The Role of Your Doctors in Your Social Security Disability Claim

Welcome to Season 1, Episode 6 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into the complicated topic of "The Role of Your Doctors in Your Social Security Disability Claim."

Join host Nancy L. Cavey, a seasoned disability attorney, as she unpacks the critical role of your doctors in a Social Security Disability claim - especially at steps three and four of the five-step sequential evaluation. Medical professionals and their evidence are key to a successful claim, making it essential to understand their impact on the process. In this episode of Winning Isn't Easy, Nancy covers everything you need to know, including how to handle an uncooperative doctor who may be unwilling to support your case. Don't miss this important discussion.

In this episode, we'll cover the following topics:

1 -  An Overview of the the Role of Your Doctors in Your Social Security Disability Claim

2 - The Role of Your Doctors at Step Three

3 - The Role of Your Doctors at Step Four

4 - What Do I Do if My Doctor Is Uncooperative?

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:00]:
 Foreign hey, I'm Nancy Cavey, Social Security Disability Attorney, and I want to welcome you to Winning Isn't Easy. Before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says I have to tell you this. Now that I've said it, nothing will prevent me from giving you an easy to understand overview of the Social Security disability claims process, the games that can be played, and what you need to know to get the Social Security disability benefits you deserve. So off we go. In the last episode, I covered steps four and five of the five step sequential evaluation. We learned about the keys to winning, including properly developed medical records which discuss your symptoms and functionality as well as residual functional capacity for I want you to remember that getting a letter from your doctor that says you're disabled just isn't going to cut it.
 
 Nancy Cavey [00:01:04]:
 So today I'm going to be talking about the role of your doctor in your Social Security disability claim. I'm going to talk about four things. First, I'm going to give you an overview of the role of your doctor in your Social Security disability claim. Next, I'm going to talk about the role of your doctor at step 3A, listing level of impairment number three. I'm going to talk about the role of your doctors at step four and five. And lastly, I'm going to talk about what you need to do if your doctor just won't play ball and isn't cooperative. Got it? Let's take a break for a moment.
 
 Speaker B [00:01:41]:
 Filing for Social Security Disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security disability benefits, which will cover everything you need to know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:02:06]:
 Welcome back to Winning Isn't Easy. Let's talk about an overview of the role of your doctor or doctors in your Social Security disability claim. Why and how the Social Security Administration and a judge can ignore the opinions of your doctor who says you're disabled and unable to work. Now, has your doctor told you that you're disabled or that you're unable to work? I hear that all the time. And you might think that a letter to that effect from your doctor is enough to win your case. But guess what? You would be wrong. Why would you be wrong? Well, this is an issue reserved to the Social Security Administration Commissioner. Social Security ruling 96.5p provides that there are certain issues that are reserved to the Commissioner, and one of those issues is whether you're disabled or not, as those terms are defined by the Social Security rules and regulations.
 
 Nancy Cavey [00:03:05]:
 When a doctor says issues an opinion on an issue, that's reserved for the commissioner, the Social Security Administration, and the judge can freely reject or outright ignore that statement. That's why a letter from your doctor saying you're disabled or unable to work is going to be ignored because Social Security is applying a five step sequential evaluation process to the question of whether you're disabled. And just because your doctor says you're disabled doesn't mean that that opinion equals the five step sequential evaluation test. Now, let's say that your doctor does write a letter on your behalf and says that you are disabled, but then goes on to say that you are disabled because you have low back pain that requires you to alternate sitting and standing every 45 minutes and that you can only lift 10 pounds occasionally, your doctor's comments about your functional abilities can be considered and it would be outright legally improper for the Social Security administration or judge to dismiss that opinion. So they can dismiss the opinion that you are disabled, but they have to consider the doctor's comments about you need to alternate sitting and standing every 45 minutes and then you can only lift up to 10 pounds occasionally. Now, you have to understand that judges don't always get it right. And many times a judge or Social Security will reject your doctor's statement if it has mixed opinions. That's not legally right, but is a practical matter.
 
