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The invaluable role nurses play in the SSDI process

By Lauryn May 9, 2022

For the past 30 years, the American Nurses Association (ANA) has celebrated National Nurses Week annually from May 6th through May 12th. In honor of the extraordinary efforts exhibited by nurses throughout the COVID-19 pandemic, ANA extended the celebration, declaring the entire month of May as National Nurses Month. As we celebrate nurses throughout the month, we recognize their increasing significance in the healthcare industry, pay homage to their efforts, and highlight their importance in the lives of individuals applying for Social Security Disability Insurance (SSDI) benefits.

The future of nurses in the healthcare industry
As the world continues to navigate the lingering effects of the pandemic, many individuals still struggle to obtain the healthcare treatment they desperately need. Staff level shortages will continue plaguing the healthcare industry in the coming years, with many essential areas – including primary care treatment – expected to fall to nurses. With added responsibilities on top of the strain felt from shortages across other areas of the healthcare industry, nurses will be among the most in-demand type of healthcare talent for years to come.

Nurses as “acceptable medical sources” in an SSDI evaluation
Despite the increasing importance of nurses in the healthcare industry, the Social Security Administration (SSA) has not always considered nurses an “acceptable medical source” for which to use their medical evidence to make a decision. For SSA to determine that an impairing condition – or group of conditions – exists, medical evidence from an acceptable medical source must identify the existence through diagnostic or laboratory testing. Once verified that a medically determinable impairment exists, Social Security will review all additional evidence, including evidence not from acceptable sources, to determine the severity of the impairment.

Before including nurses as acceptable medical sources, applicants who regularly attended appointments and sought the care of nurse practitioners or clinical nursing specialists were unable to use those medical records as evidence that their condition led to a medically determinable impairment. Instead, the medical records would be secondary evidence, despite any frequency or quality of treatment. Applicants may seek treatment with nurses – as opposed to doctors – for various reasons, with appointment availability, particularly for pre-operation or follow-up appointments, one of the most common. Regardless of the reason, including if an applicant had a nurse as their primary care provider, these medical records were not considered to be from an acceptable medical source.

In 2017, SSA announced that adjudicators would begin to include Advanced Practice Registered Nurses (APRN), audiologists, and physician assistants as acceptable medical sources for impairments within their licensed scope of practice. APRNs, also known as advanced practice nurses or advanced registered nurse practitioners, provide vital care for individuals. With this change, Social Security has not only provided additional support for SSDI applicants but has acknowledged the importance of nurses in our healthcare system.

SSA currently recognizes four types of APRNs as acceptable medical sources (with a few variations across the country):

  • Certified nurse-midwives;
  • Nurse practitioners;
  • Certified registered nurse anesthetists; and
  • Clinical nurse specialists.

Medical records and the SSDI process
Medical records are arguably the most important piece of evidence submitted as part of an application for SSDI benefits. Without comprehensive medical evidence, the adjudicator cannot issue a favorable decision on behalf of an applicant. This information is vital to the success of an SSDI claim as it attests to how an applicant’s medical condition(s) impacts their daily life and ability to work. An applicant regularly receiving medical treatment demonstrates the need for consistent care as well as a desire to regain their health – both of which bode well for their SSDI claim. On the other hand, a lack of sufficient medical evidence can cause a delay in the decision or even lead to a denial.

With APRNs recognized as acceptable medical sources, SSDI applicants have a greater chance of providing sufficient medical evidence to support their claim for benefits.

Need help applying for SSDI?

Brown & Brown can help you better understand and take advantage of the many benefits of Social Security Disability, to help maximize your financial well-being during your period of disability.