Maine, Massachusetts and New Hampshire Social Security New Medical Evidence Rules, Part II

As we were discussing during our last blog post, Maine, Massachusetts and New Hampshire Social Security disability applicants are facing new evidence rules beginning March 27, 2017 that will  effect the manner by which the Social Security Administration reviews medical opinions from one’s medical treatment providers.    In addition, it is important that disabled Veterans who have been found disabled by the Veteran’s Administration and who may be considering applying for Social Security disability benefits, will likewise see a change in these rules that will adversely impact their Social Security disability application.

For many years, the Social Security regulations provided that acceptable medical sources (which were determined to be the only providers sufficiently skilled and educated enough to establish one’s medical impairments) were limited to the following medical providers: licensed physicians (medical or osteopathic doctors), licensed or certified psychologists (including school psychologists, or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing intellectual disability, learning disabilities, and borderline intellectual functioning only), licensed optometrists, licensed podiatrists and qualified speech pathologists.   The revised regulations, which will apply to claims filed on March 27, 2017, reflects the understanding that the medical provider landscape has changed dramatically over the course of the last few decades as a result of the managed care rules set forth by one’s insurance.

It has become more difficult over the years to see an actual doctor, and medical care is many times left to nurses or physician’s assistants: we see  this especially in the more rural areas of Maine, Massachusetts and New Hampshire, where finding a doctor that will see you is almost impossible unless you require urgent medical care.   This new reality in medical delivery, while somewhat acknowledged by the newly promulgated regulations, does not receive its full due and will leave many patients/claimants wondering why their medical provider is deemed capable enough of treating their condition but incapable of expressing an opinion that will carry much weight with the Social Security Administration.

Whether in Maine, Massachusetts or New Hampshire, bringing a Social Security disability claim brings with it the challenge of showing that one remains totally disabled from all forms of gainful employment from  a severe medically determinable impairment, despite prescribed treatment.  The new regulations acknowledge what has been a very accepted fact in the medical community for many years: that is, that modern healthcare delivery in this country is not limited to simply medical doctors.  The new rules provide that nurses will be now be recognized as acceptable medical sources, however, only those nurses who have obtained the credentials of an A.P.R.N. (that is, an Advanced Practice Registered Nurse), finding that the rigorous educational and credentialing process required of such individuals satisfies Social Security’s concerns that individuals be sufficiently qualified to make determinations such an individuals diagnosed medical impairments.   Simply being a registered nurse, or for that matter, an LPN, will not suffice.  The regulation notes that APRNs include four types of medical sources (Certified Nurse Midwife, NP, Certified Registered Nurse Anesthetist and Clinical Nurse Specialists) and, likewise, includes practitioners that may be credentialed as Advanced Practice Nurse and Advanced Registered Nurse Practitioner.   Likewise, the new regulation provides that Physician Assistants (PAs) likewise qualify as acceptable medical sources.

For disabled Veterans who have been determined disabled and “unemployable” under the Veterans Administration’s rules, the Social Security regulations  (specifically, 20 C.F.R. § 1504) has allowed the Social Security Administration (SSA) to consider the VA findings as part of its determination as to whether the individual claimant has remained disabled for purposes of Social Security’s rules.   The regulation did provided that the VA decision was not binding on SSA.  Unfortunately, for VA claimants who have been found disabled and unemployable by the VA, it is important to note that for any claim brought March 27, 2017 or after, SSA will not provide any analysis in their decision as to the how the VA made a determination as to “disability” or “unemployability.”   While the regulation provides that another agency decision is not binding on them, and the fact that their decision on the ultimate conclusion as to whether one disabled or unemployable may not be taken into account, the revised regulation does provide that SSA must consider “all of the supporting evidence underlying the other governmental agency decision.”

If you or someone you love has found themselves unable to work as a result of disabling medical conditions, contact a Social Security lawyer who, for that last 27 years has been deep in the trenches fighting for those who are long term injured and disabled.  Contact the Law Offices of Russell J. Goldsmith for a no cost, confidential evaluation at 1-800-773-8622.