DI 24503.005:
Categories of Evidence
Effective Dates: 07/31/2017 - Present- Effective Dates: 03/15/2018 - Present
- BASIC (03-17)
- DI 24503.005 Categories of Evidence
- A. Basic policy
- All of the evidence that we receive falls into one of the categories of evidence described in this section. The category of evidence, and in some instances the filing date, will determine:
- * the policy we use to evaluate the evidence, and
- * the articulation requirements about the evidence for the determination.
- When a document from a source contains different categories of evidence, treat each kind of evidence according to the applicable policy and articulation requirements outlined in this subchapter.
- Some definitions of a category of evidence differ based on the filing date of the claim.
- For information on what filing date to use in evaluation and articulation, see DI 24503.050 Determining the Filing Date for Evaluating Medical Opinions.
- B. The categories of evidence
- 1. Objective medical evidence
- Objective medical evidence means signs, laboratory findings, or both, from a medical source. Objective medical evidence does not include symptoms, diagnoses, or medical opinions. For more information, see DI 24501.020 Establishing a Medically Determinable Impairment (MDI).
- 2. Medical opinion
- In general, under the current rules, the definition of a medical opinion focuses on functional abilities and limitations. Under the prior rules, the definition of a medical opinion included items other than functioning, such as information about symptoms, diagnosis and prognosis. For additional details, see DI 24503.005B.2a.-c.
- a. Medical opinion – adult claim – filing date on or after March 27, 2017
- A medical opinion is a statement from a medical source about what a claimant can still do despite his or her impairment(s) and whether the claimant has one or more impairment-related limitations or restrictions in one or more of the following abilities:
- * The ability to perform physical demands of work activities, such as sitting, standing, walking, lifting, carrying, pushing, pulling, or other physical functions (including manipulative or postural functions, such as reaching, handling, stooping, or crouching).
- * The ability to perform mental demands of work activities, such as understanding; remembering; maintaining concentration, persistence, or pace; carrying out instructions; or responding appropriately to supervision, co-workers, or work pressures in a work setting.
- * The ability to perform other demands of work, such as seeing, hearing, or using other senses.
- * The ability to adapt to environmental conditions, such as temperature extremes or fumes.
b. Medical opinion – child claim – filing date on or after March 27, 2017- b. Medical opinion – title XVI child claim – filing date on or after March 27, 2017
- A medical opinion is a statement from a medical source about what a claimant can still do despite his or her impairments and whether the claimant has one or more impairment-related limitations or restrictions in the six domains of functioning:
- * Acquiring and using information
- * Attending and completing tasks
- * Interacting and relating with others
- * Moving about and manipulating objects
- * Caring for themselves
- * Health and physical well-being
- For more information about the six domains of functioning, see DI 25225.005 How We Will Consider Your Functioning (Section 416.926a(b)).
- c. Medical opinion – adult or child claim - filing date before March 27, 2017
- A medical opinion is a statement from an acceptable medical source (AMS) that reflects judgments about the nature and severity of a claimant’s impairments, including symptoms, diagnosis and prognosis, what the claimant can still do despite impairments, and the claimant’s physical or mental restrictions.
- 3. Opinion – filing date before March 27, 2017
- This category of evidence is relevant only in a claim whose filing date is before March 27, 2017. An opinion is evidence from either a medical source who is not an AMS or from a nonmedical source that reflects judgments about the nature and severity of a claimant’s impairments, including symptoms, diagnosis and prognosis, what the claimant can still do despite impairments, and the claimant’s physical or mental restrictions. For more information, see 24503.035 Evaluation and Articulation Requirements for Medical Opinions, Opinions, and Prior Administrative Medical Findings - Claims Filed before March 27, 2017.
- 4. Other medical evidence
- Other medical evidence is all other evidence from a medical source that is not objective medical evidence or a medical opinion. This includes judgments about the nature and severity of the claimant’s impairments, medical history, clinical findings, diagnosis, treatment prescribed with response, and prognosis. This simplifies our rules because we categorize and treat all of this evidence the same way. For a definition of medical source, see DI 22505.001A.4.
- NOTE: For claims filed before March 27, 2017, we categorize the nature and severity of an individual’s impairments, diagnosis, or prognosis as medical opinions, not other medical evidence.
- For additional information, see DI 24503.015 Evaluating Other Medical Evidence.
- 5. Evidence from a nonmedical source
- Evidence from a nonmedical source means any information or statement from a nonmedical source about any issue in a claim. This category includes evidence about the claimant’s impairments, restrictions, daily activities, and work history. It also includes any other relevant statement a nonmedical source makes to a medical source or us during the course of examination or treatment, interviews, applications, reports, letters, testimony in our administrative proceedings, or case development.
- For additional information, see DI 24503.020 Evaluating Evidence from Nonmedical Sources.
- 6. Prior administrative medical finding
- A prior administrative medical finding is a finding of fact about a medical issue made by a medical consultant (MC) or psychological consultant (PC) at a prior administrative level in the current claim, such as:
- * The existence and severity of an impairment(s)
- * The existence and severity of a symptom(s)
- * A statement about whether an impairment(s) meets or medically equals any listing in the Listing of Impairments (Listings)
- * If the claimant is a child, a statement about whether the impairment(s) functionally equals the Listings
- * If the claimant is an adult, the residual functional capacity (RFC)
- * Whether the impairment(s) meets the duration requirement
- * How failure to follow prescribed treatment relates to the claim
- * How drug addiction and alcoholism relates to the claim
- IMPORTANT: This category applies only to the current claim. For the DDS this means they will only articulate consideration of administrative medical findings from a prior initial filing when adjudicating a reconsideration claim.
- We are not required to consider prior administrative medical findings from a prior filing, except in the Sixth Circuit in Drummond (DI 52705.000 Drummond Acquiescence Ruling) and Dennard (DI 52706.000 Dennard Acquiescence Ruling), the Fourth Circuit in Albright (DI 52715.000 Albright Acquiescence Ruling) and the Ninth circuit in Chavez (DI 52755.000 Chavez Acquiescence Ruling (AR)).
- NOTE: The ultimate finding of “disabled” or “not disabled” is a statement on an issue reserved to the Commissioner and not a prior administrative medical finding. For additional information, see DI 24503.040 Evaluating a Statement on an Issue Reserved to the Commissioner.
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