[Federal Register Volume 71, Number 153 (Wednesday, August 9, 2006)]
[Notices]
[Pages 45593-45597]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-12951]


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SOCIAL SECURITY ADMINISTRATION


Social Security Ruling, SSR 06-03p.; Titles II and XVI: 
Considering Opinions and Other Evidence From Sources Who Are Not 
``Acceptable Medical Sources'' in Disability Claims; Considering 
Decisions on Disability by Other Governmental and Nongovernmental 
Agencies

AGENCY: Social Security Administration.

ACTION: Notice of Social Security Ruling.

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SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of 
Social Security gives notice of Social Security Ruling, SSR 06-03p. 
This Ruling clarifies how we consider opinions from sources who are not 
``acceptable medical sources'' and how we consider decisions made by 
other governmental and nongovernmental agencies on the issue of 
disability or blindness.

EFFECTIVE DATE: August 9, 2006.

FOR FURTHER INFORMATION CONTACT: Mike O'Connor, Office of Disability 
Programs, Social Security Administration, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, (410) 965-1952.

SUPPLEMENTARY INFORMATION: Although 5 U.S.C. 552(a)(1) and (a)(2) do 
not require us to publish this Social Security Ruling, we are doing so 
in accordance with 20 CFR 402.35(b)(1).
    Social Security Rulings make available to the public precedential 
decisions relating to the Federal old-age, survivors, disability, 
supplemental security income, special veterans benefits, and black lung 
benefits programs. Social Security Rulings may

[[Page 45594]]

be based on case decisions made at all administrative levels of 
adjudication, Federal court decisions, Commissioner's decisions, 
opinions of the Office of the General Counsel, and other 
interpretations of the law and regulations.
    Although Social Security Rulings do not have the same force and 
effect as the statute or regulations, they are binding on all 
components of the Social Security Administration, in accordance with 20 
CFR 402.35(b)(1), and are binding as precedents in adjudicating cases.
    If this Social Security Ruling is later superseded, modified, or 
rescinded, we will publish a notice in the Federal Register to that 
effect.

(Catalog of Federal Domestic Assistance, Programs Nos. 96.001 Social 
Security-Disability Insurance; 96.004 Social Security-Survivors 
Insurance; 96.006 Supplemental Security Income.)

    Dated: August 2, 2006.
Jo Anne B. Barnhart,
Commissioner of Social Security.

Policy Interpretation Ruling

Titles II and XVI: Considering Opinions and Other Evidence From Sources 
Who Are Not ``Acceptable Medical Sources'' in Disability Claims; 
Considering Decisions on Disability by Other Governmental and 
Nongovernmental Agencies

    Purpose: To clarify how we consider opinions from sources who are 
not ``acceptable medical sources'' and how we consider decisions by 
other governmental and nongovernmental agencies on the issue of 
disability or blindness.
    Citations: Sections 205(a), 216(i), 221, 223(d), 1614(a)(3), 
1631(d), and 1633 of the Social Security Act (the Act), as amended; 
Regulations No. 4, subpart P, sections 404.1502, 404.1503, 404.1504, 
404.1512(b), 404.1513(a), (d), and (e), 404.1520(a), 404.1527, and 
subpart Q, section 404.1613, and Regulations No. 16, subpart I, 
sections 416.902, 416.903, 416.904, 416.912(b), 416.913(a), (d), and 
(e), 416.920(a), 416.927 and subpart J, section 416.1013.
    Introduction: We use medical and other evidence to reach 
conclusions about an individual's impairment(s) to make a disability 
determination or decision as described in 20 CFR 404.1512, 404.1513, 
416.912 and 416.913. In accordance with sections 223(d)(5) and 
1614(a)(3)(H) of the Act, when we make a determination or decision of 
disability, we will consider all of the available evidence in the 
individual's case record. This includes, but is not limited to, 
objective medical evidence; other evidence from medical sources, 
including their opinions; statements by the individual and others about 
the impairment(s) and how it affects the individual's functioning; 
information from other ``non-medical sources'' and decisions by other 
governmental and nongovernmental agencies about whether an individual 
is disabled or blind. See 20 CFR 404.1512 and 416.912.

