Last Update: 5/19/08 (Transmittal I-2-72)
Citations:
20 CFR §§ 404.941, 404.1502, 404.1512- 404.1518, 404.1519- 404.1519t, 404.1520a, 404.1527, 416.902, 416.912- 416.918, 416.919- 416.919t, 416.920a, and 416.1441;
SSR 83-20, SSR 91-5p, SSR 96-6p, SSR 96-7p, SSR 96-8p, SSR 00-4p, and SSR 06-03p.
“Claimant,” as used herein, refers to the party to the initial, reconsidered, or revised determination who has requested a hearing before an ALJ, and any other party to the determination, or person whose rights may be adversely affected by a hearing decision.
The claimant is responsible for providing evidence to support his or her claim. If the claimant does not provide medical or other evidence the Administrative Law Judge (ALJ) needs and asks for, the ALJ will generally make a decision based on the evidence in the record, including evidence the ALJ has obtained directly. To document that the ALJ has made an attempt to fully and fairly develop the record, the ALJ should include documentation of all attempts to obtain the evidence as an exhibit(s) in the record.
The regulations at 20 CFR §§ 404.1513(a) and 416.913(a) define “acceptable medical sources” as licensed physicians (medical or osteopathic doctors); licensed or certified psychologists (including 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 purposes of establishing visual disorders only (except, in the U.S. Virgin Islands, licensed optometrists, for the measurement of visual acuity and visual fields only); licensed podiatrists, for the purpose of establishing impairments of the foot or the 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. 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 he or she practices, or hold a Certificate of Clinical Competence from the American Speech-Language-Hearing Association.
The regulations at 20 CFR §§ 404.1502 and 416.902 define “medical sources” as acceptable medical sources or other health care providers who are not acceptable medical sources. These sections define “treating source” as a claimant's own physician or psychologist, or other acceptable medical source who provides or has provided the claimant with medical treatment or evaluation, and who has or has had an ongoing treatment relationship with the claimant.
SSA considers a claimant's treating source(s) to be the primary source of medical evidence about the claimant's impairment(s). If a claimant's treating source(s) cannot provide adequate evidence about the claimant's impairment(s) for the ALJ to determine whether the claimant is disabled or blind, the ALJ may obtain existing evidence from other sources or ask the claimant to undergo a physical or mental examination(s) or test(s).
SSA will pay health care professionals not employed by the Federal government and other non-federal providers of medical services for the reasonable cost of providing existing medical evidence that the ALJ requests. SSA will also pay for any physical or mental examination or test that it arranges. However, SSA will not pay for any physical or mental examination or test the claimant or the claimant's representative arranges without advance approval.
The ALJ must review the evidence before the hearing to determine whether it is sufficient for a full and fair inquiry into the matters at issue. (See I-2-1-1, Prehearing – Case Analysis and Workup — General, and I-2-1-5, Conducting Prehearing Case Analysis and Workup.)
Development may be needed to:
obtain additional medical evidence (e.g., current evidence from a treating source);
obtain technical or specialized medical opinion; or
resolve conflicts or differences in the evidence.
If the ALJ decides that additional evidence is needed, the ALJ or the HO staff will undertake appropriate development before the hearing and arrange for any necessary witnesses to be present at the hearing. (See I-2-6-60 Testimony of Claimants and Witnesses.) If a witness will not appear voluntarily, the ALJ may consider issuing a subpoena under 20 CFR 404.950(d) and 416.1450(d). (See I-2-5-80 Preparation and Service of a Subpoena.)
If the ALJ obtains evidence after the hearing from a source other than the claimant, the ALJ generally must provide the claimant an opportunity to examine the evidence before entering it into the record as an exhibit. (See I-2-7-30, Proffer Procedures; I-2-6-78, Closing the Hearing; and I-2-7-99 Sample Waiver By Claimant of Right to Inspect Additional Evidence.)