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Obtaining Persuasive Medical Opinion Evidence

patients meeting physicianWhen applying for Social Security disability benefits, you will need to prove to the Social Security Administration (SSA) that you have been diagnosed with a medical condition, the medical condition has lasted for at least one year, and you are unable to do substantial gainful work activity.

To prove your disability, one of the most compelling pieces of evidence you can provide is a medical opinion from your doctor.  However, not all medical opinions are treated the same by Social Security.  Social Security regulations give a long list of factors the SSA will consider when evaluating opinion evidence.  As such, you should consult with a St. Petersburg disability attorney to help you in obtaining a persuasive doctor opinion.

3 Types of Medical Opinion Evidence

There is a hierarchy for determining what weight will be given to medical opinions.  The order, from highest to lowest, is as follows: (1) treating doctor, (2) examining doctor, and (3) reviewing doctor (a doctor who has not seen you in person).  A treating doctor is a doctor who has a long-lasting treating relationship with you, understands the progression and history of your medical conditions, and has performed at least a few medical examinations in person.  A well-reasoned statement or questionnaire from your treating doctor will be given controlling weight over an examining doctor if it is consistent with and supported by the available medical evidence.

If a treating doctor’s opinion is inconsistent with objective medical evidence, then the SSA might decide to give more weight to the opinion of an examining doctor.  For example, if your treating doctor has diagnosed you with left shoulder pain, and has written a medical opinion limiting you from lifting over 10 pounds with your left arm, then there should be an x-ray confirming the severity of your shoulder condition.  There also should be medical evidence in the form of a physical examination which shows muscle weakness or other abnormality with your left shoulder.  If your medical records show relatively normal examinations, then the SSA is allowed to reject the opinion of your treating doctor.

To be considered a medical opinion, it must be from an “acceptable medical source” such as a licensed doctor or psychologist.  A nurse practitioner or other medical professional, such as a chiropractor, is not considered an acceptable medical source.  These nonacceptable medical sources are treated differently from licensed doctors and their opinions are usually given less weight than treating, examining, or reviewing doctors except in rare occasions.

The Content of a Medical Opinion

A medical opinion from a doctor should include the following information:

  • When the doctor started treating the client
  • What medical conditions (impairments) have been diagnosed
  • What symptoms are experienced by the client and which medical signs have been observed by the doctor
  • Any functional limitations that result from the medical condition when considering the client’s ability to perform work on an eight-hour basis such as: an inability to carry 20 pounds frequently during the workday due to an arm injury, the inability to stand for more than 4 hours out of an 8 hour workday due to a back injury, or the inability to interact with the general public due to depression.
  • Whether the client would miss any days of work each month due to his or her impairment.
  • How long the medical condition is expected to last.
  • Whether the client is taking any medications, if the medications have any side effects, and how much the medications help to control any symptoms.
  • Whether the client’s impairment and associated symptoms meet or are equivalent to a listing found in the Blue Book or Social Security’s Listing of Impairments.

To be persuasive, the medical statement should describe what medical evidence in the record supports his or her findings.  In addition, Social Security regulations provide that the decision of whether a person is disabled is reserved to the Commissioner of Social Security.  Therefore, a doctor cannot use any conclusory statements such as “this person is disabled.”  Instead, the SSA will look at the functional limitations given by the doctor to determine your residual functional capacity (RFC).  Your RFC is all the activities you could perform in a work environment.  Social Security will use your RFC in deciding whether you can perform your past relevant work, and whether you can perform any work in significant numbers in the national economy.

Even if your treating doctor gives only one functional limitation, then that restriction can help your disability case by narrowing the number of jobs available.  A limitation can be that you can use an arm only occasionally (1/3 of the day), rather than frequently (2/3 of the day).  Remember, there will be other doctor opinions as well, and if they do not conflict with each other, then each medical opinion will need to be addressed by Social Security and potentially included as part of your overall RFC assessment.

If you do not have a treating doctor, then Social Security Administration might consider sending you to an independent medical examination for the purpose of determining your functional limitations.  A St. Petersburg disability attorney can help you in gathering additional medical records and requesting an independent medical examination.