The Role of Medical Evidence
The medical documentation in the record can make all the difference in whether an individual will qualify for Social Security disability benefits.
For everyone:
1. Weight of evidence.
The opinion of your treating physician is central to the disability determination under Social Security law and judicial decisions. The opinion of a treating physician is entitled to more weight than that of a physician who merely examines the claimant or reviews the file. The Social Security Administration cannot reject the opinion of a treating physician without clear, convincing, specific and legitimate reasons for doing so.
2. Acceptable medical sources.
Under Social Security law, all medical providers are not created equal. Opinions by medical doctors (M.D.) and licensed psychologists (Ph.D.) carry much more weight than those with other degrees, including nurses, nurse practitioners, social workers and other providers, such as naturopaths and chiropractors. However, if your healthcare provider is not an M.D. but provides medical care to you under the direct supervision of an M.D. or a Ph.D., his or her opinion is accorded the same weight as a doctor's.
Especially for healthcare providers:
1. Encouraging your patient to apply.
Although the Social Security system is set up for applicants to apply for benefits fairly easily over the phone, it is nevertheless an intimidating process for the disabled to deal with a large bureaucracy. If you believe your patient has a disability that will last longer than 12 months but the disability is still in the initial stages, you should encourage your patient to apply, because the date that he applies will determine the amount of benefits he can receive.
2. Persuasive Medical Opinions.
The most persuasive medical opinions are those that offer solid reasoning rather than strong advocacy. It is helpful to state that a patient would be unable to work if that conclusion is explained and is consistent with the medical chart. It is very helpful to say your patient is unable to get himself to work every day; withstand a consistent 40 hour work schedule or complete tasks in a timely way; accept supervision; get along with coworkers; or concentrate. The more specific you can be, the better. It is always counterproductive to state that a patient "should receive benefits" or to mention litigation, lawyers, or Social Security anywhere in the file.
When making statements in the chart such as "the patient is doing better," it is helpful to remember that the Social Security Administration can misuse such statements. Qualifying such statements by noting that symptoms wax and wane or that improvement is slight or temporary, if that is the case, will give the SSA a more realistic picture of your patient's true condition. Of course remarks about "secondary gain," "exaggeration of symptoms," or "malingering" are very damaging to a claimant's case, and we hope that you will make them only where there is clear evidence to support them.
Our office, Swanson, Thomas, Coon & Newton, takes calls from claimants at any stage in the process, whether we represent them or not.