Your Doctor’s Opinion vs. The Social Security Administration

By: Disability Group

You doctor’s medical decision is just one thing the SSA considers when evaluating your disability claim.

What does the SSA have to determine in order to find me disabled?

The SSA needs to determine that you have either a physical or mental condition that is expected to last at least 12 months or result in death.  Your condition has to prevent you from working at your prior job and prevent you from performing any other type of work in the economy based on your health, education and work experience.

I was seen one time by a SSA doctor, how important is that doctor’s opinion?

Usually, the one time medical evaluation done by a SSA doctor will not be given more weight than your treating doctor’s opinion.

How important is my doctor’s opinion to the SSA?

The SSA has guidelines, which dictate how much weight can be given to your doctor’s medical opinion. The SSA will give more weight to your doctor’s opinion if your doctor has been treating you over a long period of time. In addition, your doctor’s opinion will be given controlling weight (most important medical opinion in the record) if:

  • Your doctor has been treating you over a long period of time,
  • Your doctor’s opinion is supported by clinical and laboratory tests, and
  • Your doctor’s opinion is consistent with the other substantial evidence in the record.

What happens if my doctor’s opinion is not consistent with other medical evidence in the record or not supported by objective tests?

In this situation the SSA can decide not to automatically give controlling weight to your doctor’s opinion.  The SSA will evaluate each medical opinion in the record and use the following factors to determine the weight given to each opinion:

  1. The length of time the doctor has been treating you and how often this doctor saw you.  The longer and more frequent that a doctor has treated you increases the weight the doctor’s opinion receives from SSA.
  2. The nature and extent of the treatment relationship. The more the doctor knows about your condition increases the weight of this doctor’s opinion.
  3. Supportability.  Opinions supported by medical signs and laboratory findings, are assigned more weight by the SSA.  The SSA is more likely to consider a doctor’s opinion if there is a well written explanation for the opinion.
  4. Consistency. The more consistent the doctor’s opinion is with the rest of the medical evidence record, the more weight the SSA will assign to the opinion.
  5. Specialization. The SSA will assign more weight to the opinion of a specialist provided the opinion given is within the doctor’s area of specialization.
  6. Other factors. The SSA will give increased weight to a doctor’s opinion, if that doctor is familiar with the SSA’s disability programs and requirements.  Additional weight is given to a doctor’s opinion if that doctor has extensive knowledge of your case record.

How can a disability attorney help me?

A disability attorney can request medical records so your file is complete. The SSA can only base their decision on the medical evidence provided. An attorney can also provide medical source statements (questionnaires) for you to take to your doctor so your disability limitations are documented and the judge can base his decision on your treating doctor’s opinion.