SSR 06-03p: Rescinded

Rescinded by Federal Register Notice Vol. 82, No. 57, page 15263

effective March 27, 2017

Effective/Publication Date: 08/09/2006

POLICY INTERPRETATION RULING

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:

y 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.

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);

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”

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.

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.

on-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

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:

- 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;

g medical

opinions from treating sources, nontreating sources, and

nonexamining sources. See 20 CFR 404.1527(d) and 416.927(d) .

These factors include:

- 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.

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

;

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

h 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

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

urces,” 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.

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”

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 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

e 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.

or

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”

sional 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:

dicator 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.

ver, 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 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:

idual 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.

[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.”