This is the third of four articles on recently rescinded Social Security Rulings(SSR). This article explains how the rescinding of SSR 96-6p negatively affects claimants. SSR 96-6p was titled “Consideration of Administrative Findings of Fact” by State Agency Medical and Psychological Consultants and Other Program Physicians and Psychologist at the Appeals Council Levels of Administrative Review; Medical Equivalence.”
The first section of this ruling states:
- Findings of fact made by State agency medical and psychological consultants and other program physicians and psychologists regarding the nature and severity of an individual’s impairment(s) must be treated as expert opinion evidence of non-examining sources at the administrative law judge and Appeals Council levels of administrative review
- Administrative law judges and the Appeals Council may not ignore these opinions and must explain the weight given to these opinions in their decisions
- An updated medical expert opinion must be obtained by the administrative law judge or the Appeals Council before a decision of disability based on medical equivalence can be made
This helped claimants by requiring the ALJ and the Appeals Council explain why a Social Security medical expert was wrong if the judge did not agree with the opinions of the Social Security experts. If the Social Security Administration(SSA) ignored an opinion of one of their own doctors and the decision was deemed wrong, a claimant would get a new hearing. This ruling also required the ALJ and the Appeals Council get an opinion from a doctor if a claimant was close to meeting a listed disability. This is what they called medical equivalence.
An example of a medical equivalence occurs when there are four elements to qualify for benefits and a claimant had three elements from one disability and one element from a second disability. If the doctor admitted that each of the four elements existed then an ALJ would usually issue a favorable decision.
They say this ruling was replaced with SSR 17-3p which is titled “Evidence Needed by Adjudicators at the Hearings and Appeals Council Levels of the Administrative Review Process to Make Findings about Medical Equivalence.” The new ruling now lets the adjudicator, ALJs, or the Appeals Council make the decision whether medical equivalence had been met. The ALJs do not need a doctor to give them an opinion. This hurts claimants because before if a doctor testified there was medical equivalence, the Judge would find a person disabled. Now they do not even need to call a doctor to decide, so there is no way to get a medical expert to admit that one element of a second disability equaled the fourth element of the first disability.
Three positive effects of ruling SSR 96-6p include using Social Security doctor’s opinions to help a claimant, get a new hearing if the ALJ failed to discuss a Social Security doctor’s opinion, and using a Social Security doctor to get a finding of medical equivalence are all gone.
They have been replaced with a ruling that says the ALJ gets to decide.
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