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!

“When talking with Social Security disability claimants, I often hear a statement like “I can’t work because I have been diagnosed with bipolar disorder” (or degenerative disc disease, or fibromyalgia). The claimant makes the statement like the matter is settled. The reasoning seems to be: since there is a doctor’s diagnosis of my impairment, my disability claim should be granted.

Unfortunately, that reasoning is not at all correct. It is not the diagnosis of the impairment but the severity of the impairment that matters in a Social Security disability claim. And I explain this to clients every day.

The diagnosis is just the beginning. A good beginning to be sure, since the diagnosis satisfies the medically determinable requirement in a Social Security disability claim. But the important thing is the severity of your impairment. How much does it affect your functionality? How does it affect your ability to work? These are the important questions in a Social Security disability case.

What is missing from almost every denied Social Security disability claim is evidence establishing a claimant’s functional limitations. A medical diagnosis alone does not establish any functional limitations. And unfortunately, a patient’s medical records usually have little information regarding functional limitations (medical records are created and maintained for medical providers to track a patient’s medical care, not to establish disability).

So remember, it’s not the diagnosis but the severity of the impairment that matters. And a Social Security disability lawyer spends a great deal of time trying to obtain evidence – often a medical source statement – that will establish a claimant’s functional limitations.”

I am in complete agreement with Mr. Gates observations. I have the same conversations with people all the time. I remind people that they need to tell the whole truth about their inability to work. You really do need to know the rules of Social Security disability.

A new client informed me that Paul Harvey had died. Why was I talking to my new client about Paul Harvey when we were discussing her disability case? I knew that if she had heard radio legend Paul Harvey’s show, The Rest of the Story, she could learn and understand an important lesson about her disability case. Like so many others, she was not telling The Rest of the Story.

Paul Harvey’s radio show always had a spot he called “The Rest of the Story”. Paul always had an interesting story that he would begin to tell. He would let you know how the story would end and give you some facts up to the commercial. When you heard the facts that he told you up to the commercial, the story did not make any sense because you just could not understand how given those facts there could be the end he had told you about. In fact, many times, I thought it was impossible!

Once Paul came back from the commercial, he would tell you The Rest of the Story. Paul would add one or two more facts, and the story would fall into place. Suddenly, the impossible ending was not only possible, it was required!

Based upon what my client had told me, I knew that she had left out some very important facts out of her disability story. I started talking to her about Paul Harvey’s radio show. I told her she had only gotten up to the commercial. I told her that her disability story did not make sense. She needed to tell The Rest of the Story. Once I pointed out to her the facts she had left out, she began to realize how she was not bothering to tell very important facts. She understood that she needed to tell The Rest of the Story.

Many people who have been turned down for disability do not realize that they are not telling The Rest of the Story. Paul Harvey’s radio program has been a valuable tool to help them understand how they can tell the truth, whole truth, and nothing but the truth by telling The Rest of the Story.

Paul Harvey will be missed.

I went over her case with her in preparation for the hearing the next day. We discussed our theory as to why she should be found disabled under the rules of Social Security. We discussed her past work and discussed why her medical conditions prevented her from being able to do that work. I reminded her how a Social Security hearing was different from “TV court” and from other court proceedings. When I asked her if she had any other questions about her hearing, she said she felt that she was ready. She had read our memo about testifying at her hearing and said it answered so many of her questions that she felt she was now ready for the hearing.

After she left, I prepared my questions for the vocational expert. From my past experience, I knew that her past work had been light work that had transferable skills. I knew enough that I could handle the questioning of the vocational expert without any further preparation, but I went ahead and looked up all of the details in the Dictionary of Occupational Titles. I wanted to be over prepared “just in case.”

Because of all of our preparation, the hearing went smoothly. She answered each of the judge’s questions with the whole truth. The client got the result that she wanted. As I thought, I did not really need to look up all of the details in the Dictionary of Occupational Titles. But you never know for sure how a hearing will go. I still follow the motto of the Boy Scouts that I learned so many years ago-Be Prepared. It is still the key to success.