 Nancy Cavey [00:04:37]:
 That's why I prefer that my clients have their doctors complete what's called a residual functional capacity form. Now, we Social Security lawyers have developed these residual functional capacity forms as a vehicle to help the doctor address not only the basis of the diagnosis and the nature of your symptoms and the nature of your functionality. So our job as a Social Security lawyer is to listen to your story about your medical conditions and pick out the right residual functional capacity forms to have your doctor fill out. Now, as I said, the form is going to address the diagnosis, the basis of the diagnosis, the symptoms, the side effects of medication, but they're specifically going to address your functional, physical and psychiatric restrictions and limitations. I think that that's the smart thing to do is to get a residual functional capacity form. So I don't want the judge or Social Security to reject one of these mixed opinions by your physician that you're disabled and you can only do X, y or Z. I like that particular form or the appropriate residual disability functional form. Now, sometimes my clients have more than one medical problem, so we will give them multiple residual Functional capacity forms.
 
 Nancy Cavey [00:06:00]:
 I obviously argue that my client is disabled as a result of each of their medical conditions. But then I also argue that it's the combination of those problems that will result in disability. And I like to have the residual functional capacity forms, as I said, for each one of the disabling medical conditions. Why is this important? Well, let's talk about the five factors that must be met before the Social Security Administration has to give your treating doctor's opinions controlling weight in your Social Security disability claim. The first thing you need to understand is that there is no treating physician rule in a Social Security claim, but the opinions of your physicians are crucial to the success of the claim. Again, the most important thing you can do, in my view, is one, give a really good history to your doctor of your symptoms and functionality. So there is this consistency. And two, get your doctor to complete an appropriate residual functional capacity form.
 
 Nancy Cavey [00:06:58]:
 Now, under the Social Security rules and regulations, the medical opinion from a treating physician about the nature and severity of your impairment is entitled to deference. Not controlling deference necessarily, but it can be given controlling weight. So what do I mean by that? The judge can reject the doctor's opinions on the basis that it's that the doctor's source of information isn't accurate. They're relying on you and the judge or Social Security disbelieves the nature of your complaints or the frequency of your complaints. So just because the controlling weight issue is there doesn't necessarily mean they're going to give controlling weight. Sounds confusing, doesn't it? So let me give you a more thorough explanation of what controlling weight is. In a Social Security case, the Social Security administration and the judge can review your medical records and the opinions of your physicians to determine whether or not they're going to give your physician's opinions controlling weight. And there are four factors that Social Security or the judge will consider.
 
 Nancy Cavey [00:08:09]:
 Number one, is the doctor considered an acceptable medical source? Not all doctors are qualified to give an opinion under Social Security rules or regulations. An example of acceptable medical sources include a physician, a psychologist, a podiatrist, an optometrist, a qualified speech language pathologist. But who isn't an acceptable medical source? A chiropractor, a nurse practitioner, unless it's signed off by a doctor who an audiologist, unless it's signed off by a doctor, licensed physician assistants, unless it's signed off by a doctor, physical therapist, acupuncturist, nutritionist, naturopaths. That's not considered an acceptable medical source. And their opinion is not going to carry much weight. Now, of course, we do submit that evidence to the Social Security administration, but you need to understand it's not going to be considered to be an acceptable medical source that will be given controlling weight. It's good for history, but not so good for convincing Social Security or a judge that you have restrictions and limitations that prevent you from doing your past work or other work. The second factor that Social Security will consider in giving controlling weight is whether or not the doctor who saw you is in fact a treating source.
 
 Nancy Cavey [00:09:32]:
 So how many times did this doctor see you? If the doctor only saw you one time for an evaluation or they didn't treat you, Social Security is going to say, too bad, so sad, they're not going to be a treating source. Number three is they're going to consider your doctor's opinion to be a medical opinion about the nature and severity of your impairment. The signs, the symptoms, the diagnosis and prognosis, what you can still do in view of your impairment and your physical or mental restrictions and limitations. Anything else doesn't count. As I've explained, if the doctor says you're disabled, Social Security is going to throw that out the window because they're going to use the five step sequential evaluation in determining whether or not you're disabled. So remember, that opinion is irrelevant and it's not considered a medical opinion. Now, the fourth factor is that your doctor's opinion has to be well supported. Social Security or a judge is going to review the doctor's opinion to see whether it's well supported by medically acceptable clinical and laboratory diagnostic techniques.
 
