Medical Evidence

The initial disability determination is a case record review, a paper review. It is the responsibility of the individual who is claiming to be disabled to provide the SSA with medical evidence to support the claim. Medical evidence consists of clinical signs, symptoms, and/or laboratory or psychological test findings. Clinical signs are medically demonstrable phenomena that reflect specific abnormalities of behavior, affect, thought, memory, orientation or contact with reality. A psychiatrist or psychologist generally assesses clinical signs. Symptoms are complaints presented by the individual. The findings may indicate an intermittent or persistent impairment depending on the nature of the disorder.

Medical evidence also includes information from other informed sources, such as family members and rehabilitation therapists, who have relevant knowledge of the claimant’s functional capacity and limitations. This information is germane to the assessment of the B criteria on the PRTF and for the MRFCA review. There are no SSA-mandated forms for the provision of medical evidence. The collection of medical evidence is initiated by the local SSA district office and continued by the state-level DDS reviewing team to the point at which a disability determination of either an allowance or denial can be substantiated.

If the sources of medical evidence identified by the claimant do not provide sufficient evidence necessary to make a disability determination, a consultative examination can be provided. The SSA or DDS pays to have the claimant interviewed and a report sent to the DDS. The Consultative Examiner is generally someone not known to the claimant.

The Listings of Mental Impairment, and the forms used by Reviewing Medical Consultants—the PRTF and MRFCA—constitute the medical aspect of disability determination. For claims that do not result in a medical determination (i.e., a denial at step 2 using the PRTF because the disability is not severe or an allowance at step 3 because the disability is so severe that it precludes work on a medical review alone), the Disability Analyst continues the review with additional nonmedical factors. It is the medical aspect of the review of claims for disability benefits based on mental disorders that received a scientific evaluation.

AMERICAN PSYCHIATRIC ASSOCIATION EVALUATION STUDY

In 1984, prior to the publication of the 1985 Listings of Mental Impairments, the SSA, under the direction of the then-Assistant Commissioner for Disability Patricia Owens, contracted with the APA to design an evaluation of the soon-to-be-released standards and guidelines for the evaluation of mental impairments. The evaluation would include the Listings,



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement