Justia Lawyer Rating
Massachussets Bar Association
Maine state Bar

Social Security Disability Claims and the Importance of Obtaining Medical Opinions from Treating Sources

Social Security Disability Claims and the Importance of Obtaining Medical Opinions from Treating Sources When attempting to pursue a Social Security disability claim, it is important to remember that the burden of proving one’s disabling condition (that is, that one has remained totally disabled from working as a result of a severe medical impairment) rests on the disabled claimant. While the Social Security Administration (SSA) will request your treatment records, the responsibility of providing evidence from one’s treating sources that address SSA’s regulations is left to the claimant and his/her attorney.

Social Security’s regulations require proof that one’s medical condition or condition is a severe medical impairment that either a) meets or equals in severity a medical listing of impairment or b) causes one to remain functionally disabled such that they remain incapable of performing the duties of both their past relevant work or other forms of work that exist in significant numbers in the regional or national economy. Unfortunately, Social Security’s regulations are antiquated insofar as they do not recognize that modern medicine does not always involve treatment with a doctor (that is to say, an M.D. or D.O.). Managed care in today’s times many times means that patients are relegated to treating with nurse practitioners or physician assistants: in fact, many primary care physician offices have no doctor on staff at all.

Social Security regulation 20 C.F.R. § 404.1513 (and Social Security Ruling 06-2P) sets forth the rules concerning what medical providers are deemed "acceptable medical sources" for purposes of providing professional opinions as to the nature and severity of your impairments and how they impact one’s ability to function (both from a mental health and physical standpoint). Such "acceptable medical sources" are noted to include: licensed physicians (M.D. and D.O.), licensed or certified psychologists (including school psychologists), licensed optometrists, licensed podiatrists (for purposes of establishing impairment with reference to the foot and ankle only) and qualified speech-language pathologists. Their opinions as to your ability to undertake physical activities such as "sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling" and, in the case of mental health impairments, one’s ability, for example "to understand, to carry out and remember instructions, and to respond appropriately to supervision, coworkers, and work pressures in a work setting," must be provided consideration. It is important to note, however, that other clinicians, such as nurse practitioners, physician assistants, naturopaths, chiropractors, therapists and counselors are not considered acceptable medical sources. Instead, these providers are referred to as other medical sources, whose opinions may be considered only with reference to how one’s condition may impact one’s ability to function in a work setting.

Social Security Ruling 96-2P, 3P, 5P and 8P provide additional information as to how SSA will weight the evidence provided by source medical opinions. Treating source opinions from acceptable medical sources may be entitled to what is called "controlling weight" if the opinions are "well supported by medically acceptable clinical and laboratory diagnostic techniques." Likewise, such opinions may not be inconsistent with other substantial evidence in the medical evidence record. Thus, Social Security Ruling 96-2P stands for the proposition that "if a treating source’s medical opinion is well-supported and not inconsistent with the other substantial evidence in the record, it must be given controlling weight; i.e., it must be adopted."

Given the above, it remains extremely important that for any condition one deems to be severe and disabling one is in consistent, zealous, ongoing treatment with one of the acceptable medical sources set forth above. It is likewise important that the doctor is pursuing any necessary diagnostic testing necessary to fully document the condition. Assuming then that the doctor has gotten to know the claimant well, and remains knowledgeable as to the nature and severity of their medical conditions and how they continue to impact them, then their opinions may be subject to "controlling weight." Social Security Ruling 96-5P and 8P discuss in greater detail the parameters for providing such weight to these opinions. more fully how these opinions are to

This is not to say that medical opinions from other medical sources (not deemed acceptable) , such as physician assistants, nurse practitioners, physical therapists, and licensed clinical social workers are not important. Social Security Ruling 06-3P makes clear that these opinions "remain important and should be evaluated on key issues such as impairment severity and functional effects, along with the other relevant evidence in the file." Thus, while they may provide helpful information in documenting the extent to which one remains impacted from a functional standpoint, their opinions may not be used to established that one has a medically diagnosed impairment: this would remain the province of an acceptable medical source: in other words, a doctor.

Thus, when pursuing a Social Security disability claim, it is important to consult with a Social Security disability attorney who can discuss with you both your past and current treatment so as to advise you, for both your personal well-being and for purposes of your case, whether additional treatment with a different medical practitioner might be appropriate. For more than 34 years, the Law Offices of Russell J. Goldsmith has been providing legal advice and assistance to those who remain long term disabled from working. You should call us now at (800) 773-8622 to discuss your circumstances.