Richard A. Gutstadt, P.C.
Northern California SSI & SSDI Appeals
510-992-6934

Critical Elements of Effective Representation #6

Element 6: The Importance of Medical Evidence

     According to the Social Security Administration website, SSA.gov, "medical evidence is the cornerstone of the disability determination" for both Social Security Disability Insurance (Title II), and for SSI (Title XVI) claims. But what exactly is medical evidence?

     Medical evidence consists of medical treatment records from an attending or treating doctor or clinic, as well as medical disability-related records and opinions such as Worker's Compensation, State Disability, or Personal Injury records.

     Social Security classifies medical evidence into 2 critical categories. The first is objective evidence, and the second is subjective evidence.

     Examples of objective evidence include the results of blood tests or MRI results, as well as clinical findings from physical examinations generally performed by a Claimant's physicians or physician assistants. Mental examinations may be performed by either psychologists (Ph.D or Psy.D) or psychiatrists (M.D.) Often, the SSA will arrange for an individual to be examined by a state approved physician with no charge to the Claimant. This is called a Consultative Examination (CE), and can be done for severe physical and/or mental conditions.

     Subjective medical evidence consists of an individual's descriptions of their symptoms, such as pain or fatigue, and the resulting limitations (e.g. "My sore back makes it hard to bend over"). Although subjective evidence is important, an Administrative Law Judge (ALJ) will almost always require objective evidence to support an individual's assertions of physical or mental limitations.

     Treating physician evidence is critical to help establish an individual's disability. Because treating physicians are more familiar with their patients than doctors hired by the SSA, their opinions are generally entitled to greater weight than other physicians.

     Hence, it may be critical to obtain a treating doctor report in support of an individual's disability, to assess an individual's medical condition and Residual Functional Capacity (RFC).

     Also, it is important to be aware that while more non-physicians (i.e. physician's assistants, nurse practicioners, chiropractors, LCSW's, MFT's, etc) are providing essential medical treatment, they are not generally considered "acceptable treating sources" by the SSA.2

     In short, consistent and well-documented medical evidence is essential to a successful claim for Social Security Disability Benefits.

Eric J. Patrick, Esq. & Richard A. Gutstadt, Esq. 


 [1] See our 3/21/13 Blog entry "A Successful Disability Claim - More than Just a Diagnosis" for an explanation of RFC.

 [2] An exception is that once a "severe" medical impairment is established, non-physician opinion evidence can be given considerable weight in assessing an individual's residual functional capacity ( RFC). Important factors include the actual treating relationship and specialty of the various medical sources.

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