Understanding the Role of Medical Evidence

The SSA uses your medical evidence to determine whether your health condition qualifies as a “disability” under federal law. To be considered disabled, you must prove that:

• Your medical condition is severe enough to prevent you from working full-time.
• It has lasted, or is expected to last, for at least 12 months or result in death.
• Your condition meets or equals a medical listing in the SSA’s Blue Book (official list of qualifying impairments).

Medical evidence must be objective, consistent, and current — meaning it should come from licensed healthcare professionals and reflect your most recent condition.

Types of Acceptable Medical Evidence

In North Carolina, Disability Determination Services (DDS) reviews your case using medical records from your healthcare providers. Acceptable evidence includes:

1. Medical Records from Licensed Professionals

Your records should come from licensed doctors (MD or DO), psychologists, or qualified specialists. The SSA gives more weight to long-term treating physicians since they have an established relationship with you.

2. Clinical and Laboratory Findings

Objective test results such as X-rays, MRIs, CT scans, blood tests, and neurological exams carry strong weight. These confirm the existence and severity of your medical condition.

3. Treatment Notes

Your doctor’s progress notes and treatment plans help the SSA see how your condition has changed over time and whether treatments have improved your ability to work.

4. Hospital and Emergency Room Records

If you’ve been hospitalized or treated in the ER, include all documentation — discharge summaries, test results, and doctor’s notes — to show the full picture of your condition.

5. Mental Health Records (if applicable)

If your disability involves depression, anxiety, or other mental conditions, include records from psychiatrists, therapists, or counselors. SSA evaluates both physical and mental impairments.

Rules for Submitting Medical Evidence

The SSA has specific rules for how medical evidence must be presented:

• Records must be recent: The SSA typically requires medical documentation from the past 90 days to confirm your current condition.
• Evidence must come from acceptable medical sources: The SSA will not accept evidence from non-licensed sources alone (such as chiropractors or family members), though supporting statements may be considered.
• All conditions must be documented: If you have multiple disabilities, you must submit medical evidence for each one, even if one condition alone isn’t disabling.
• Doctors should include functional assessments: The SSA values opinions that describe how your condition limits your ability to work — such as walking, standing, sitting, concentrating, or lifting.

If your existing records are incomplete, the SSA may schedule a Consultative Examination (CE) with a doctor they choose to verify your condition.

Common Reasons SSDI Claims Are Denied in North Carolina

Many SSDI claims are denied because of weak or incomplete medical evidence. Common issues include:

• Missing or outdated records.
• Doctors who fail to explain functional limitations clearly.
• Gaps in treatment or inconsistent follow-ups.
• Reliance on self-reported symptoms without supporting tests.

To avoid these problems, make sure your records are comprehensive, current, and specific about how your condition limits your daily functioning.