 Nancy Cavey [00:10:40]:
 They're going to also look at your medical records and determine whether your records support the degree of the limitations assigned by your doctor. And then they're going to look at your medical records for consistency whether the daily activities you report to your doctor or the other forms that you complete for Social Security are consistent with the doctor's opinion. So, for example, if you say you can't sit for more than 30 minutes, but you and your family drove to Disney World two hours away, the judges or the Social Security administration is not going to find that consistent and will reject potentially the doctor's opinion. Now, what's the fifth factor? The treating physician's opinion isn't consistent with other substantial evidence. Again, what does the term not inconsistent mean? Well, what that means in English is that the medical opinion is not necessarily. It doesn't necessarily need to be consistent with all the other evidence. If there's no other substantial evidence that contradicts or conflicts with that opinion, that's like gobbledygook. But remember when I went back to this example of you say and your doctor says you can only sit for two hours and you drive to Disney.
 
 Nancy Cavey [00:11:55]:
 Well, that fact that you drove to Disney for two hours is inconsistent with all the other medical evidence. So consistency is a key. So what happens if the opinion of your treating physician does not meet this test? Well, even if the Social Security administration or a judge doesn't give your treating physician's opinion controlling weight, they still have to weigh that opinion under other Social Security regulations. The Social Security has to recognize the special relationship that you have, the special status of a treating physician and give their opinions some weight, even if the opinions may be unsupported or contradicted as compared to a physician who has only looked at your medical records and opined that you know about your restrictions and limitations. And that will normally happen at the initial and recon stage where your file is reviewed by state agency doctors who never see you. So you have a doctor who's never seen you. You have a doctor who has seen you. But there's some inconsistencies here between what the doctor says and what you're doing or the results of testing.
 
 Nancy Cavey [00:13:16]:
 And so what happens is there, there is this kind of weighing, if you will, that's going to go on about what weight is to be given. Should there be greater weight given to the treating physician as opposed to the state agency doctor? Judges will find all sorts of reasons to accept the state agency doctor's opinion even though they haven't seen you because they want to deny the claim. So you need to understand that this weighing goes on. And it sometimes can be hard to convince if you lose the appellate court that that decision by the judge is wrong. However, one of the things that I argue is that most state agency opinions are not well supported based on the medical records that they either had available at the time they review those records or has been superseded by subsequent medical or records. The judge is required, by the way, to give a good reason and explain the weight that they've given to each physician's opinion. And if they don't do it right, that can give a good reason to take an appeal if you lose to a higher court. Got it.
 
 Nancy Cavey [00:14:29]:
 Let's take a break. Welcome back to Winning isn't Easy. What's the role of your doctor at step three Listing level impairments? Must the Social Security Administration accept the opinion of a physician that I meet a medical listing? Now, as I've explained in the past, Social Security uses a five step sequential evaluation process. And at step three, the issue is whether or not your medical condition meets or equals what's called a listing. That's important because if you meet a listing, your benefits are automatically awarded based on the severity of your medical condition. However, if your doctor renders an opinion that you meet the listing without an explanation, the opinion is no more valuable and the doctor saying you were disabled, it's worthless. Now, the Social Security Administration uses a book called the Listing of Impairments or the Blue Book based on body systems like you learned in high school. And you can open up the listing for your particular medical condition and see the elements of a listing.
 
 Nancy Cavey [00:15:50]:
 You have to meet the elements of a listing or you're just not entitled to a decision at step three that you meet a listing. Let me give you an example. Let's say you have a back problem. You have to have under the listings for back problems, loss of range of motion, the presence of muscle spasm, positive sensory examination findings, the loss of motor strength, and all the other elements that are in a listing. And literally, Social Security is going to go through that listing, look at your medical records and check off whether or not you have the elements of a listing. I will tell you that having read many medical records that often, I find that the medical records just don't explain the elements of a listing. And that's understandable. Doctors didn't take a class in medical school.
 