Medical Sources

    The term ``medical sources'' refers to both ``acceptable medical 
sources'' and other health care providers who are not ``acceptable 
medical sources.'' See 20 CFR 404.1502 and 416.902.
    Under our current regulations, ``acceptable medical sources'' are:
     Licensed physicians (medical or osteopathic doctors);
     Licensed or certified psychologists. Included are 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 mental retardation, 
learning disabilities, and borderline intellectual functioning only;
     Licensed optometrists, for the measurement of visual 
acuity and visual fields (for claims under title II, we may need a 
report from a physician to determine other aspects of eye disease);
     Licensed podiatrists, for purposes of establishing 
impairments of the foot, or foot and ankle only, depending on whether 
the State in which the podiatrist practices permits the practice of 
podiatry on the foot only, or the foot and ankle; and
     Qualified speech-language pathologists, for purposes of 
establishing speech or language impairments only.

See 20 CFR 404.1513(a) and 416.913(a).

Medical Source Distinction

    The distinction between ``acceptable medical sources'' and other 
health care providers who are not ``acceptable medical sources'' is 
necessary for three reasons. First, we need evidence from ``acceptable 
medical sources'' to establish the existence of a medically 
determinable impairment. See 20 CFR 404.1513(a) and 416.913(a). Second, 
only ``acceptable medical sources'' can give us medical opinions. See 
20 CFR 404.1527(a)(2) and 416.927(a)(2). Third, only ``acceptable 
medical sources'' can be considered treating sources, as defined in 20 
CFR 404.1502 and 416.902, whose medical opinions may be entitled to 
controlling weight. See 20 CFR 404.1527(d) and 416.927(d).
    Making a distinction between ``acceptable medical sources'' and 
medical sources who are not ``acceptable medical sources'' facilitates 
the application of our rules on establishing the existence of an 
impairment, evaluating medical opinions, and who can be considered a 
treating source.

''Other Sources''

    In addition to evidence from ``acceptable medical sources,'' we may 
use evidence from ``other sources,'' as defined in 20 CFR 404.1513(d) 
and 416.913(d), to show the severity of the individual's impairment(s) 
and how it affects the individual's ability to function. These sources 
include, but are not limited to:
     Medical sources who are not ``acceptable medical 
sources,'' such as nurse practitioners, physician assistants, licensed 
clinical social workers, naturopaths, chiropractors, audiologists, and 
therapists; and
     ``Non-medical Sources'' including, but not limited to:
     Educational personnel, such as school teachers, 
counselors, early intervention team members, developmental center 
workers, and daycare center workers;
     Public and private social welfare agency personnel, 
rehabilitation counselors; and
     Spouses, parents and other caregivers, siblings, other 
relatives, friends, neighbors, clergy, and employers.
    Information from these ``other sources'' cannot establish the 
existence of a medically determinable impairment. Instead, there must 
be evidence from an ``acceptable medical source'' for this purpose. 
However, information from such ``other sources'' may be based on 
special knowledge of the individual and may provide insight into the 
severity of the impairment(s) and how it affects the individual's 
ability to function.

Evaluating Opinions and Other Evidence

    Sections 404.1527 and 416.927 of our regulations provide general 
guidance for evaluating all relevant evidence in a case record and 
provide detailed rules for evaluating medical opinions from 
``acceptable medical sources.'' \1\ Medical

[[Page 45595]]

