When it comes to winning your case for Social Security Disability (SSD) benefits the opinion of your doctor matters. Not all medical opinions are treated the same by the Social Security Administration (SSA) for disability benefits. Social Security regulations provide a long list of factors the SSA will consider when evaluating opinion evidence. One of the most compelling pieces of evidence necessary in proving a disability claim is a medical opinion from your doctor. This is compelling medical evidence supporting a Social Security Disability benefits claim.
What Is The Importance Of Medical Evidence?
When a disability claim is filed with the SSA, medical evidence is required to show that a disability exists, the medical condition has lasted for at least one year, and, as a result of this medical condition, you are unable to work. As an individual filing a claim you have the ability to request an opinion or ask the SSA to make the request on your behalf. Because the SSA may request records from physicians and hospitals it can be helpful to inform your treating physicians and other medical professional to expect this request.
In order to have the best chance of winning SSD benefits you will want to provide all relevant medical records. For this reason you may wish to take charge of the medical opinion request from your providers to make sure it is done thoroughly. And in the least, if you are relying on SSA to gather the medical evidence, be sure to give them a complete list of all of your providers.
Who Are My Treatment Providers?
The doctors or hospitals that you have been treating you are the ones you must seek an opinion from first. Treatment from psychologists, psychiatrists, chiropractors, and others should be included, even if they are not preferred, if they will support your claim for disability. If you are relying on SSA to gather this medical information for you, be sure to provide a complete list of hospitals where you have been seen in the emergency room and/or admitted.
In reviewing a claim, the SSA places special weight on evidence from your current treating physicians because they know more detail of your medical history than other sources that you have seen only once. Your physician usually knows your medical history so well that he or she can provide much stronger support for your disability claim than a doctor who spends one short visit with you. The SSA will be suspect to a claim in which the individual claiming the disability has a previous record with a doctor that indicates good health and a report from a new doctor, seen one time, which are inconsistent with one another.
Be sure to follow up with your primary treatment providers to be sure they have received the required paperwork, whether from you or the SSA, and remind them of the importance of completing it. To help your case, ask your doctor to write a letter to the SSA that provides his opinion on what you can and cannot do. This should be included along with his or her reports and may be much more persuasive than medical records alone. Remember, this may be one of the most influential pieces of evidence you can submit in support of your claim. Further, have this evidence submitted directly to the SSA to help your claim move more quickly through the system.
Are Some Treatment Providers Preferred?
Yes; and you can help your claim by submitting as much evidence as possible from preferred treatment providers. Under Social Security law all medical providers are not treated the same. The SSA considers certain treatment providers as “acceptable medical sources.” (See § 404.1513(a) of the Code of Federal Regulations on Social Security). Opinions from licensed medical doctors (M.D.) and licensed psychologists (Ph.D.) are more persuasive than those from other degrees. Opinions from nurses, nurse practitioners, social workers, and chiropractors are treated differently from licensed doctors and their opinions are not given as much weight as a treating, examining, or reviewing doctor.
Even among the licensed professionals there is a preference for opinions from “treating doctors” over “examining doctors” or a “reviewing doctor” who has not seen you in person. The treating doctor understands the history of your medical conditions because he or she has performed at least a few in-person medical examinations. The opinion of a doctor may be rejected, of course, if the medical records are not consistent with or do not support the opinion itself.
Although opinions from licensed professionals are the most persuasive, information from social workers, employers, physical therapists, and alternative treatment providers such as chiropractors can be used to show the severity of your impairments and how it affects your ability to work. Further, in the case of a child, information from schools, teachers, parents, and caregivers can be useful. (See § 404.1513(d)).
If you do not have a treating doctor, then the SSA will likely require an independent medical examination for the purpose of determining your functional limitations.
What Should a Medical Opinion Include?
Medical evidence from your treating doctors that supports your claim is persuasive. The medical reports and record evidence from your providers should include:
- History of your medical problems and diagnoses
- Results of clinical exams
- Test results
- Laboratory or radiological findings (such as blood or urine tests, x-rays, MRIs)
- Current diagnoses of disabling conditions
- Evidence of limitations
- Prescribed treatment, your response to the treatment, and your prognosis
(See § 404.1513(b))
The medical opinion of treatment providers should be a statement that acknowledges the medical evidence on record and makes a professional opinion about what you are still able to do in spite of your condition, including information on your work-related mental and physical abilities. (§ 404.1513(c)). To be persuasive, a medical opinion should include the following information:
- When the doctor started treating you;
- What medical conditions or impairments have been diagnosed;
- What symptoms you experienced and which medical signs have been observed by the doctor;
- Any functional limitations that result from the medical condition when considering your ability to perform work on an eight-hour basis;
- Whether you are taking any medications, if the medications have any side effects, and how much the medications help to control any symptoms; and
- Whether your impairment and associated symptoms meet or are equivalent to a listing found in Blue Book or Social Security’s Listing of Impairments.
The Social Security regulations provide that the decision of whether someone is disabled is reserved for the Commissioner of Social Security, therefore, the doctor cannot actually label you “disabled” in the opinion. The opinion should not include any reference to Social Security, lawyers, or benefits. Rather, the medical statement should describe what medical evidence in the record supports his or her findings. Statements on record that “the patient is doing better” without qualifying statements that improvement is slight or temporary may be very damaging as well. The opinion of a treating physician is critical evidence and will not be rejected by the SSA without clear, convincing, specific and legitimate reasons for doing so.
What Else Can I Do To Support My Claim For SSD Benefits?
Providing all relevant medical evidence is of primary importance; however, there are other things you can do to help support your claim. You may choose to keep a journal of your daily activities and how your condition affects you. In your journal, for example, you may detail whether your sleep is affected, concerns and problems you have, what tasks you are required to perform and how your disability makes you unable to do them, the amount of pain you may be suffering, and how even simple tasks (like walking, cooking, remembering, or driving a vehicle) may be difficult.
Further, it is important to continue to receive medical treatment and care. It may sound obvious but perhaps it is not. If you stop seeking regular medical care from a professional or stop taking the prescribed medication, the SSA is not going to look favorably on your behavior in support of your claim.
The medical opinion of your doctor may be the best evidence you can obtain in making your case for SSD and we can help. Call Adams & Associates Disability Inc. at 1-888-551-1190 to schedule an appointment with a knowledgeable Social Security disability representative who can help you obtain and gather all your medical evidence supporting a social security disability benefits claim.