Social Security divides medical sources into two categories: “acceptable medical sources” and other health care providers who are not “acceptable medical sources”. Nurse Practitioners are in the category of other health care providers who are not “acceptable medical sources”.

In Social Security Ruling 06-03, SSA explains that it makes the distinction for three  reasons: First, SSA needs evidence from “acceptable medical sources” to establish the existence of a medically determinable impairment. Second, only “acceptable medical sources” can give SSA medical opinions.  Third, only “acceptable medical sources” can be considered treating sources whose medical opinions may be entitled to controlling weight.

This means that the medical evidence from a Nurse Practitioner can not establish your medical impairment at Step 2 of the Sequential Evaluation. You must establish your medical impairment in order to win your benefits.

This means that if all of your treatment is by a Nurse Practitioner, then you have no one who can give SSA a medical opinion about how your medical impairments restrict what you can do.

In a card game, a King beats a Jack. Social Security does not even treat a Nurse Practitioner as a Jack–more like a low card. This is not good for your case!

Just because your doctor told you six months ago that there was nothing more the doctor could do for you – this is as good as it gets – does not mean that you can stop going to the doctor. If you do not have medical records (that third party verification) for those six months, the judge can say that there is no proof that your medical condition did not improve during that time or that it stayed the same, therefore you have not proved that your medical condition prevented you from working those six months. This could result in a complete loss of benefits. If you have seen the doctor in that time, then the medical records can document that you did not improve. Also, the doctor may document some facts that the doctor did not previously document. These facts may be what convince the judge that you can not work.

Another problem is that most doctors do not put in their medical records that they told you that this is as good as it gets. When you tell the judge that is what the doctor says, there is no way to verify this in the medical records. In preparing your case to win, you must assume that without third party verification of what you say that the judge will not believe you. Otherwise you are gambling that maybe you will be lucky and the judge will believe you. Why would you want to gamble on winning when you can continue to see the doctor and generate the third party evidence (medical records) that will show what your medical condition was?

I told the nurse that I hated the pain scale as I have had clients who had rated their pain at a number that the judge in their disability case thought was the wrong number for what they were describing. “What is a level 5, what is a level 8?” I asked. I was over-thinking this and the nurse just wanted to chart it, give me my shot, and move on. She agreed with me that the number was arbitrary, but that she needed to chart it. So I picked a number.

As I lay in my hospital bed, I could not help but think of the countless hearings I have been in where the judge has asked my clients to rate their pain. One judge said that a 10 was the worst pain you could imagine. What he did not say was that if you said a 10 he automatically disbelieved you as he believed that no one could be sitting there with a pain level of 10 (he never told them that to their faces). Other judges had no problem with a pain level 10.

I hate the pain scale because there is no way for us all to calibrate our measurements so that they are all the same. I have observed clients in great pain who state that their pain is a 6. I have had other clients who appeared to be in less pain that also said that their pain was a 6. So what is a level 6?

How did I want to compare the pain I had the two nights that I could not sleep from the pain to the pain that I had after surgery? There was a time I thought my pain might be a 10, but what about those I have seen who suffered more than I did those two nights I could not sleep? If delivering a baby is a pain level of 10, was my pain that bad? Since I am a man, I will obviously never know how my pain compares to the pain of childbirth.

So I started to answer the nurse the way I advise my clients to tell their medical providers about the pain. I started to describe the pain without putting a number on it. I started to give the nurse details about the pain. How it felt. Where it was. What aggravated it (at that point for me it was just shifting in the bed). What kind of pain it was ( by this I mean was it hot, cold, constant, throbbing, stabbing, electrifying ect.) How intense it was. She wrote down my description. Now a “real” description of my pain was recorded.

It is important to get a “real” description of your pain recorded into the medical records every time you visit your medical provider. This will allow the judge to read your descriptions and know how your pain was at the beginning of your disability and how the pain continued during all of the time that was disabled. If you only give a number, you and the judge may have different ideas as to what that means. The only way you could “both be on the same page” would be for you to calibrate with the judge your pain measurements on the same scale to discover that your 6 is his or her 8. The problem is that this can not happen until the hearing, and the judge will have already read the file and decided how bad your level 6 pain is. It may be hard for the judge to change his mind. If your full blown description of the pain is in your medical records, the judge will read that as he reads the file and decides how bad your pain is.

Your full blown description of the pain in your medical records is vital to your case.

When you are proving that it is your medical impairment that is keeping you from working, SSA will want to know how your medical impairment prevents you from being able to work. SSA will look to see if the medical impairment you have could produce the problems you describe. If the medical community generally does not believe that you could have the problems you describe as a result of the medical impairment you identify, then SSA will find that your medical impairment does not prevent you from working. For example, if you identify that you have a hang nail, that would not explain why you have back pain that prevents you from working. Social Security would ignore that you have back pain because you have not proved that your impairment, a hang nail, causes the back pain that prevents you from working.

There is a big difference between what you know and what you can prove. You will not be able to win your disability claim based only on your testimony about how your medical impairment affects you. Even though your immediate family knows you the best and they are most likely to know what you could do before you were disabled and what you can now do, SSA is suspicious of this testimony because SSA thinks your family is likely to say anything to help you get the disability money. SSA will be looking to your medical records to decide how severe your medical impairment really is. From your medical records SSA will be deciding how long you can sit, stand, and walk in an eight hour competitive work day. SSA will also decide from your medical records how much you can lift and carry and how often you could do this, your ability to reach, handle, and finger and many other physical tasks. Any limitations in your abilities must be due to your medical impairments. And the best source of evidence is usually your medical records.

Behind every question that Social Security asks is the real question: how does your medical impairment keep you from working and how does what we are now talking about show how your medical impairment keeps you from working?<–>