In my November 24, 2017, blog post, “Does a Statement from A Family Doctor Writing “Disabled” Guarantee A Finding of Disability?” I discussed the need for the report of a treating physician to important details, medical findings, and medical reasoning. Equally important is the need for sufficient and consistent medical evidence.
20 CFR 404.1520b and 20 CFR 416.920b details what is considered “sufficient” and “consistent” medical evidence. For medical evidence to be sufficient when it contains all of the information which the Commissioner needs to make a decision. Medical evidence is considered consistent when it does not conflict with other evidence in the case file, when there are no internal conflicts and is not ambiguous. Finally, the Commissioner will not view the medical evidence as consistent if the evidence is not based on medically acceptable diagnostic techniques.
An example of how medical evidence might be considered to be incomplete is when one or more of the elements required in the Listings of Impairments are not found in the medical evidence. Consider, Listing 5.06, inflammatory bowel disease. Subsection A requires an obstruction of stenotic areas in the small intestine or colon that resulted in hospitalization for surgery. There must have been two surgeries at least 60 days apart occurring within 6-months. If the medical evidence includes only one hospitalization, the record will be insufficient. If the record is insufficient, the Commissioner is allowed to request existing medical evidence.