EDPNA TEST COMPREHENSIVE ANSWERS AND
QUESTIONS SET A+
✔✔Categories Of Evidence: Acceptable medical sources - ✔✔Citations: 404.1502,
404.1513, 416.902, 416.913
• physicians who are licensed, typically designated by M.D. or D.O.
• licensed or certified psychologists including school psychologists
• licensed optometrists
• licensed podiatrists
• licensed or certified speech-language pathologists
• licensed audiologists
- occupational therapist
- physical therapist
-teachers, family, friends, employers
✔✔Consultative Examinations (CEs) - ✔✔Citiation: 404.1503a, 404.1512b2 404.1519
416.903a, 416.912b2, 416.919, 416.919 g-i,
A physical or mental examination or test purchased by DDS or SSA to help the agency
or judge have a complete record in making the determination. CEs are ordered when
necessary information is not in the file, the file contains inconsistencies that need to be
resolved.The claimant or the representative can object to the doctor for many reasons
including language barriers and no interpreter, lack of accessibility to the exam location,
prior knowledge of the claimant.
✔✔Evaluating Opinion Evidence - ✔✔Citations: For claims filed before March 27, 2017
see 404.1527C
For claims filed after March 27, 2017 see 404.1520C
After March 27, 2017, treating source opinions are evaluated under the same criteria as
all medical opinion evidence and are no longer automatically given controlling weight.
✔✔Evaluating Symptoms Including Pain - ✔✔Citations: 404.1529
What SSA considers when evaluating symptoms:
• Statements about symptoms, including pain - these are usually found on the
application, disability report and function report, but can also be found within medical
records when claimants are describing symptoms to their providers.
, • Any description medical sources or nonmedical sources may provide about how the
symptoms affect ADLs and ability to do work.
*If a claimant is alleging disabling symptoms, those symptoms must be supported by
objective evidence in order for SSA to consider them.*
✔✔Sequential Evaluation Step 3 Meeting A Listing - ✔✔Citations: 404.1525, 404.1526,
416.925, 416.926, Appendix 1 of Subpart P
Test Tip 1: If a claimant meets the criteria for a medical listing, their age, education, and
work experience do not matter! SSA can approve the claim at Step 3 of the Sequential
Evaluation Process without evaluating Steps 4 and 5.
Test Tip 2:Know where to find the Listings in the CFR!!! (Appendix 1 of Subpart P)
Test Tip 3: When evaluating a particular listing criteria, pay attention to words like AND
& OR!
✔✔Meeting A Listing - ✔✔Citations: 404.1525, 404.1526, 416.925, 416.926, Appendix
1 of Subpart P
Part A applies to individuals under 18
Part B applies to individuals over 18
SSA can find medical equivalence when the claimant comes close to meeting the listing
criteria, but the symptoms, findings or other findings are not the same as what is listed.
For cases at Initial or Reconsideration, a finding of medical equivalence must be made
by a State agency medical or psychological consultant or other designee of the
Commissioner. For cases at the ALJ or AC level, the responsibility for deciding medical
equivalence rests with the administrative law judge or Appeals Council.
✔✔Following Prescribed Treatment - ✔✔Citations: 404.1530, 416.930
In order for a claimant to receive benefits, they must follow treatment prescribed by their
medical source(s) if the treatment is expected to restore the ability to work.
Unless:
• The specific medical treatment is contrary to the established teaching and tenets of the
claimant's religion.
• Surgery was previously performed with unsuccessful results and the same surgery is
again being recommended for the same impairment.
• The treatment is very risky (open heart surgery, organ transplant)
• The treatment involves amputation of an extremity, or a major part of an extremity.
✔✔Drugs Addiction And Alcoholism (DAA) - ✔✔1. Would the claimant still be disabled if
he or she stopped using drugs or alcohol? SSA evaluates which of the claimant's
current physical and mental limitations, upon which the disability determination is based,
would remain if there were no substance abuse, and then whether any or all limitations
would be disabling.
2. If SSA determines that the remaining limitations would not be disabling, the DA&A will
be considered a contributing factor material to the determination, likely resulting in a
denial.