 Nancy Cavey [00:16:39]:
 Learn how to write a report for Social Security purposes. That ticks off every element of a listing. Now, we do, as I've said before, try to have doctors complete residual functional capacity forms. And part of those RFC forms do have the elements of a listing. So we're trying to get the doctor to directly address in this form whether or not a person meets a listing. We don't tell the doctor this is the listing, but we're ticking off the elements of the listing. You do need to understand that very few cases actually meet the severity requirements of a listing. And most cases are decided at steps four and five, which I'm going to discuss next.
 
 Nancy Cavey [00:17:19]:
 Let's take a quick break.
 
 Speaker B [00:17:23]:
 Struggling with your Social Security disability case. The right attorney can make all the difference. Get our booklet the key to hiring a great attorney for your Social Security disability case. Discover how to find an experienced attorney who will fight for your rights and navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Nancy Cavey [00:17:54]:
 Welcome back. Let's talk about the role of your doctor at Steps four and five of the five step sequential evaluation. So you need to understand that the question here is ultimately, what are your physical or cognitive restrictions and limitations or psychological restrictions? At step four, you have to establish that you can't go back to the lightest and simplest job you held in the five years before your disability claim is decided. And if you can't, then the Social Security Administration has to decide whether or not you're capable of doing other work in the mythical, hypothetical, not real world national economy in view of your age, your education, your skills and your residual functional capacity. So will the Social Security Administration accept the opinions of your doctor that you can only do sedentary, light or medium work in your Social Security disability claim? I will tell you that the Social Security Administration and a judge won't accept the opinion of a physician who opines, well, you can do sedentary work or light work or medium work. That's an issue reserved to the Social Security Administration and a judge. The Social Security Administration and the judge is going to consider the opinion, but it's not necessarily going to be given controlling weight. Nor is the fact that your doctor says you're disabled or you can't do your past work going to give controlling weight.
 
 Nancy Cavey [00:19:22]:
 So what is it that the Social Security Administration or a judge is looking for in determining what you can do despite your limitations? Well, the Social Security Administration wants to understand what it is you can still do despite your impairments and your physical, mental or cognitive restrictions. So, for example, how long can you sit, stand, walk, stoop, bend? What's your ability to carry out and remember instructions, respond appropriately to supervision or work pressures in the work setting? Would you be off task? Do you need to take breaks? Would you be missing time from work? And the way, as I've said before, to get at that is to have your doctor complete a residual functional capacity form that's appropriate to their specialty in the nature of your disabling medical condition. This information will let the Social Security Administration or a judge determine the level of your physical functioning. Is it medium work? Is it light work? Is it sedentary work? Is it less than sedentary? Ultimately, the issue of your restrictions and limitations is an issue reserved for the Social Security Administration, not for a treating physician. Got it? Let's take a break. Foreign welcome back to Winning Isn't Easy. So what am I supposed to do if my doctor is uncooperative? My doctor says I don't know the definition of disability for Social Security purposes and I'm not going to fill out any residual Functional capacity forms. Too bad.
 
 Nancy Cavey [00:21:10]:
 So sad. What are you going to do? Well, first off, your doctor does not need to know the definition of disability under the Social Security Security rules. In fact, as I've explained, the Social Security Administration does not want your doctor to address the question of whether you're disabled. It's the Social Security Administration's job to determine whether or not you meet the five step sequential evaluation. Number one, do you have a medically determinable impairment? Two, is your impairment expected to result in death or has already lasted or can be expected to last for a continuous period of 12 months? Number three, does your impairment meet or equal a medical listing? Number four, does your impairment prevent you from performing the lightest and simplest job you held in the five years before your disability claim is adjudicated or decided? And number five, does your impairment or impairments prevent you from doing other substantial gainful work in the national economy in view of your age, your education, your work experience, and your restrictions and limitations? Remember, if your doctor wrote a letter saying you were disabled, Social Security is going to throw it in the garbage can. What they want to know is your doctor's opinion. The best way to get at that about the opinion about your restrictions and limitations is to have your doctor complete a residual functional capacity form that talks about lifting, bending, stooping, alternating sitting and standing breaks, problems with your upper extremities, inability to do sustained work for eight hours a day. Social Security lawyers have developed a number of residual functional capacity forms that we give our clients to take to the doctor to complete to help Social Security and us determine what you can still do notwithstanding your disabling medical conditions.
 
