When proceeding with a Social Security disability claim or appeal, one of the most important considerations moving forward is whether your treating physician understands the seriousness of your medical conditions and the extent to which your problems are impacting your ability to function (both in and out of the home). Ultimately, it’s important that your treatment providers are willing and able to express in a meaningful manner to the Social Security Administration (SSA) he nature and severity of your medical conditions and the extent to which you would be impacted in terms of your ability to function in a work site.
As part of the five (5) step sequential evaluation process, it is first necessary to establish that one is suffering from a medically determinable to severe impairment before SSA will next determine what symptoms could reasonably be expected to follow from such medically determinable impairments. At that point, the Social Security regulations require that the agency determine the persistence and severity of one’s symptoms and the manner in which it impacts one’s ability to function in a work setting. This requires a determination of one’s Residual Functional Capacity, which is defined by the regulations as the most one can do despite their physical and mental limitations.
The Social Security regulations, for claims filed prior to March 27, 2017, provided that treating source opinions (which would include the opinions of one’s medical doctors) would carry controlling weight assuming that the opinions were supported by the not inconsistent with the treatment records of the provider. Amendments made to the Social Security regulations provide that for those claims filed on or after March 27, 2017, controlling weight will not be provided to the opinions of a treating source (such as one’s primary care physician, psychiatrist or surgeon). Rather, their opinions will be evaluated along side those of non-treating sources using the same set of factors that have now been outlines at 20 C.F.R. 1520(c). Medical sources have now been expanded to include that of licensed physician assistants, with respect evaluation of impairments that fall into their licensed scope of practice and for licensed advanced practice nurses, and yet the opinions of your own providers may no longer be presumed to carry more weight than one of Social Security’s providers that may be asked to see you.
Many times, Social Security disability claims or appeals are denied based on the findings of physicians that are asked to review your file for the Social Security Administration and draw conclusions as to the nature and severity of your condition and the extent to which your physical or mental residual functional capacity (RFC) has been impacted. Thus, ordinarily your Social Security disability lawyer will seek out a report from one’s treating physician in order to establish the extent to which one remains limited. Otherwise, one may very well see that the lack of an opinion from one’s treating physician will cause the state agency doctor to assume that there must not be much in the way of functional limitations. Even still, we find that the state agency doctors will inappropriately discount the value of such opinions because they come from a treating source (when they should be considered carefully, either with controlling weight under the old set of rules or based on the factors set forth in the new set of rules).
For those claims filed on on or after March 27, 2017, the state agency (at an initial level or at the reconsideration level) or the administrative law judge (at the hearing level) is required to take into account the following factors in determining the weight to be given to a report: 1) supportability (that is to say, the extent to which the treatment records and testing available to the treating source) provides support for the findings being made), 2) consistency (the extent to which the opinions are consistent with other medical opinions or findings from both medical and non-medical sources in the file), 3) relationship with the claimant (including length of the treatment relationship, frequency of the examinations, purposes of the treatment relationship (that is to say, for example, was it for the impairment they’re complaining has been long-term disabled or was it for a one (1) time visit for purposes of trying to get a questionnaire completed), and extent of the treatment relationship (that is, how involved was the provider in terms of undergoing follow-up examinations and testing so as to attempt to address the condition).
Thus, just as important as obtaining supportive documentation from your providers (especially your specialists) that detail the nature and severity of your medical condition and the extent to which it impacts your medical condition is ensuring that 1) you have established a solid and ongoing foundation of treatment with your provider to ensure that 1) you’re doing everything can do to get better and 2) there is a strong basis for the opinions they’re providing such that the opinions will carry great weight.
Having the guidance of a Social Security disability attorney who understands the rules and regulations can help you determine how best to proceed with obtaining medical opinions that might help serve well your individual disability claim. Contact the Law Offices of Russell J. Goldsmith for a no fee consultation as to how we might be able to assist you.