BASIC (03-17)

DI 24503.025 Evaluating Medical Opinions and Prior Administrative Medical Findings – Claims filed on or after March 27, 2017

A. When to use this section

For claims with a filing date on or after March 27, 2017, follow the guidance in this section. For claims with a filing date before March 27, 2017, follow the guidance in DI 24503.035 Evaluation and Articulation Requirements for Medical Opinions, Opinions, and Prior Administrative Medical Findings - Claims Filed before March 27, 2017. For more information about how to determine the filing date of a claim, see DI 24503.050 Determining the Filing Date for Evaluating Evidence.

B. Definition of medical opinions and prior administrative medical findings

For the definition of medical opinions and prior administrative medical findings, see DI 24503.005 Categories of Evidence.

C. Sources of medical opinions and prior administrative medical findings

All medical sources, not just acceptable medical sources (AMSs), can make evidence we categorize as medical opinions. Only medical consultants (MC) and psychological consultants (PC) can make evidence we categorize as prior administrative medical findings.

D. Considering opinions and prior administrative medical findings

Do not consider medical opinions or prior administrative medical findings when establishing a medically determinable impairment (MDI). However, once an MDI is established, consider prior administrative medical findings for all other findings in a claim. Because medical opinions relate to functional abilities and limitations, consider medical opinions for determining severity at step 2, at step 3, and for determining an adult’s residual functional capacity (RFC).

E. Evaluating medical opinions and prior administrative medical findings

Consider the five factors listed in this subsection to determine the persuasiveness of medical opinions and prior administrative medical findings. The most important factors are supportability and consistency. However, we recognize that a claimant’s own medical source may have a unique perspective about the claimant’s impairment(s).

1. Supportability

Supportability means the extent that an opinion is supported by the relevant objective medical evidence and the explanations provided by the medical source. The more relevant the objective medical evidence and supporting explanations presented by a medical source are to support his or her medical opinions or prior administrative medical findings, the more persuasive the medical opinions or prior administrative medical finding(s) will be.

2. Consistency

Consistency means the extent an opinion is consistent with the medical evidence from other medical and nonmedical sources. This also includes considering internal conflicts within the evidence from the same source. The more consistent a medical opinion or prior administrative medical finding is with the evidence from other medical and nonmedical sources in the claim, the more persuasive the medical opinion or prior administrative medical finding.

3. Relationship with the claimant

This factor includes the combined consideration of the following five issues:

a. Length of the treatment relationship

The length of time the medical source treated the claimant may help demonstrate whether the medical source has a longitudinal understanding of the claimant’s impairments.

b. Frequency of examinations

The frequency of the claimant’s visits with the medical source may help demonstrate whether the medical source has a longitudinal understanding of the claimant’s impairments.

c. Purpose of treatment relationship

The purpose for treatment the claimant received from the medical source may help demonstrate the level of knowledge the medical source has of the claimant’s impairments.

d. Extent of the treatment relationship

The kinds and extent of examinations and testing the medical source has performed or ordered from specialists or independent laboratories may help demonstrate the level of knowledge the medical source has of the claimant’s impairments.

e.