opinions are statements from physicians and psychologists or other 
``acceptable medical sources'' that reflect judgments about the nature 
and severity of an individual's impairment(s), including symptoms, 
diagnosis and prognosis, what the individual can still do despite the 
impairment(s), and physical and mental restrictions. See 20 CFR 
404.1527(a)(2) and 416.927(a)(2). The regulations set out factors we 
consider in weighing medical opinions from treating sources, 
nontreating sources, and nonexamining sources. See 20 CFR 404.1527(d) 
and 416.927(d). These factors include:
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    \1\ As explained in SSR 96-6p, ``Titles II and XVI: 
Consideration of Administrative Findings of Fact by State Agency 
Medical and Psychological Consultants and Other Program Physicians 
and Psychologists at the Administrative Law Judge and Appeals 
Council Levels of Administrative Review; Medical Equivalence,'' 
paragraphs (c), (d), and (e) of 20 CFR 404.1527 and 416.927 provide 
general rules for evaluating the record, with particular attention 
to medical opinions from ``acceptable medical sources.''
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     The examining relationship between the individual and the 
``acceptable medical source'';
     The treatment relationship between the individual and a 
treating source, including its length, nature, and extent as well as 
frequency of examination;
     The degree to which the ``acceptable medical source'' 
presents an explanation and relevant evidence to support an opinion, 
particularly medical signs and laboratory findings;
     How consistent the medical opinion is with the record as a 
whole;
     Whether the opinion is from an ``acceptable medical 
source'' who is a specialist and is about medical issues related to his 
or her area of specialty; and
     Any other factors brought to our attention, or of which we 
are aware, which tend to support or contradict the opinion. For 
example, the amount of understanding of our disability programs and 
their evidentiary requirements that an ``acceptable medical source'' 
has, regardless of the source of that understanding, and the extent to 
which an ``acceptable medical source'' is familiar with the other 
information in the case record, are all relevant factors that we will 
consider in deciding the weight to give to a medical opinion.
    In addition, these regulations provide that the final 
responsibility for deciding certain issues, such as whether an 
individual is disabled under the Act, is reserved to the Commissioner.
    These regulations provide specific criteria for evaluating medical 
opinions from ``acceptable medical sources''; however, they do not 
explicitly address how to consider relevant opinions and other evidence 
from ``other sources'' listed in 20 CFR 404.1513(d) and 416.913(d). 
With the growth of managed health care in recent years and the emphasis 
on containing medical costs, medical sources who are not ``acceptable 
medical sources,'' such as nurse practitioners, physician assistants, 
and licensed clinical social workers, have increasingly assumed a 
greater percentage of the treatment and evaluation functions previously 
handled primarily by physicians and psychologists. Opinions from these 
medical sources, who are not technically deemed ``acceptable medical 
sources'' under our rules, are important and should be evaluated on key 
issues such as impairment severity and functional effects, along with 
the other relevant evidence in the file.
    ``Non-medical sources'' who have had contact with the individual in 
their professional capacity, such as teachers, school counselors, and 
social welfare agency personnel who are not health care providers, are 
also valuable sources of evidence for assessing impairment severity and 
functioning. Often, these sources have close contact with the 
individuals and have personal knowledge and expertise to make judgments 
about their impairment(s), activities, and level of functioning over a 
period of time. Consistent with 20 CFR 404.1513(d)(4) and 
416.913(d)(4), we also consider evidence provided by other ``non-
medical sources'' such as spouses, other relatives, friends, employers, 
and neighbors.
    Although 20 CFR 404.1527 and 416.927 do not address explicitly how 
to evaluate evidence (including opinions) from ``other sources,'' they 
do require consideration of such evidence when evaluating an 
``acceptable medical source's'' opinion. For example, SSA's regulations 
include a provision that requires adjudicators to consider any other 
factors brought to our attention, or of which we are aware, which tend 
to support or contradict a medical opinion. Information, including 
opinions, from ``other sources''--both medical sources and ``non-
medical sources''--can be important in this regard. In addition, and as 
already noted, the Act requires us to consider all of the available 
evidence in the individual's case record in every case.
    Accordingly, this ruling clarifies how we consider opinions and 
other evidence from medical sources who are not ``acceptable medical 
sources'' and from ``non-medical sources,'' such as teachers, school 
counselors, social workers, and others who have seen the individual in 
their professional capacity, as well as evidence from employers, 
spouses, relatives, and friends. This ruling also explains how we 
consider decisions on disability made by other governmental and 
nongovernmental agencies.

