DI 22505.003: Evidence from an Acceptable Medical Source (AMS)

changes
←	*	→

~~Effective Dates: 03/24/2017 - Present~~
Effective Dates: 06/15/2018 - Present
TN 22 (03-17)
DI 22505.003 Evidence from an Acceptable Medical Source (AMS)
Citations:
20 CFR 404.1502, 404.1513, 416.902, and 416.913.
A. Medical sources who are AMSs
The following are AMSs:
* Licensed physicians (medical or osteopathic doctors).
* Licensed or certified psychologists at the independent practice level.
* School psychologists, or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, are AMSs for impairments of intellectual disability, learning disabilities, and borderline intellectual functioning only.
* Licensed optometrists for impairments of visual disorders, or measurement of visual acuity and visual fields only, depending on the scope of practice in the State in which the optometrist practices.
* Licensed podiatrists for 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.
* Qualified speech-language pathologists (SLPs) for speech or language impairments only. For this source, “qualified” means that the SLP must be licensed by the State professional licensing agency, or be fully certified by the State education agency in the State that he or she practices, or hold a Certificate of Clinical Competence in Speech-Language-Pathology from the American Speech-Language Hearing Association.
* In claims with a filing date on or after March 27, 2017, licensed physician assistants for impairments within the licensed scope of practice only.
* In claims with a filing date on or after March 27, 2017, licensed audiologists for impairments of hearing loss, auditory processing disorders, and balance disorders within the licensed scope of practice only. NOTE: Audiologists’ scope of practice generally includes evaluation, examination, and treatment of certain balance impairments that result from the audio-vestibular system. However, some impairments involving balance involve several different body systems that are outside the scope of practice for audiologists, such as those involving muscles, bones, joints, vision, nerves, heart and blood vessels.
* In claims with a filing date on or after March 27, 2017, licensed Advanced Practice Registered Nurses (APRN), also known in some States as Advanced Practice Nurse (APN), and Advanced Registered Nurse Practitioner (ARNP) for impairments within his or her licensed scope of practice.
There are four types of APRNs with a handful of State variations:
* Certified Nurse Midwife (CNM);
* Nurse Practitioner (NP);
* Certified Registered Nurse Anesthetist (CRNA); and
* Clinical Nurse Specialist (CNS).
NOTE: For more information about how we determine a claim’s filing date, see Determining the Filing Date for Evaluating Evidence per DI 24503.050.
1. How we categorize evidence from an AMS
We categorize all evidence from an AMS as objective medical evidence (signs, laboratory findings, or both), medical opinions, or other medical evidence. For more information, see Categories of Evidence in DI 24503.005.
NOTE: If a person who is a medical source provides evidence in his or her capacity as a friend or family member, evaluate that evidence as if from a nonmedical source. For more information, see Evaluating Evidence from Nonmedical Sources.in DI 24503.020.
2. Objective medical evidence from an AMS needed to establish the existence of a medically determinable impairment (MDI)
We require objective medical evidence (signs, laboratory findings, or both) from an AMS to establish that an individual has an MDI(s) at step 2 of the sequential evaluation process. For instructions on Establishing a Medically Determinable Impairment (MDI) see DI 24501.020.
REMEMBER:
* We cannot establish an MDI based on symptoms, a diagnosis, or a medical opinion.
* An MDI must result from anatomical, physiological, or psychological abnormalities identified by medically acceptable clinical and laboratory diagnostic techniques.
* If we need objective medical evidence from a consultative examination (CE) to establish the existence of an MDI, a qualified CE source who is also an AMS must personally examine the claimant, though qualified support staff may assist.
See details:
DI 22510.010 Selecting a Qualified Medical Source to Perform a Consultative Examination (CE).
3. Considering all evidence
Once we establish that a claimant has an MDI based on objective medical evidence from an AMS, we use all evidence from all sources for all other findings in the sequential evaluation process, including showing the severity of a claimant’s MDI at step 2. These sources include:
* Medical sources who are not AMSs but are legally permitted to provide healthcare, such as naturopaths, chiropractors, and therapists;
* Nonmedical sources such as:
* educational personnel (for example, school teachers, counselors, early intervention team members, developmental center workers, and daycare center workers);
* public and private social welfare agency personnel; and
* relatives (spouses, parents, siblings, etc.), caregivers, friends, neighbors, past employers, and clergy.
B. Identifying AMS evidence
1. Confirming evidence is from an AMS
Consider medical evidence to be from an AMS, as described in DI 22505.003A in this section, if it shows the AMS’s:
* role in the care or evaluation; and
* connection to the evidence.
a. The AMS’ role in the care or evaluation
An AMS had a role in the care or evaluation of the individual alone or as part of an interdisciplinary team, (such as treating, examining, interpreting test results, reviewing treatment records, or overseeing treatment).
b. The AMS’ connection to the evidence
There is a connection between the AMS and the received evidence.
Usually, this means the documentation contains the AMS’ written, typed, or signed name and credentials.
REMINDER: For a consultative examination (CE), the medical source that actually performed the CE must personally review and sign the CE report as explained in DI 22510.015C.
2. Indications that the evidence is not from an AMS
Evidence is not from an AMS if it shows only a non-AMS source(s) provided the medical care for the claimant without an AMS taking a role in the care and having a direct connection to the evidence.
3. Resolution of AMS status issues
If we cannot determine whether the evidence is from an AMS after reviewing the evidence, and the issue is material to the determination (for example, no other evidence in the file would establish the existence of an MDI), resolve the issue with subsequent development. You may, for example:
* recontact the source for clarification; or
* consult State licensing or credentialing agency official resources, such as an official website to determine if he or she is an AMS.
After recontact, if you still cannot verify that the source is an AMS, then you cannot consider that source to be an AMS.
NOTE: Clearly document efforts to resolve any medical source issues. For the electronic claims analysis tool (eCAT) claims, use the “Claims Communication” function in eCAT to document the disability determination explanation. For information about the Disability Determination Services documentation requirements in non-eCAT claims, see DI 20503.001E and DI 40525.125.
C. References
* DI 22505.001 Medical Evidence of Record (MER) Policies
* DI 22505.004 Establishing the Credentials for Psychologists and School Psychologists Who Do Not Show Their Licensing or Certification Status
* DI 22505.005 Establishing Acceptability for Speech-Language Pathologists (SLPs) Who Do Not Show Their Credentials
* DI 22505.012 Development Issue - No Evidence Furnished from an Acceptable Medical Source
* DI 22510.010 Selecting a Qualified Medical Source to Perform a Consultative Examination (CE)
* DI 24501.020 Establishing a Medically Determinable Impairment (MDI)
* DI 24515.065 Symptoms, Medically Determinable Physical and Mental Impairments, and Exertional and Nonexertional Limitations (SSR 96-4p)

POMS Reference

DI 22505.003: Evidence from an Acceptable Medical Source (AMS)