The Social Security Administration has regulations that determine the relative weight to be given to different types of medical treating professionals and medical reviewers.
For example, where a person is claiming Social Security Disability benefits (SSDI), or Supplemental Security Income (SSI) benefits, the regulations look first to the records of any treating professionals who have seen the patient, the claimant, for a long period of time. This is called a “longitudinal record”.
Preference is also given to “acceptable medical sources”. This term of art means generally an MD, DO, PhD in psychology, podiatrist, or other highly trained medical professional. While the opinions of other medical providers must be considered by the administrative law judge (ALJ) hearing your case, such as chiropractors, nurse practitioners, physician’s assistants, physical therapists and licensed clinical social workers, these practitioners are by rule given less weight than an acceptable medical source.
Any opinions from doctors provided to the state agency that initially evaluates your case, any case evaluators for SSA who are acceptable medical sources, and any doctors that SSA sends you to see, known as consultative examiners, also must be considered by the ALJ.
However, the ALJ must assign more weight, sometimes near conclusive weight, to your own treating physician’s opinions. Many ALJ’s try to ignore or minimize such opinions on one theory or another if they want to deny benefits to a claimant. This failure to assign proper weight to your doctor’s opinions is one of the most common grounds for a successful appeal of an unfavorable decision from an ALJ. It is very important to have your doctor give an opinion on your limitations and restrictions, not just state that you are disabled and should receive benefits. That ultimate decision is reserved to the Commissioner of Social Security.
It is also unacceptable for the ALJ to “cherry pick” only unfavorable portions of a medical provider’s opinions, while excluding other more favorable portions of the opinions, especially without good and clear grounds for doing so.
The effect of the injury on your ability to work, the limitations, is the important consideration. Getting a proper report from your physician or other “acceptable medical source” can make the difference between winning a fully favorable decision or having an unfavorable decision from the administrative law judge (ALJ) in your case. This is one area where your attorney can really help you to present a case to the ALJ that would otherwise be lost.
The listing of impairment tests get complicated rather quickly, and the amount of evidence required to prove a case can be very high. Also, even if the claimant does not exactly meet a listing, he or she may medically equal a listing, or have limitations that would preclude gainful employment either due solely to the main disabling condition or in conjunction with other limitations. We try to find an acceptable medical source who can give you an opinion as to the limitations and restrictions caused by your injury or illness, and get an opinion as to those limitations and restrictions that meets the SSA requirements. Even if you do not meet a listing the opinion may be very helpful to the ALJ in understanding your case, and to the outcome of your case.
If you or a loved one has a disabling condition it is important to retain the services of a claimant’s representative who is familiar with the requirements of the law, and who can help you to present the correct evidence to the ALJ for consideration of your disability.
For a free consultation call us, or fill out our interactive web site contact sheet and we will help you to evaluate your case.
Please note that nothing in this article should be considered legal advice, which we give after in-office consultation only. The decision in your case is made by a judge and the results of your case depend on the adjudicatory process, not our evaluations of your case. Please contact us for a free consultation and an opinion regarding your case.