medical treatment and social security disability Archives - Social Security Disability | Expert Help

Doctors play a pivotal role in the social security disability process. Their contributions of expertise and documentation provide insight to an applicant’s mental and/or physical condition, and this insight may prove useful when a social security adjudicator is reviewing a claimant’s file. In essence, what a doctor’s contributions to a claimant’s disability file can influence the ultimate decision made by the Social Security Administrative Law Judge. For this reason, it is often said that medical records and documentation are the backbone of a successful disability claim, but in this post we look beyond that to discuss the logic of why a doctor’s opinions are so important.

Imagine you have a condition like migraine headaches, and you are trying to win disability benefits. Well, in this case, it may be difficult to prove something like migraines can prevent you from working. This is where the doctor comes in to save the day. If you are able to see some kind of migraine specialist or neurologist whose office notes from your visits illustrate the severity of your migraines, you are that much closer to winning your disability claim. This is why it is always recommended that you seek the services of a doctor who specializes in your condition, whatever that condition may be. A specialist’s notes may be seen by the SSA as even more credible and as stronger evidence backing up your claim.

Cardiologists, rheumatologists, neurologists and orthopedic surgeons are examples of those physicians who specialize in certain areas of medicine, and such specialty doctors should definitely be consulted with over the course of your claim. They can provide certain testing, are knowledgeable of certain procedures, and have the right skills to render a better diagnosis of your condition and judgment of how it impacts your ability to work. Having that firm diagnosis of a condition and backup from a doctor can prove so valuable in your case.

Another reason doctors play an important role in disability claims is probably because of the strict standards doctors operate under today. I read an interesting article in the Chattanooga Times Free Press, dated April 7, 2010, which is titled Doctors face board specialty ‘expiration dates’ and which discusses just how strict the standards are today for practicing doctors. The article states that prior to the 1990s, doctors who had received specialized training in certain areas were only required to obtain certification ONCE. There were no additional requirements for retesting. In essence, once a doctor was certified, he or she was certified for the duration of his or her practice. Now, however, doctors constantly face the requirement of having to take tests and participate in continuing education to renew their board certification.

This seems like good news for the disability claimant, not just because doctors are held to higher standards, but because the work and opinions of doctors are highly regarded by the SSA. Social Security Judges certainly seem to put a premium on quality medical records. But aside from that, just knowing our doctors’ skills are up to date is a reassuring factor.

To sum up, doctor support is very important in a disability claim, and this is especially the case when it comes to board-certified specialists. Their diagnoses and treatment plans not only can speed up a disability process, but also can assist in winning one as well.

Last week, I wrote a post describing a case that will be denied because of my client’s poorly worded testimony. Today, I want to continue this theme and talk about a far more common basis for hearing denials – gaps in medical treatment or absence of medical treatment.

I save hearing decisions in the cases I try. Fortunately I usually choose decent cases and I don’t have too many unfavorables, but not every case turns out to be a winner. Interestingly, when looking at the unfavorables as a group, certain trends emerged. Perhaps the most common thread had to do with gaps and inconsistence in medical treatment.

Here is the actual wording from one such decision in a case involving a woman with depression and anxiety:

Although the claimant’s anxiety is severe, she has had no significant amount of mental health treatment. Even though she has been in the Atlanta area, she has had no psychiatric treatment. Had she obtained treatment, her anxiety would not be severe. Her husband is working, so there is no apparent reason she could not seek mental health treatment if she chooses to do so.

In this particular case, the medical record was not particularly strong and the claimant’s treating doctor was unwilling to provide us with a completed functional capacity form. I find it interesting that the judge would focus on what was not there, rather than what was there. Could there be legitimate reasons why an individual would not seek mental health treatment? Is it fair to assume that the husband’s insurance would cover psychological or psychiatric treatment, or that the deductibles would be affordable?

I think that the lesson to learn from cases like this relates to the need for every claimant to build a “paper trail” of medical treatment records. Judges expect you to see your doctor regularly and to seek specialized help when necessary. If you don’t have a lot of money,you need to explore all options – local emergency rooms, public hospitals, free clinics. I think that the days are over when a claimant can win a hearing with a medical record that is less than an inch thick.

I am certain that there are many deserving claimants out there who truly are disabled, but who will be denied because the medical record is sparse. This may not be fair, but this is how the system works.

Ginsberg Law Offices

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