3.5 Your Doctors Opinion

How it can affect your Disability Benefits Application


There are many factors that can contribute to a successful Social Security Disability claim. Your doctor’s opinion on your functional capacity (or your restrictions, limitations, and remaining ability) may be one of the most significant factors in obtaining a favorable ruling from an Administrative Law Judge (“ALJ”).

One of the main reasons an opinion from your treating physician is important is that disability claims often come down to an ALJ’s determination of what the Social Security Administration calls your “Residual Functional Capacity” or RFC. What many claimants do not know, is that by the time you reach the hearing level, the Social Security Administration has likely provided the ALJ with at least one, if not two or more, opinions of your RFC. Depending on your type of claim, a medical doctor, hired by the Social Security Administration has likely reviewed your claim after your initial application and given an opinion on what you are still capable of, either physically, mentally, or both. You may also be asked to attend a one-time, no cost doctor’s visit, to a doctor that the Social Security Administration has hired to perform an examination called a Consultative Examination. Very likely, this doctor has provided yet another opinion of your RFC that the ALJ will review along with the other medical records in your Exhibit File, prior to the hearing. More often than not, this Consultative Examination will not result in an opinion that will be beneficial to your claim.

The result, is that by the time you sit down at the hearing, these doctors, who have either never actually examined or met with you, or have only met you once for a brief time, will have provided their opinion on what your limitations are to the ALJ. Therefore, it is critical to obtain an opinion from your own treating physician, as your treating physician is likely the person who has the best understanding of what you are actually capable or incapable of doing. Your treating physician should have more background and more knowledge of your impairments based on the length and duration of your relationship with him or her, and should be able to provide a more accurate account of your RFC.

Yet another reason why an opinion from your treating source is incredibly important to the success of your claim, is that Social Security Ruling 96-2p specifies that ALJ’s should provide controlling weight to a “treating source” opinion from a medical doctor. This means that if your treating physician provides an opinion of your limitations and restrictions, and that opinion is “well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with other substantial evidence” (meaning the opinion is supported by your doctors treating records and not contradicted by other doctor’s records), the ALJ should give your doctor’s opinions more credit than the doctor at the initial level that aided in your denial.

So, when Myler Disability asks you to obtain an opinion from your doctor, in either the form that our office provides to each and every client, or even if you can obtain a written statement directly from your doctor, it is critical that you do so. The success of your claim may rely on your doctor’s opinion.

Finally, some things to remember. An opinion from a nurse practitioner, physician’s assistant, chiropractor, mental health therapist, or other non-doctor medical provider is NOT given the same consideration as a doctor. So if you are not sure whether the person you see most often for your impairments is a medical doctor, ASK. Additionally, if you are being treated by a primary care physician who has referred you to a specialist (such as a neurologist, orthopedic, or other specialized field), an opinion from that specialist will likely be given more deference than your primary care physician. And remember, the more consistent and thorough medical record that your doctor produces, the better support you will have for your doctor’s opinion. So spend time with your doctor at each visit, don’t exaggerate or understate your symptoms, and make sure you don’t miss regularly scheduled visits.

Blake S. Griffin