QUESTIONS SET A+
✔✔Categories Of Evidence: Acceptable medical sources - ✔✔Citations: 404.1502,
404.1513, 416.902, 416.913
• physicians who are licensed, typically designated by M.D. or D.O.
• licensed or certified psychologists including school psychologists
• licensed optometrists
• licensed podiatrists
• licensed or certified speech-language pathologists
• licensed audiologists
- occupational therapist
- physical therapist
-teachers, family, friends, employers
✔✔Consultative Examinations (CEs) - ✔✔Citiation: 404.1503a, 404.1512b2 404.1519
416.903a, 416.912b2, 416.919, 416.919 g-i,
A physical or mental examination or test purchased by DDS or SSA to help the agency
or judge have a complete record in making the determination. CEs are ordered when
necessary information is not in the file, the file contains inconsistencies that need to be
resolved.The claimant or the representative can object to the doctor for many reasons
including language barriers and no interpreter, lack of accessibility to the exam location,
prior knowledge of the claimant.
✔✔Evaluating Opinion Evidence - ✔✔Citations: For claims filed before March 27, 2017
see 404.1527C
For claims filed after March 27, 2017 see 404.1520C
After March 27, 2017, treating source opinions are evaluated under the same criteria as
all medical opinion evidence and are no longer automatically given controlling weight.
✔✔Evaluating Symptoms Including Pain - ✔✔Citations: 404.1529
What SSA considers when evaluating symptoms:
• Statements about symptoms, including pain - these are usually found on the
application, disability report and function report, but can also be found within medical
records when claimants are describing symptoms to their providers.
, • Any description medical sources or nonmedical sources may provide about how the
symptoms affect ADLs and ability to do work.
*If a claimant is alleging disabling symptoms, those symptoms must be supported by
objective evidence in order for SSA to consider them.*
✔✔Sequential Evaluation Step 3 Meeting A Listing - ✔✔Citations: 404.1525, 404.1526,
416.925, 416.926, Appendix 1 of Subpart P
Test Tip 1: If a claimant meets the criteria for a medical listing, their age, education, and
work experience do not matter! SSA can approve the claim at Step 3 of the Sequential
Evaluation Process without evaluating Steps 4 and 5.
Test Tip 2:Know where to find the Listings in the CFR!!! (Appendix 1 of Subpart P)
Test Tip 3: When evaluating a particular listing criteria, pay attention to words like AND
& OR!
✔✔Meeting A Listing - ✔✔Citations: 404.1525, 404.1526, 416.925, 416.926, Appendix
1 of Subpart P
Part A applies to individuals under 18
Part B applies to individuals over 18
SSA can find medical equivalence when the claimant comes close to meeting the listing
criteria, but the symptoms, findings or other findings are not the same as what is listed.
For cases at Initial or Reconsideration, a finding of medical equivalence must be made
by a State agency medical or psychological consultant or other designee of the
Commissioner. For cases at the ALJ or AC level, the responsibility for deciding medical
equivalence rests with the administrative law judge or Appeals Council.
✔✔Following Prescribed Treatment - ✔✔Citations: 404.1530, 416.930
In order for a claimant to receive benefits, they must follow treatment prescribed by their
medical source(s) if the treatment is expected to restore the ability to work.
Unless:
• The specific medical treatment is contrary to the established teaching and tenets of the
claimant's religion.
• Surgery was previously performed with unsuccessful results and the same surgery is
again being recommended for the same impairment.
• The treatment is very risky (open heart surgery, organ transplant)
• The treatment involves amputation of an extremity, or a major part of an extremity.
✔✔Drugs Addiction And Alcoholism (DAA) - ✔✔1. Would the claimant still be disabled if
he or she stopped using drugs or alcohol? SSA evaluates which of the claimant's
current physical and mental limitations, upon which the disability determination is based,
would remain if there were no substance abuse, and then whether any or all limitations
would be disabling.
2. If SSA determines that the remaining limitations would not be disabling, the DA&A will
be considered a contributing factor material to the determination, likely resulting in a
denial.