Policy Interpretation

I. Evidence From ``Other Sources''

    As set forth in regulations at 20 CFR 404.1527(b) and 416.927(b), 
we consider all relevant evidence in the case record when we make a 
determination or decision about whether the individual is disabled. 
Evidence includes, but is not limited to, opinion evidence from 
``acceptable medical sources,'' medical sources who are not 
``acceptable medical sources,'' and ``non-medical sources'' who have 
seen the individual in their professional capacity. The weight to which 
such evidence may be entitled will vary according to the particular 
facts of the case, the source of the opinion, including that source's 
qualifications, the issue(s) that the opinion is about, and many other 
factors, as described below.
Factors for Considering Opinion Evidence
    Although the factors in 20 CFR 404.1527(d) and 416.927(d) 
explicitly apply only to the evaluation of medical opinions from 
``acceptable medical sources,'' these same factors can be applied to 
opinion evidence from ``other sources.'' These factors represent basic 
principles that apply to the consideration of all opinions from medical 
sources who are not ``acceptable medical sources'' as well as from 
``other sources,'' such as teachers and school counselors, who have 
seen the individual in their professional capacity. These factors 
include:
     How long the source has known and how frequently the 
source has seen the individual;
     How consistent the opinion is with other evidence;
     The degree to which the source presents relevant evidence 
to support an opinion;
     How well the source explains the opinion;
     Whether the source has a specialty or area of expertise 
related to the individual's impairment(s); and
     Any other factors that tend to support or refute the 
opinion.
Opinions From Medical Sources Who Are Not ``Acceptable Medical 
Sources''
    Opinions from ``other medical sources'' may reflect the source's 
judgment about some of the same issues addressed in medical opinions 
from ``acceptable medical sources,'' including symptoms, diagnosis and 
prognosis, what the individual can still do despite the impairment(s), 
and physical and mental restrictions.
    Not every factor for weighing opinion evidence will apply in every 
case. The

[[Page 45596]]

evaluation of an opinion from a medical source who is not an 
``acceptable medical source'' depends on the particular facts in each 
case. Each case must be adjudicated on its own merits based on a 
consideration of the probative value of the opinions and a weighing of 
all the evidence in that particular case.
    The fact that a medical opinion is from an ``acceptable medical 
source'' is a factor that may justify giving that opinion greater 
weight than an opinion from a medical source who is not an ``acceptable 
medical source'' because, as we previously indicated in the preamble to 
our regulations at 65 FR 34955, dated June 1, 2000, ``acceptable 
medical sources'' ``are the most qualified health care professionals.'' 
However, depending on the particular facts in a case, and after 
applying the factors for weighing opinion evidence, an opinion from a 
medical source who is not an ``acceptable medical source'' may outweigh 
the opinion of an ``acceptable medical source,'' including the medical 
opinion of a treating source. For example, it may be appropriate to 
give more weight to the opinion of a medical source who is not an 
``acceptable medical source'' if he or she has seen the individual more 
often than the treating source and has provided better supporting 
evidence and a better explanation for his or her opinion. Giving more 
weight to the opinion from a medical source who is not an ``acceptable 
medical source'' than to the opinion from a treating source does not 
conflict with the treating source rules in 20 CFR 404.1527(d)(2) and 
416.927(d)(2) and SSR 96-2p, ``Titles II and XVI: Giving Controlling 
Weight To Treating Source Medical Opinions.''
Evidence From ``Non-Medical Sources''
    Opinions from ``non-medical sources'' who have seen the individual 
in their professional capacity should be evaluated by using the 
applicable factors listed above in the section ``Factors for Weighing 
Opinion Evidence.'' Not every factor for weighing opinion evidence will 
apply in every case. The evaluation of an opinion from a ``non-medical 
source'' who has seen the individual in his or her professional 
capacity depends on the particular facts in each case. Each case must 
be adjudicated on its own merits based on a consideration of the 
probative value of the opinions and a weighing of all the evidence in 
that particular case.
    For opinions from sources such as teachers, counselors, and social 
workers who are not medical sources, and other non-medical 
professionals, it would be appropriate to consider such factors as the 
nature and extent of the relationship between the source and the 
individual, the source's qualifications, the source's area of specialty 
or expertise, the degree to which the source presents relevant evidence 
to support his or her opinion, whether the opinion is consistent with 
other evidence, and any other factors that tend to support or refute 
the opinion.
    An opinion from a ``non-medical source'' who has seen the claimant 
in his or her professional capacity may, under certain circumstances, 
properly be determined to outweigh the opinion from a medical source, 
including a treating source. For example, this could occur if the 
``non-medical source'' has seen the individual more often and has 
greater knowledge of the individual's functioning over time and if the 
``non-medical source's'' opinion has better supporting evidence and is 
more consistent with the evidence as a whole.
    In considering evidence from ``non-medical sources'' who have not 
seen the individual in a professional capacity in connection with their 
impairments, such as spouses, parents, friends, and neighbors, it would 
be appropriate to consider such factors as the nature and extent of the 
relationship, whether the evidence is consistent with other evidence, 
and any other factors that tend to support or refute the evidence.
Explanation of the Consideration Given to Opinions From ``Other 
Sources''
    Since there is a requirement to consider all relevant evidence in 
an individual's case record, the case record should reflect the 
consideration of opinions from medical sources who are not ``acceptable 
medical sources'' and from ``non-medical sources'' who have seen the 
claimant in their professional capacity. Although there is a 
distinction between what an adjudicator must consider and what the 
adjudicator must explain in the disability determination or decision, 
the adjudicator generally should explain the weight given to opinions 
from these ``other sources,'' or otherwise ensure that the discussion 
of the evidence in the determination or decision allows a claimant or 
subsequent reviewer to follow the adjudicator's reasoning, when such 
opinions may have an effect on the outcome of the case. In addition, 
when an adjudicator determines that an opinion from such a source is 
entitled to greater weight than a medical opinion from a treating 
source, the adjudicator must explain the reasons in the notice of 
decision in hearing cases and in the notice of determination (that is, 
in the personalized disability notice) at the initial and 
reconsideration levels, if the determination is less than fully 
favorable.

