The Role of Your Physician in Your Social Security Disability Claim

Welcome to Season 1, Episode 34 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 Physician in Your Social Security Disability Claim."

For many Social Security Disability applicants, one of the most important and misunderstood parts of the process is the role of their physician. You might think that having your doctor say you’re disabled should be enough to win your case. But the Social Security Administration doesn’t automatically accept those statements, and what your doctor writes - or doesn’t write - can make or break your claim. In this episode of Winning Isn’t Easy, we’re unpacking how your physician’s opinions factor into your SSDI claim. We’ll explain what kinds of medical documentation the SSA actually relies on, how doctors should describe your symptoms and limitations, and when their opinions are given controlling weight under the rules. You’ll learn what makes a strong Residual Functional Capacity (RFC) assessment, why vague or unsupported statements can be ignored, and how to make sure your doctor’s records align with your testimony and daily limitations. We’ll also discuss common mistakes that cause even supportive doctors’ statements to be overlooked and how to fix them. If you’re preparing an SSDI claim or appeal, this episode will help you understand how to turn your doctor’s input into persuasive, credible evidence the SSA can’t ignore. Because when it comes to winning disability benefits, the story your medical records tell matters just as much as the one you live.

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

One - What Are the Five Factors That Must Be Met Before Social Security Gives Your Treating Doctor’s Opinions Controlling Weight?

Two - The Role of Your Doctor at Step Three

Three - The Role of Your Doctor at Step Four

Four - Why and How the Social Security Administration Can Ignore Your Doctor’s Opinion That You Are Disabled

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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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. Welcome back to Winning Isn't Easy. Social Security disability Benefits. This is the podcast where we break down everything you need to know about navigating the Social Security system. Before we get started, I have to give you this legal disclaimer. This podcast isn't legal advice. I.
 
 Nancy Cavey [00:00:28]:
 The Florida Bar association says I have to tell you this. And now that I've done that, nothing will ever prevent me from giving you an easy to understand overview of the Social Security claims process, the games that are played during the disability claims process, and what you need to know to get the Social Security disability or SSI benefits that you deserve. So off we go. Now, in today's episode, I'm going to take a deep dive into the role of your physician in a Social Security disability claim. If you're applying for your Social Security disability benefits, you might assume that just because your doctor says you're disabled, that that's enough and you're going to get a Social Security disability check. Guess what? The Social Security Administration does not automatically accept statements about disability from your doctors. They don't really care that your doctor writes a note that says you're disabled. Why is that? Because the Social Security uses a five step sequential evaluation test and they ultimately make the decision as to whether or not you meet their disability test.
 
 Nancy Cavey [00:01:27]:
 So what does your doctor need to document? How should they frame their opinions? And what weight does this really carry in your claim? I will tell you that cases are won and lost every day based on the documentation that's in your records or not, and the fact that your doctor is your strongest ally. Now, the doctor really needs to be explaining the severity of your impairments. And I think the best way to do that is to complete some forms we Social Security lawyers created called residual capacity forms, RFC forms. And that's certainly crucial, but they also are playing an important role in documenting your symptoms and your functionality. We just lost a case. Well, we actually, we didn't lose it. The doctor helped lose the case because the claimant would come in and say, I have 7 out of 10 pain. These are the problems that I'm functioning with.
 
 Nancy Cavey [00:02:23]:
 I can't do this, I can't do that. And the doctor would close every note by saying that the claimant's pain is well controlled, they are recovering and their functionality is adequate. That didn't help. The judge looked at the claimant's complaints in the medical records and the doctors sign off lines and concluded that the doctor was telling the truth and not the claimant and disbelieved the claimant. So we're going to break down in this episode exactly how Social Security evaluates your doctor's opinions when they are given controlling weight and what kinds of documentation can make the difference between an approval and denial. Again, I'm going to cover why some statements from doctors can be ignored and how to make sure that your doctor's input really counts. So if you want to understand how your medical evidence is crucial and will give your Social Security claim the best chance of success, this episode is essential. So we're going to talk about four things today.
 
 Nancy Cavey [00:03:23]:
 Number one, what are the five factors that must be met before the Social Security administration gives your treating doctor's opinion? Controlling weight. Number two, the role of your doctor at step three of the five step sequential evaluation. Number three, the role of your doctor at step four of the five step sequential evaluation. And number four, why and how the Social Security administration can ignore your doctor's opinion that you're disabled. Got it. Got a lot to cover, so come back with a piece of paper and a pen. Let's take a quick break. So what are the five factors that have to be met before the Social Security administration or a judge will give your treating doctors opinion? Controlling weight? Well, the first thing you need to understand is that there is no treating physician rule in a Social Security claim.
 
