 832.  This law states that we must make every reasonable effort to ensure that a qualified physician ( where evidence indicates the existence of a physical impairment) or a qualified psychiatrist or psychologist ( where evidence indicates the existence of a mental impairment) completes the medical portion of the case review  and any applicable residual functional capacity assessment . 

Q9: What changes did we make to the definition of a medical opinion?

A9: For claims filed on or after March 27, 2017, the definition focuses on perspectives from medical sources about an individual’s functional abilities and limitations.  This makes our evidence rules easier to understand and use and improves our adjudicative process.  Under the new rules, all medical sources other than MCs and PCs, not just AMSs, can create evidence that we categorize as medical opinions.

Q10: Why did we change our rules about considering medical opinions?

A10: We revised how we consider medical opinions to reflect a modern healthcare delivery model that involves many types of medical sources.  We also address several adjudicative issues resulting from our prior rules for weighing medical opinions.  For example, the treating source rule resulted in reviewing courts focusing more on whether we sufficiently articulated the weight we gave treating source opinions rather than on whether substantial evidence supported the Commissioner’s final decision.  In addition, the Ninth Circuit’s use of a “credit-as-true” rule sometimes resulted in the court ordering us to award benefits instead of remanding cases, preventing us from reconsidering the evidence in the record as a whole and correcting any errors that may have existed, effectively supplanting the judgment of our decision makers. 

Q11: What changes did we make to our rules about considering medical opinions?

A11: For claims filed on or after March 27, 2017, we no longer defer or give any specific evidentiary weight, including controlling weight, to medical opinions .  Instead, we focus on the persuasiveness of medical opinions from all medical sources equally using factors specified in our rules.  We emphasize supportability and consistency as the most important factors for considering the value and persuasiveness of medical opinions.   

Q12: What changes did we make to our rules about providing written explanations about how we consider medical opinions?

A12: For claims filed on or after March 27, 2017, we articulate in our determination or decision how persuasive we find all of the medical opinions from all medical sources.  When a medical source provides multiple medical opinions, we articulate how we considered the medical opinions from that medical source together in a single analysis using specified factors, as appropriate.  We are not required to articulate how we considered each medical opinion from one medical source individually.  We explain how we considered the supportability and consistency factors for a medical source’s opinions because those are the most important factors we consider when we determine how persuasive we find a medical source’s medical opinions.  W e may, but are not required to, explain how we considered the other specified factors, as appropriate, when we articulate how we consider medical opinions in the case record .  When we find that two or more medical opinions about the same issue are equally well-supported and consistent with the record but are not exactly the same, we articulate how we considered the other most persuasive factors. 

Q13: What changes did we make to our rules about considering and providing written explanations about how we consider evidence from MCs and PCs?

A13: For claims filed on our after March 27, 2017, w e use the same rules for considering and articulating prior administrative medical findings as we do for medical opinions, which we discuss above in questions 11 and 12.

Q14: What changes did we make to our rules about how we consider decisions from other governmental agencies and nongovernmental entities?

A14: For claims filed on or after March 27, 2017, we do not provide any written analysis in our determination or decision about a decision made by any other governmental agency or a nongovernmental entity about whether an individual is disabled, blind, or employable, or entitled to any benefits. However, we consider all of the supporting evidence underlying the other governmental agency or nongovernmental entity’s decision that we receive as evidence in a claim in accordance with our rules about how we consider evidence.

Q15: What changes did we make to our rules about how we consider statements on issues reserved to the Commissioner?

A15: For claims filed on or after March 27, 2017, we do not provide any written analysis in our determination or decision about statements on issues reserved to the Commissioner because we are responsible for making the determination or decision about whether an individual is disabled or blind under the Act.  

Q16: What training are we providing to our adjudicators about the final rules?

A16: To help adjudicators understand and apply the revised medical evidence rules, we provide written training materials, several training videos, and training sessions targeted to adjudicators at each level of administrative review. 

Additional Resources

• Policy Guide
• Notice of Proposed Rulemaking
• Final Rules
• Final Rules, correction