I had a discussion with a colleague recently about acceptable medical sources for mental impairments. Yes, we really do talk to each other about stuff like that. The issue is part of proving a Social Security disability claim. So, for the purpose of this post, let’s assume that a person aplying for disability suffers from severe depression. Who is qualified to diagnose that depression?
For a starting place, the Social Security Act requires a medically determinable physical or mental impairment as the basis for a finding of disability. The regulations specify that a medically determinable impairment must be established by an acceptable medical source. So to have the depression recognized as a severe impairment at step 2 of the sequential evaluation, it must be diagnosed by an acceptable medical source.
In my view, any physician (or a psychologist) can diagnose depression (or another mental impairment) as an acceptable medical source under the regulations.
My colleague had the viewpoint that the depression diagnosis must come from a psychiatrist or psychologist, who deal with mental issues all the time. In support of this position, my colleague noted that the DDS state agencies use psychologists instead of M.D.’s to determine mental MDIs and resultant functional limitations. Furthermore, at the hearing level, a psychologist or psychiatrist is used as a medical expert on the issue of a claimant’s mental impairments, and a “regular” doctor is used to evaluate a claimant’s physical impairments. So my colleague’s view is that a plain vanilla primary care physician is not an acceptable medical source to diagnose depression.
Let’s see what the regulations say.
20 C.F.R. 404.1513 states in part:
§ 404.1513. Medical and other evidence of your impairment(s).
(a) Sources who can provide evidence to establish an impairment. We need evidence from acceptable medical sources to establish whether you have a medically determinable impairment(s). See § 404.1508. Acceptable medical sources are—
(1) Licensed physicians (medical or osteopathic doctors);
(2) Licensed or certified psychologists. Included are school psychologists, or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing mental retardation, learning disabilities, and borderline intellectual functioning only;
(3) Licensed optometrists, for purposes of establishing visual disorders only (except, in the U.S. Virgin Islands, licensed optometrists, for the measurement of visual acuity and visual fields only);
(4) Licensed podiatrists, for purposes of establishing impairments of the foot, or foot and ankle only, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle; and
(5) Qualified speech-language pathologists, for purposes of establishing speech or language impairments only.
The regulation contains no limitation regarding the areas in which a physician’s evidence is acceptable to establish MDIs. A diagnosis of depression from a licensed M.D. or D.O. is sufficient to establish a medically determinable impairment (the evidence must be established by medical evidence consisting of signs, symptoms, and laboratory findings – see 20 C.F.R. 404.1508).
In my view, this conclusion is supported by real world medical practice, where primary care physicians regularly screen for and diagnose depression (and other mental impairments), and prescribe medication for the treatment of mental impairments.
A medically determinable impairment just gets you to step 2 of the sequential evaluation. In terms of a Social Security disability claim, that’s just getting your foot in the door. To me, there is no good reason to have a restrictive rule for the diagnosis of a mental impairment. The more difficult aspect of the claim is establishing the severity of mental impairments.
It is worth noting that the regulations do recognize the role of a specialist, such as a psychiatrist or psychologist, in 20 C.F.R. 404.1527(d)(5): “We generally give more weight to the opinion of a specialist about medical issues related to his or her area of specialty than to the opinion of a source who is not a specialist. We generally give more weight to the opinion of a specialist about medical issues related to his or her area of specialty than to the opinion of a source who is not a specialist.” So when weighing a medical opinion, particularly regarding a claimant’s functional limitations, a specialist’s opinion tends to carry greater weight.