Despite the presence of Physicians Assistants (P.A.s), Advanced Practice Registered Nurses (APRNs, also called ARNPs), Audiologists in the medical community for decades, the Social Security Administration (SSA) refused to treat their opinions the same as M.D. or D.O. physicians or Ph.D. psychologists in Social Security Disability or SSI claims. As the medical community changed and physician offices started using P.A.s and APRNs more, SSA refused to change along with it. That has finally changed, and SSA will give weight to P.A., APRN, and Audiologist opinions.
The key is what “Accepted Medical Sources” Social Security will rely upon.
The Social Security Administration has historically relied on what it considers “objective” medical evidence to decide if someone is disabled. SSA required physician opinions and records to show a medically determinable impairment, and to show how advanced or severe that condition was. The only medical providers that the SSA viewed as qualified enough to give that objective medical evidence were those which it listed as “accepted medical sources” in its regulations. See 20 C.F.R. § 404.1513.
Disability claimants had to have good and reputable doctors – accepted medical sources – because evidence from those providers was necessary to pass the hurdles in Social Security’s evaluation process. Without access to acceptable medical sources, disabled claimants were almost guaranteed to lose any claim they had for disability benefits.
For years, SSA’s list of accepted sources was limited to:
- Licensed Physicians (medical or osteopathic doctors)
- Licensed or Certified Psychologists
- Licensed Optometrists
- Licensed Podiatrists
- Qualified Speech-Language Pathologists
For their part, the SSA did consider evidence from non AMS providers, such as nurse-practitioners, physicians’ assistants, naturopaths, chiropractors, audiologists, and therapists, but their interpretation of that evidence was simply to show the severity of the claimant’s impairment(s) and how it affected the claimant’s ability to work. SSA gave little weight to medical evidence from non-accepted sources.
This was a problem for claimants who lived in areas that were considered healthcare deserts, or places that did not offer many choices for healthcare. As the cost of healthcare has increased, P.A.s, ARNPs and other assistant providers have become much more common. Many claimants did not have access to accepted sources in their local or regional area. For those that wanted to have a chance at obtaining disability benefits, a long and sometimes costly trip to another location was necessary.
2017: SSA changes – Expands List of Accepted Medical Sources
In 2017, the SSA recognized the difficulties of those claimants, and the expanding stratification of healthcare providers, by including advanced practice registered nurses, physician assistants (PAs), and audiologists in the list of acceptable medical sources. This new rule was published in the Federal Register, and it applies to disability claims filed on or after March 27, 2017.
As of March 27, 2017, the new list of Accepted Medical Sources is as follows:
- License Physicians (medical or osteopathic doctors)
- Advanced Practice Registered Nurses
- Physician Assistants
- License or Certified Psychologists
- Licensed Optometrists
- Licensed Podiatrists
- Qualified Speech-Language Pathologists
- Audiologists
This change greatly benefits claimants who have had an APRN or P.A. as a primary provider, or been treated at a location where an APRN or P.A. was the only specialist who was available to see them for their medical condition. This change also reduces unintentional discrimination against those whom cannot afford to travel to be seen by licensed physicians.
The details….there are always details….
SSA has placed some restrictions on the definitions of the newly minted AMSs. Although SSA defined APRN to include some types of medical sources:
- Certified Nurse Midwives,
- Nurse Practitioners,
- Certified Registered Nurse Anesthetists, and
- Clinical Nurse Specialist. APRNs do not include Nurse Practitioners, or NPs.
BUT SSA refused to include NPs – Nurse Practitioners – as acceptable sources. SSA did acknowledge that difference states use different terms for APRN, including Advanced Practice Nurse and Advanced Registered Nurse Practitioner.
Also, licensed audiologists are accepted sources for impairments of hearing loss, auditory processing disorders, and balance disorders within the licensed scope of their practice only. This means that medical evidence from audiologists will not be considered as coming from an acceptable source if they are giving an opinion outside the scope of their practice, such as conditions involving muscles, bones, joints, vision, nerves, heart, and blood vessels.
One can only hope that going forward, the SSA continues to consider the needs of those with limited access to proper healthcare.