 Nancy Cavey [00:23:01]:
 The key, quite frankly, is if you're under 50, is to prove that you can't even do full time sedentary work. Now, that requires you to sit for six out of eight hours, stand or walk intermittently two hours a day, and occasionally lift 10 pounds and frequently lift lighter objects. That's the key, I think, particularly if you're under 50. But I think it's also the key if you're over 50 and we're not necessarily gridding out and we're dealing with that determination of whether you can do other work in the mythical hypothetical, not real world national economy. Now, I know that there are doctors who refuse to fill out residual functional capacity forms, and that's particularly true if you're a veteran and you're getting treatment at the VA, VA doctors are required by rule to fill out the forms. But they will say they won't and they won't and they won't. And they won't. So I know when I have a case involving a veteran, I'm not going to be getting residual functional capacity forms.
 
 Nancy Cavey [00:24:04]:
 But I want my client to try to give a really good medical history about their symptoms and functionality. And I want to use any VA ratings or determination of total impermanent or other benefits where there's been a really thorough examination. That's what we try to do in lieu of getting an RFC form in a VA case. But how about those of you who are not veterans? If they are going to tell you that you need a functional capacity evaluation or they just aren't going to fill out forms, let me tell you this. They don't need a functional capacity evaluation for them to fill out this form. It's based on common sense. They've been practicing medicine for years. They know by virtue of their experience in training what the functional restrictions and limitations are.
 
 Nancy Cavey [00:25:02]:
 They just don't want to get involved. They don't want to do paperwork. They can't be bothered. I don't have a lot of sympathy for those kinds of doctors. And if that's what your doctor tells you, then it's time for you to find another doctor who will play ball with you. And you're probably going to have to do that as quickly as possible. So before you stop work and apply for benefits, you want to have an off the record discussion with your physician about whether they'll fill out a form and whether they support your claim. If they say no, too bad.
 
 Nancy Cavey [00:25:32]:
 So sad. Then that's the message you need to hear now so that you can go find another doctor. Now, if that happens, that may impact the timing of your claim. And that's something that I obviously discuss with my clients in the claims process. If you have to find a new doctor, you don't want to walk in there with a residual functional capacity form and say, doctor, would you agree I'm disabled. Will you fill it out? That will really turn off a doctor. So you're going to have to wait a while before you ask the doctor to fill out the form. Unfortunately, it is taking at this point in time, at least a year once you file that application to get a claims examiner assigned.
 
 Nancy Cavey [00:26:18]:
 So unfortunately, because of the huge time delay, we'll have a lot of time for you to find a new doctor, potentially get those residual functional capacity forms. I wish that wasn't the case. It makes me very unhappy to tell my clients that we've got this delay. But on the one hand, if you have a physician who wants to play ball with you. It gives us time to develop the case. Yes, we're going to apply, but we will develop, hopefully with your new physician, the residual functional capacity forms that will help you win your Social Security disability case. Got it. I hope that you have enjoyed this week's episode of Winning Isn't Easy.
 
 Nancy Cavey [00:26:58]:
 Please like this page, leave a review, share it with your family and friends, and of course, subscribe to this podcast. Please tune in next week for another insightful episode of Winning Isn't Easy, and I'm going to talk about what it costs or doesn't cost to file a Social Security disability claim and how much you might get in terms of benefits. Got it. Look forward to talking with you next week.