 Nancy Cavey [00:04:25]:
 However, the opinions of your physicians are crucial to the success of your claim. And the most important thing, in my view, that you can provide is a residual functional capacity form opinion. So what is this? Well, it's a form that we Social Security lawyers have created, and we've created, I think, about 70 of them. We pick out the ones that are right for our client's claim and we ask our client to get the doctor to complete them. Now, not all doctors know about them, and they certainly aren't going to suggest that they fill out an RFC form. But an RFC form is an opinion from your treating physician about the nature and severity of your symptoms, your diagnosis, your prognosis, and and what you can still do from a physical, mental, or cognitive standpoint despite your impairment. Now, under the Social Security regulations, the medical opinion from a treating physician about the nature and severity of your impairment is entitled to deference and may be entitled to controlling weight. So what is controlling weight in a Social Security disability claim? Well, the Social Security administration and the judge is going to review your medical records and the opinions of your doctor to determine whether they should be given that controlling weight.
 
 Nancy Cavey [00:05:37]:
 And there are five factors that they will measure in deciding whether to give Your doctor's opinion controlling weight. Number one, is the doctor an acceptable medical source? Not all doctors are qualified to give an opinion under Social Security rules or regulations. An acceptable medical source is a physician, a psychologist, a podiatrist, an optometrist, a qualified speech language pathologist. But what aren't or who aren't chiropractors, nurse practitioners, audiologists, PAS therapists, acupuncturists, nutritionists and naturopaths are not considered acceptable medical sources and as a result, their opinion doesn't carry much weight. What happens in these cases though is that I try to get the treating physician to sign off on the nurse practitioner reports and the licensed physician assistant reports. In the case of psychological reports, I want the reports of a therapist or even a social worker signed off that RFC form signed off by a licensed psychologist or psychiatrist. Chiropractors are a different matter. I have a case right now where the claimant has treated for 25 years with a chiropractor, doesn't want to see an orthopedist, doesn't want to see a pain doctor.
 
 Nancy Cavey [00:06:57]:
 That's going to be a problem, though I will tell you, the length of the relationship will help. Now, number two, is the doctor a treating source? If the doctor saw you one time on a one off or they didn't treat you, that's not going to count. They're not going to be considered a treating source. Number three, is the doctor's opinion, a medical opinion about the nature and severity of your impairments. So what we want to see in the records is, is your history of your symptoms, the doctor's opinion about your diagnosis, prognosis and what you can still do despite your impairments. Anything else doesn't really count. So if your doctor says you're disabled and you can't work, just ball it up and throw it in a garbage can. If you paid for it, you just wasted a lot of money.
 
 Nancy Cavey [00:07:43]:
 So that opinion is irrelevant because that comment is not considered to be a medical opinion. Remember, Social Security uses a five step sequential evaluation test. Number four. Okay, well we've got the opinion of the doctor. Is that doctor's opinion well supported? Social Security. The judge is going to review the doctor's opinion to see whether it's well supported by medically acceptable clinical and laboratory diagnostic techniques. So they're going to look at your medical records and say, okay, here's the diagnostic studies, the mri, the X ray, the emg, the MRI of the brain, whatever it is. They're going to look at the laboratory findings.
 
 Nancy Cavey [00:08:23]:
 They're going to look for the objective basis of the diagnosis and then they're going to look for the objective basis of the restrictions and limitations. So are the exam findings consistent with your complaints and are the exam findings consistent with the diagnostic studies? Are your symptoms consistent with the diagnosis and the diagnostic studies? They're going to look at your records and determine whether the medical records support the degree of limitations assigned by the doctor. And they're also, by the way, going to look at the forms you filled out. You've been asked to fill out forms about your activity of daily living and you did it at the beginning of the claim. Judges are going to look back to what you said a couple years ago and sometimes they'll fixate on, well, you said then that you could do X, Y and Z and now you're saying you can't do X, Y and Z. That's not supported by the medical records. So we don't believe you. We actually believe that what you said originally about what you could do is sufficient for us to deny the claim.
 
 Nancy Cavey [00:09:23]:
 So be very careful here about what you're telling Social Security about what you're doing and don't be Superman or Superwoman. Tell the truth and tell the truth when you see your doctor. Number five. Is a treating physician's opinion consistent or inconsistent with other substantial evidence? Well, the medical opinion doesn't necessarily need to be consistent with all the other evidence so long as there isn't substantial evidence that contradicts or conflicts with the opinion. That can be problematic because again, you're filling out forms and you may say one thing on the forms, but your doctor is recording something completely different. So once again, we had a case where the claimant says, I'm a pain level of 7 to 10, I can't do X, Y and Z. But then the physical exam findings aren't consistent with the level of the pain or X, Y and Z. And the doctor is concluding, based on examining the patient and listening to the patient, that their pain is under control and that they're functioning well.
 
