Mental Retardation

Getting Your Charge’s Doctor’s Medical Opinion about What Your Charge Can Still Do

Your Charge’s Doctor’s Medical Opinion Can Help Your Charge Qualify for Social Security Disability Benefits

The Social Security Administration’s job is to determine if your charge is disabled, a legal conclusion based on your charge’s age, education and work experience and medical evidence. Your charge’s doctor’s role is to provide the Social Security Administration with information concerning the degree of your charge’s medical impairment. Your doctor’s description of your charge’s capacity for work is called a medical source statement and the Social Security Administration’s conclusion about your charge’s work capacity is called a Residual Functional Capacity Assessment. Residual functional capacity is what your charge can still do despite his or her limitations. The Social Security Administration asks that medical source statements include a statement about what your charge can still do despite his or her impairments.

The Social Security Administration must consider your charge’s treating doctor’s opinion and, under appropriate circumstances, give it controlling weight.

The Social Security Administration evaluates the weight to be given your charge’s doctor’s opinion by considering:

• The nature and extent of the treatment relationship between your charge and his or her doctor.
• How well your charge’s doctor knows him/her.
• The number of times your charge’s doctor has seen him/her.
• Whether your charge’s doctor has obtained a detailed picture over time of his or her impairment.
• Your charge’s doctor’s specialization.
• The kinds and extent of examinations and testing performed by or ordered by your charge’s doctor.
• The quality of your charge’s doctor’s explanation of your charge’s impairment.
• The degree to which your charge’s doctor’s opinion is supported by relevant evidence, particularly medically acceptable clinical and laboratory diagnostic techniques.
• How consistent your charge’s doctor’s opinion is with other evidence.

When to Ask Your Charge’s Doctor for an Opinion

If your application for Social Security disability benefits has been denied and you have appealed, you should get a medical source statement (your doctor’s opinion about what you can still do) from your charge’s doctor to use as evidence at the hearing.

When is the best time to request an opinion from your charge’s doctor? Many disability attorneys wait until they have reviewed the file and the hearing is scheduled before requesting an opinion from the treating doctor. This has two advantages.

• First, by waiting until your attorney has fully reviewed the file, he or she will be able to refine the theory of why your charge cannot work and will be better able to seek support for this theory from the treating doctor.
• Second, the report will be fresh at the time of the hearing.

But this approach also has some disadvantages.

• When there is a long time between the time your attorney first sees you and the time of the hearing, a lot of things can happen. Your charge can improve and go back to work. Your lawyer can still seek evidence that you were disabled for a certain length of time. But then your lawyer will be asking the doctor to describe your ability to work at some time in the past, something that not all doctors are good at.
• Your charge might change doctors, or worse yet, stop seeing doctors altogether because his or her medical insurance has run out. When your attorney writes to a doctor who has not seen your charge recently, your attorney runs the risk that the doctor will be reluctant to complete the form. Doctors seem much more willing to provide opinions about current patients than about patients whom they have not seen for a long time.

Here is an alternative. Suggest that your attorney request your charge’s doctor to complete a Medical Opinion Form on the day you retain your attorney. This will provide a snapshot description of your charge’s residual functional capacity (RFC) early in the case. If your charge improves and returns to work, the description of your charge’s RFC provides a basis for showing that your charge was disabled for a specific period. If your charge changes doctors, your attorney can get an opinion from the new doctor, too. If your charge stops seeing doctors, at least your attorney has one treating doctor opinion and can present your testimony at the hearing to establish that your charge has not improved.

If your charge continues seeing the doctor but it has been a long time since the doctor’s opinion was obtained, just before the hearing your attorney can send the doctor a copy of the form completed earlier, along with a blank form and a cover letter asking the doctor to complete a new form if your charge’s condition has changed significantly. If not, your attorney can ask the doctor to send a one-line letter that says there have been no significant changes since the date the earlier form was completed.

There are times, though, that your attorney needs to consider not requesting a report early in the case.

• First, depending on the impairment, if your charge has not been disabled for twelve months, it is usually better that your attorney wait until the twelve-month duration requirement is met.
• Second, if your charge just began seeing a new doctor, it is usually best to wait until the doctor is more familiar with your charge’s condition before requesting an opinion.
• Third, if there are competing diagnoses or other diagnostic uncertainties, it is usually best that your attorney wait until the medical issues are resolved before requesting an opinion.
• Fourth, a really difficult judgment is involved if your charge’s medical history has many ups and downs, e.g., several acute phases, perhaps including hospitalizations, followed by significant improvement. Your attorney needs to request an opinion at a time when the treating doctor will have the best longitudinal perspective on your charge’s impairment.

Medical Opinion Forms

Many doctors do not understand the Social Security Administration’s approach to determining disability. That is not surprising, since SSA uses a complicated multi-step approach which at times defies common sense.

Your charge’s treating doctor likely needs to be asked specific questions in order to elicit the information SSA requires to make its disability assessment. The best way to obtain information helpful to SSA is to use forms designed to obtain your doctor’s analysis of your charge’s impairment and its effect on your charge’s daily living activities capacity for work.

We have a large collection of these time-tested forms. However, these forms are not suitable for use by claimants, because they frequently need to be modified for each case by someone knowledgeable about disability determinations. We thus keep our medical opinion forms in a password-protected section of this website accessible only to clients of the firm.

If you would like us to consider taking your charge on as a client, please complete the claim submission form on this page.

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