§ 220.46. Medical evidence.

908 words·~4 min read·/us/cfr/t20/s§ 220.46·

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(a)Acceptable medical sources. The Board needs reports about the claimant's impairment(s) from acceptable medical sources. Acceptable medical sources are—

(1)Licensed physicians (medical or osteopathic doctors);

(2)Licensed or certified psychologists at the independent practice level;

(3)Licensed or certified school psychologists, or other licensed or certified individuals with another title who perform the same function as a school psychologist in a school setting (for impairments of intellectual disability, learning disabilities, and borderline intellectual functioning only);

(4)Licensed optometrists (for impairments of visual disorders, or for the measurement of visual acuity and visual fields only, depending on the scope of practice in the State in which the optometrist practices);

(5)Licensed podiatrists (for impairments of the foot only, or foot and ankle only, depending on the scope of practice in the State in which the podiatrist practices);

(6)Qualified speech-language pathologists (for speech or language impairments only.) For this source, qualified means that the speech-language pathologist must be licensed by the State professional licensing agency, or be fully certified by the State education agency in the State in which the speech-language pathologist practices, or hold a Certificate of Clinical Competence in Speech-Language Pathology from the American Speech-Language-Hearing Association;

(7)Licensed audiologists (for impairments of hearing loss, auditory processing disorders, and balance disorders within the licensed scope of practice only);

(8)Licensed Advanced Practice Registered Nurses or other licensed advance practice nurses with another title (for impairments within the individual's licensed scope of practice only);

(9)Licensed Physician Assistants/Physician Associates (for impairments within the individual's licensed scope of practice); or

(10)Persons authorized to furnish a copy or summary of the records of a medical facility. Generally, the copy or summary should be certified as accurate by the custodian or by any authorized employee of the Railroad Retirement Board, Social Security Administration, Department of Veterans Affairs, or State agency.

(b)Other medical sources. Individuals who are licensed as healthcare workers by a State and are working within the scope of practice permitted under State or Federal law, other than acceptable medical sources identified in paragraph

(a)of this section, are other medical sources. Examples include licensed clinical social workers, naturopaths, and chiropractors. The Board will accept and consider evidence from other medical sources about the claimant's impairment(s) and the effect on the claimant's ability to work, but the presence of a medically determinable physical or mental impairment must be established with objective medical evidence from an acceptable medical source as defined in paragraph

(a)of this section.

(c)Medical reports. Medical reports should include—

(1)Medical history;

(2)Clinical findings (such as the results of physical or mental status examinations);

(3)Laboratory findings (such as blood pressure, x-rays);

(4)Diagnosis (statement of disease or injury based on its signs and symptoms);

(5)Treatment prescribed, with response to treatment and prognosis; and (6)(i) Statements about what the claimant can still do despite his or her impairment(s) based on the medical source's findings on factors in paragraphs (c)(1) through

(5)of this section (except in disability claims for remarried widow's and surviving divorced spouses). (See § 220.112).

(ii)Statements about what the claimant can still do (based on the medical source's findings on factors in paragraphs (c)(1) through

(5)of this section) should describe—

(A)The medical source's opinion about the claimant's ability, despite his or her impairment(s), to do work-related activities such as sitting, standing, moving about, lifting, carrying, handling objects, hearing, speaking, and traveling; and

(B)In cases of mental impairment(s), the medical source's opinion about the claimant's ability to reason or make occupational, personal, or social adjustments. (See § 220.112).

(d)Completeness. The medical evidence, including the clinical and laboratory findings, must be complete and detailed enough for the Board to determine whether the claimant is disabled. Specifically, it must allow the Board to determine—

(1)The nature and limiting effects of the claimant's impairment(s) for any period in question;

(2)The probable duration of the claimant's impairment(s); and

(3)The claimant's residual functional capacity to do work-related physical and mental activities.

(e)Evidence from treating medical sources. A statement by or the opinion of the claimant's treating medical source will not determine whether the claimant is disabled. However, the medical evidence provided by a treating medical source will be considered by the Board in making a disability decision. A treating medical source is a medical source to whom the claimant has been going for treatment on a continuing basis. The claimant may have more than one treating medical source. The Board may use consulting physicians or other medical consultants for specialized examinations or tests, to obtain more complete evidence, and to resolve any conflicts. A consulting physician is a doctor (often a specialist) to whom the claimant is referred for an examination once or on a limited basis. (See § 220.50 for an explanation of when the Board may request a consultative examination.)

(f)Information from non-medical sources. Information from other sources may also help the Board understand how an impairment affects the claimant's ability to work. Other sources include—

(1)Public and private social welfare agency personnel;

(2)Family members, caregivers, friends, and neighbors of the claimant;

(3)Educational personnel such as teachers, counselors, and daycare center workers;

(4)Railroad and nonrailroad employers; and,

(5)The claimants themselves. (Approved by the Office of Management and Budget under control number 3220-0038) [56 FR 12980, Mar. 28, 1991, as amended at 90 FR 4627, Jan. 16, 2025]

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§ 220.46

Medical evidence.

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