February, 2011: How One’s Treating Psychiatrist Can Make or Break a Case
Paul's success story (whose claim is out of the Portland, Maine Office of Disability Adjudication and Review) is one born out of a great deal of frustration with his long-term treating psychiatrist. It is difficult for me to believe that someone's treating psychiatrist (someone who has been entrusted with the care of their patient's mental health) could refuse to provide an assessment of their patient's condition for purposes of informing the Social Security Administration in a disability claim how severe their patient's condition remained. However, this was the circumstance with Paul's psychiatrist (who, unfortunately, has done this to a number of his patients who have been clients of mine). In every Social Security disability claim, it's essential that the treating physician (whether it is the orthopaedic specialist, the primary care physician, the cardiologist, the psychiatrist, etc.) address the extent of their patient's disabling conditions and how it impacts their ability to function. Unfortunately, the failure to do so leaves the Social Security Administration's doctors with commenting that there is nothing in the record to substantiate that there are physical and/or mental barriers that significantly impact the client's/patient's ability to return to work. In this circumstance, the treating psychiatrist started off by saying it was the policy of the facility that these sorts of questionnaires may not be filled out. As this was difficult to believe, I was on the phone with the head of the outpatient psychiatry unit rather early on in the process. I was informed that the decision whether to fill out the form was the psychiatrist's and that the head of outpatient psychiatry (himself a psychiatrist) does encourage staff to fill out the forms. The head of psychiatry informed me that as there is no mechanism for payment for the psychiatrist to fill out the form, they many times will refuse to address a Mental Impairment Questionnaire. Ultimately, the supervising psychiatrist informed Paul's psychiatrist that there was no policy against his filling out the form. Unfortunately, the treating psychiatry still refused to fill out the form (notwithstanding the urging of Paul's counselor, who worked with the treating psychiatrist at the same facility): his comment was simply that this was not something he fills out. For many months, the counselor attempted to urge the psychiatrist to address the questionnaire: she filled out a questionnaire herself and asked the psychiatrist to sign onto the form. She was quite supportive of Paul. Notwithstanding her efforts and mine, Paul's psychiatrist not only refused to sign onto the form, but also chastised the counselor for filling out the form when he didn't believe they should be addressing them. It is rather unfortunate that the Social Security Rulings do not provide as much weight to forms that are addressed by counselors as they do to psychologists or osteopathic and medical doctors. Given the psychiatrist's failure to comment, it became necessary to appeal multiple denials and proceed to a hearing on Paul's behalf: obviously, the hearing process can be quite stressful, and especially so for someone with an anxiety disorder such as Paul's. Paul's family was required to undergo a great deal of financial stress as a result of our inability to prevail in his claim early on in the process: a result contributed to in a significant way by the treating psychiatrist's failure to address Paul's condition. At the end of the day, I am happy to report that the administrative law judge hearing Paul's case was convinced to provide a fully favorable decision to Paul based on the evidence we were able to obtain and Paul's very telling testimony. Unfortunately, it is my belief that Paul's doctor's failure to comment on his condition in any meaningful manner caused Paul to go through a very stressful and anxiety ridden appeals process that he would likely have avoided if his doctor had simply been willing to comment on the extent of his disabling condition.