We must make every reasonable effort to ensure that a qualified physician reviews the medical portion of a case involving a physical impairment and that a qualified psychiatrist or psychologist reviews the medical portion of a case involving a mental impairment.

For claims of children under age 18 filing for Supplemental Security Income (SSI) benefits based on disability, we must make reasonable efforts to ensure that a qualified pediatrician or other individual who specializes in a field of medicine appropriate to the child's disability evaluates the medical portion of the case.

NOTE: For additional guidance on medical and psychological consultants' adjudicative roles and qualification requirements, see DI 24501.001.

When making a determination involving a physical impairment(s), in a childhood SSI claim, the preferred medical consultant (MC) is a qualified pediatrician or other qualified pediatric medical specialist.

A qualified pediatrician is a licensed physician (medical or osteopathic doctor) who:

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  has obtained specific training in the medical care and treatment of infants, children, adolescents, and young adults; and

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  is a member of a Disability Determination Services (DDS) or Social Security Administration (SSA) team that makes disability determinations.

Family practitioners are licensed physicians who provide medical care and treatment to people of all ages. They can fall under the qualified pediatrician role necessary to make a disability determination involving physical impairments if they have specific training in medical care and treatment and is a member of the DDS or SSA team.

An appropriate qualified pediatric medical specialist, must be a licensed physician with a field of specialization that is appropriate to the child's medical condition and who is also a member of the DDS or SSA team. Examples of pediatric medical specialist include, but are not limited to specialties such as a cardiology, ophthalmology, hematology-oncology, endocrinology, neurology, gastroenterology, nephrology, and pulmonology.

If a qualified pediatrician or other qualified pediatric medical specialist is not available, an internist or other medical doctor with similar training or experience may be chosen as an appropriate and acceptable MC.

A psychological consultant (PC) is a licensed psychiatrist or psychologist who is a member of the DDS or SSA team that makes a disability determination. A PC makes a medical determination when a mental impairment(s) is the only type of impairment in a childhood SSI claim; or there is a combination of mental and physical impairments, but the mental impairment(s) alone justifies a finding of disability. For additional guidance on signature responsibilities of the PC, refer to DI 24501.001B.4.

A psychiatrist PC must be licensed in the State in which they practice.

A psychologist PC must (see 20 CFR 416.1016(d)):

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  Be licensed or certified as a psychologist at the independent practice level of psychology by the State in which they practice; AND EITHER

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    Possesses a doctorate degree in psychology from a program in clinical psychology of an educational institution accredited by an organization recognized by the Council for Higher Education Accreditation, formerly the Council on Post-Secondary Accreditation; OR

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    Be listed in a national register of health service providers in psychology which the Commissioner of Social Security deems appropriate; AND

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  Possesses two years of supervised clinical experience as a psychologist in health service, at least one year of which is post master's degree.

NOTE: The National Register of Health Service Psychologists is the only national register of health service providers in psychology that the Commissioner of Social Security deems appropriate for agency use to ensure a psychologist is properly credentialed.

When we are unable to obtain the services of a qualified PC, despite making every reasonable effort (as defined in 20 CFR 416.1017) in a claim involving a mental impairment, an MC will evaluate the mental impairment(s). A pediatric MC is preferred, since pediatrics is a specialty of medical science concerned with the physical, mental, and social health of children. MCs who are pediatricians are trained and well-qualified to evaluate child behaviors and the childhood functional domains that involve mental impairments.

DI 22505.003 Evidence from an Acceptable Medical Source (AMS)

DI 24501.001 The Disability Determination Services Disability Examiner, Medical Consultant, and Psychological Consultant Team, and the Role of the Medical Advisor

HI 00401.295 Physician Defined