Doctors Play Key Role in Deciding SSDI Qualification

Social Security Administration (SSA) considers the treating doctor as one who is able to provide the clearest picture of an applicant’s medical condition and impairments.

Through reports from medical examinations, his opinion can provide clarity about the applicant’s medical condition and help Social Security determine the best course of action to take. Social Security will often ask the treating physician questions about the nature, intensity, stage, and duration of the claimant’s disability.

The medical professional can also provide the SSA with details on the side effects the patient faces and how it affects his ability to work. Such information helps the SSA draw more accurate and fair conclusion. The expert opinion of the treating doctor and consultative examiner is always useful in determining the extent to which a condition impairs a person and the jobs he may still be able to do.

Although symptoms are mainly subjective, professional judgment is important in determining how much work can still perform. In the times past when considering a Social Security Disability Application the SSA considered the doctor’s opinion one of its top priorities in examining an applicant’s case.

Prior to March 27, 2017, Social Security gave special consideration to an applicant’s treating physician. To count as a treating physician, one needs to have had a reasonable amount of encounter with the patient. Hence, the longer a doctor has treated a patient, the more likely he was to qualify as the treating physician.

A patient could also have more than one treating physician; for instance, his primary care physician and his team of oncologists or neurologists. Noteworthy is the fact there were also instances where the opinion of the treating physician had to be nullified perhaps due to conflicting medical reports or other reasons based on the judge’s discretion. More recently, precisely in the year 2017, Social Security ratified a rule that no longer places much emphasis on the opinion of the applicant’s physician.

The new rule states that the most weight should be given to a report that seems more persuasive. Determining the persuasiveness of a report mostly depends on its consistency and supportability. Consistency in this context refers to how the medical opinion in the applicant’s file is consistent with other findings while, supportability refers to how much the disability can be supported by tests, clinical notes, etc. Also, if evidence from more than one doctor is consistent and well-supported, Social Security will then evaluate the length of the doctor-patient relationship. In other words, a doctor’s opinion is still important; however, its concurrence with Social Security rules and the opinion of a consultative examiner will be considered a top priority. It is important to know that SSA does not expect doctors to know the legal definition of disability; hence, even if it is in the doctor’s opinion that a claimant is disabled, the SSA will offer a conflicting opinion until the condition satisfies the legal definition of the term.

The SSA only treats the opinion of a medical professional as a source of evidence and is responsible for determining whether or not a claimant’s condition satisfies the criteria for which he can be deemed eligible for benefits. A doctor’s opinion can, therefore, be considered more as a means to an end rather than an end in itself.