II. Decisions on Disability by Other Governmental and Nongovernmental 
Agencies

    The regulations at 20 CFR 404.1504 and 416.904 provide that:

    [a] decision by any nongovernmental agency or any other 
governmental agency about whether you are disabled or blind is based 
on its rules and is not our decision about whether you are disabled 
or blind. We must make a disability or blindness determination based 
on social security law. Therefore, a determination made by another 
agency [e.g., Workers' Compensation, the Department of Veterans 
Affairs, or an insurance company] that you are disabled or blind is 
not binding on us.

    Under sections 221 and 1633 of the Act, only a State agency or the 
Commissioner can make a determination based on Social Security law that 
you are blind or disabled. Our regulations at 20 CFR 404.1527(e) and 
416.927(e) make clear that the final responsibility for deciding 
certain issues, such as whether you are disabled, is reserved to the 
Commissioner (see also SSR 96-5p, ``Titles II and XVI: Medical Source 
Opinions on Issues Reserved to the Commissioner''). However, we are 
required to evaluate all the evidence in the case record that may have 
a bearing on our determination or decision of disability, including 
decisions by other governmental and nongovernmental agencies (20 CFR 
404.1512(b)(5) and 416.912(b)(5)). Therefore, evidence of a disability 
decision by another governmental or nongovernmental agency cannot be 
ignored and must be considered.
    These decisions, and the evidence used to make these decisions, may 
provide insight into the individual's mental and physical impairment(s) 
and show the degree of disability determined by these agencies based on 
their rules. We will evaluate the opinion evidence from medical 
sources, as well as ``non-medical sources'' who have had contact with 
the individual in their professional capacity, used by other agencies, 
that are in our case record, in accordance with 20 CFR 404.1527, 
416.927, Social Security Rulings 96-2p and 96-5p, and the applicable 
factors listed above in the section ``Factors for Weighing Opinion 
Evidence.''
    Because the ultimate responsibility for determining whether an 
individual is disabled under Social Security law rests with the 
Commissioner, we are not bound by disability decisions by other 
governmental and nongovernmental

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agencies. In addition, because other agencies may apply different rules 
and standards than we do for determining whether an individual is 
disabled, this may limit the relevance of a determination of disability 
made by another agency. However, the adjudicator should explain the 
consideration given to these decisions in the notice of decision for 
hearing cases and in the case record for initial and reconsideration 
cases.
    Effective Date: This SSR is effective upon publication in the 
Federal Register.
    Cross-References: Social Security Rulings 96-2p, ``Titles II and 
XVI: Giving Controlling Weight to Treating Source Medical Opinions,'' 
SSR 96-5p, ``Titles II and XVI: Medical Source Opinions on Issues 
Reserved to the Commissioner''; Program Operations Manual System 
sections DI 22505.003, DI 24515.001, DI 24515.002, DI 24515.011, and DI 
24515.012.

[FR Doc. E6-12951 Filed 8-8-06; 8:45 am]
BILLING CODE 4191-02-P