 Nancy Cavey [00:10:30]:
 Well, that's inconsistent with what the claimant has had to say. But guess who judge in this case accepted, accepted the opinion of the doctor. Now, again, consistency is key both ways. You have to be consistent and the doctor needs to be consistent. Got it. So what happens if the opinion of your treating doctor doesn't meet the test, even if the Social Security administration of the judge doesn't give your treating physician's opinion controlling weight and they have to weigh that opinion using other Social Security regulations? So under the regs Social Security has to recognize the special status of a treating physician and give their opinion greater weight even though it may be unsupported or contradicted when they compare that opinion to the opinion of a doctor who never saw you. I want you to remember that at the initial and recon stages of your case, your file has been reviewed by a state agency doctor who never saw you. They're going to make administrative findings about your residual functional capacity.
 
 Nancy Cavey [00:11:29]:
 But once you're in front of the judge, those types of administrative findings of the state Administrative State agency doctors are treated as expert medical opinions from a non examining source. Now I find that most state agency doctor opinions which are the basis of the original denial aren't really well supported based on the medical records or haven't had an opportunity to consider subsequent medical evidence that developed after they reviewed the claim and denied the claim. So I'm often arguing that the state agency opinion is wrong because they didn't have all the records that are available or that there's subsequent medical evidence that developed after they denied your claim which contradicts their or is inconsistent with their findings. So if the Social Security administration of the judge doesn't give your treating physician's opinion controlling weight and they have to give a good reason and explain the weight that they gave to your reading doctor's opinion. And guess what? If they fail to do that, and they often do, that can give rise to an appeal if your claim is wrongfully denied. Got it. I hope you're taking notes. Let's take a break so you can catch up.
 
 Nancy Cavey [00:12:38]:
 All right.
 
 Speaker B [00:12:39]:
 Are you considering 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 [00:13:15]:
 Welcome back to Winning Isn't Easy. The role of your doctor at step three does the Social Security Administration accept the opinion of your physician that you meet a medical listing? Now remember, we've been talking about the five step sequential evaluation test and at step three, the Social Security Administration is going to determine based on your medical records whether your medical condition meets or equals a listing. Now that's important because if you meet a listing, your benefits are going to be awarded based on the severity of your medical condition and as that severity is defined by the elements of the listing. Just because you think it's severe doesn't make it severe. If your doctor doesn't document in your Medical records, the necessary elements of a listing. The only other way we try to get the doctor to address it is the residual functional capacity forms. Now, if they don't explain either in their medical records or in a residual functional capacity form why you meet a listing, then that opinion is kind of worthless, and Social Security is not going to accept that opinion. They're going to want to see, here are the elements of the listing, whatever it is.
 
 Nancy Cavey [00:14:23]:
 Here are the medical records. Let's check them off and see if we meet the elements of a listing. Doctors did not go to medical school to learn how to write a report for Social Security purposes, and they certainly didn't take a class that talks about the listing of impairments. And these are the things you need to check off. So let me give you an example. Most listings have elements that have to be established to show that your impairment meets or equals a listing. So if you have a back condition, among the things you have to show in your records are a loss of range of motion, muscle spasms, positive sensory exam findings, loss of motor strength, and the other elements of a listing. So Social Security wants to see checking off that you meet these things, and they want to see the diagnostic studies that.
 
 Nancy Cavey [00:15:07]:
 That cooperate, that you're meeting the elements of the listing. What I try to do if I can't get the doctor to complete a residual functional capacity form, is to write a letter to the doctor asking them to address the elements of the listing. And I give them to them, wanting them to comment on the existence, nature, and severity of the impairment. Many physicians, quite frankly, won't do that. And that's why we really like the residual functional capacity form, because in that form, we're trying to build in at the beginning of the form the elements of the listing. So the doctor or their staff are checking the elements off based on the medical records. Now, that doesn't mean we still don't have to cooperate them, because I have to explain to the judge, page in verse, where it is in the medical records that you actually meet the elements. So when we do a memorandum of law for a judge at a hearing, we are literally giving them page and verse.
 
 Nancy Cavey [00:16:00]:
 Here's the mri. Here's exhibit number three, page four, line three, page and verse. All right, so let's take a break, because next we're going to talk about the physician's role at steps four and five. Got it. Let's. We'll be back in a minute. I want to talk about the role of your doctor at both steps four and five. Now, what needs to be determined at step four and five is what is your residual functional capacity, in other words, what it is you can do notwithstanding your physical, cognitive or psychological impairments.
 
 Nancy Cavey [00:16:46]:
 And at step four, you have to establish that you can't return to the lightest and simplest job you did in the five years before you became disabled. And if you can't, then Social Security is going to determine in step five whether you can do other work in the mythical, not real world national economy in view of your age, your education, the skills and your residual functional capacity form. But what Social Security is not going to accept is the opinion of your doctor that you can't do your past work or other work. And they're not going to accept the physician's opinion that you can have a you have a particular level of residual functional capacity. In other words, you can do sedentary work or light work. Social Security is going to consider their opinion, but is not going to give them deference or controlling weight. The fact that you can't do your past work, they don't care. They have to determine if you can't do your past work based on your restrictions and limitations.
 
 Nancy Cavey [00:17:43]:
 They don't care if your doctor says you can't do other work, they are going to determine that based on your residual functional capacity. So what do they want? What are they looking for? Social Security wants your doctor's opinion about what you can still do despite your impairment physically, cognitively, psychiatrically. So, for example, they want to know how long can you sit, stand or walk at one time? How much can you lift or carry? What's your ability to understand, carry out or remember instructions? How do you respond to supervision or work pressures? Would you be off task? How much do you have problems with bilateral manual dexterity? Can you reach overhead out in front of you? Can you use your hands? Do you have problems with fingering? Would you be missing work? How often would you be missing work? Those are the kinds of things that Social Security and a judge is going to consider in determining your residual functional capacity form. Under the Social Security statute and regulations that issue, your residual functional capacity is reserved for the Social Security Administration or the judge, not your treating physician. Got it? Let's take a break.
 
 Speaker B [00:18:56]:
 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 [00:19:37]:
 Welcome back to Winning isn't easy. So why in hell can the Social Security administration or a judge ignore your opinion that you are disabled? Again, I get this question all the time. People will call us up and say, well, I want to apply for Social Security because my doctor told me that I'm disabled and I can't work. By the way, the doctor is willing to write a letter, to which I say, too bad. So sad. That doesn't count. That is an issue reserved to the commissioner. There is an actual Social Security regulation.
 
 Nancy Cavey [00:20:10]:
 SSR96.59 says that certain issues are reserved for the commissioner, and one of those issues is the determination of disability. So when a doctor says they can't work, they should stop work, they're disabled. That's an issue reserved for the commissioner and. And the Social Security Administration. And the judge will freely reject or ignore it. That's why I tell people, look, that letter stating you're disabled or unable to work is going to be ignored. How about a mixed opinion? So if your doctor gives us a mixed opinion, you're disabled because you have low back pain, that requires alternate sitting, standing up to 45 minutes and you can only lift up to 15 pounds. Social Security is going to parse that statement.
 
 Nancy Cavey [00:20:54]:
 They're going to ignore that you are disabled, and they're going to look at the alternating sitting and standing every 45 minutes and lifting up to £10. So it would be improper for them to dismiss the whole opinion. They've got to look at that functional opinion. But I have seen judges reject mixed opinions, and that's why I prefer to get the residual functional capacity form because it will address the physical, cognitive or psychological residual functional capacity that you have. What you can do despite those limitations. I love RFC forms and you've heard me harping about this. We Social Security lawyers have created, I think, 70 of them. So at our law firm, we listen to our client's story and we pick out the right residual functional capacity forms, and generally it's more than one, and ask our client to take them to the applicable specialist to be completed.
 
 Nancy Cavey [00:21:51]:
 Because these forms are going to address the diagnosis, the basis of the diagnosis, the symptoms, the effect of medication, the physical or psychiatric or cognitive functional limitations. Sitting, standing, walking, stooping, bending, bilateral manual dexterity, absenteeism, off task. Those are the things that could prevent you from doing your past work or prevent you from doing other work in the national economy at step five. So this approach, I think, ensures that the Social Security administration and the judge properly consider and potentially accept the opinions of treating physicians regarding your functionality. Remember, blanket statements regarding issues reserved to the Commissioner like your disability or inability to work are ignored. They're not worth the piece of paper that they're written on or whatever it is you may have paid the doctor to write that letter. It's the RFC forms, in my humble opinion, that I think make all the difference. So that's it for today's episode of Winning Isn't Easy.
 
 Nancy Cavey [00:22:52]:
 Remember, your treating physician's role in a Social Security claim is nuanced. Documenting your symptoms, limitations, functional abilities is crucial to giving Social Security the evidence that it needs to evaluate your claim accurately and fairly. If you found this episode helpful, please take a moment to like our page, leave a review, share it with your family and friends and subscribe to this podcast. Join us please next week for another insightful episode of Winning Isn't Easy. Thanks for listening.