Treating Physicians and their Role in the Social Security Disability Process

There is nothing more frustrating when representing someone in their Social Security disability claim than hearing that a longstanding medical provider is not willing to address a residual functional capacity questionnaire.  These forms are meant to address in a rather organized fashion: 1) the nature of the contact they have had with the patient, 2) the diagnoses, prognoses, symptomatology and objective signs related to the conditions for which they are treating them and 3) the patient’s residual functional capacity (that is, the extent to which they remain limited in terms of undertaking functions necessary for a potential work environment).

The Social Security disability regulations provide that in order to find one disabled from a medically determinable severe impairment, an acceptable source must establish a diagnosis of that medical condition.   Once that takes place, it is vital that the treating source address the extent to which one remains impacted in terms of their ability to perform such functions as sitting, standing, walking for a length of time, the extent to which they can lift and carry, bend, stoop, etc.

Likewise, in a case involving mental health impairments, it is just as important that the treating physician (preferably, a psychiatrist and/or psychiatrist) has established a diagnosis/diagnoses.  It is then critical that an acceptable medical source (which now can include a physician assistant or a advanced practice registered nurse, who specialize in mental health) set forth the extent to which their patient remains impaired in terms of their ability to undertake such activities as maintaining their attention and concentration, dealing with normal work stress, interacting with the public, coworkers and supervisors, etc.

Unfortunately, as a Social Security disability lawyer practicing throughout Massachusetts, Maine and New Hampshire, I have encountered a great many medical providers that simply do not understand the importance of their role in the disability process.     Upon the filing of an initial Social Security disability claim (and the presentation of a complete initial application), the Social Security Administration transfers the claim file to Disability Determination Services (DDS), the state agency responsible for the disability evaluation process.  The file is assigned a DDS adjudicator responsible for obtaining all of the treatment records, requesting treatment records going back at least 1 year prior to the alleged onset date.

While DDS will go about obtaining treatment records, it is left to either the claimant or the claimant’s attorney to submit additional supportive medical evidence which may evidence the extent to which the claimant has remained disabled from performing activities that would be necessary for some manner of gainful employment.    What many medical providers do not seem to understand is that SSA, through DDS, will provide the claim file to a physician contracted by SSA to review files for purposes of assessing the nature and severity of the claimant’s medical conditions and their corresponding residual functional capacity.  This assessment is completed by way of a paper review only: without ever meeting the claimant.

Too many times, we hear from doctors that they believe they are not trained to assess their patient’s functional limitations.   What they fail to understand or feign ignorance concerning is the fact that no special training is required for such a determination: they are more than qualified to provide their opinion on the subject.  Certainly, SSA’s doctors have no training either, and they are simply looking at a paper file rather than the patient.  Unfortunately, without an opinion from the treating physician, SSA is left to rely on these state doctors who have never set their eyes on the claimant.   Many times these practitioners will comment that they see no limitations being imposed by the treating physician, and so will then assume there must not be an significant limitations.

Many facilities that we encounter that are simply too busy to address their patients’ needs for such forms as their bottom line remains the “bottom line.”   One such office we’ve encountered is a pain management facility (Northeast Pain Management) out of Bangor, Maine, and a physician, Benjamin Zolper, M.D.  While comfortable evaluating claimants for purposes of charging thousands of dollars in injections, they suggest they are simply incapable of filling out a form addressing their patient’s functional limitations.   Despite having seen one of our patient for many years, making tens of thousands of dollars injecting this patient monthly, they still refused:  despite having been informed that their patient was facing years of Social Security denials as a result of their unwillingness to address the severity of her condition (and that SSA’s doctors, with no special training have assumed there are no such functional limitations as they have not spoken up about any).

Many providers will suggest that their patient simply go to a functional capacity assessment, failing (or not caring) to understand not caring that such an evaluation will not be covered by insurance and their claimant remains incapable of paying what can be $1000 or more.

This is the unfortunate reality many our claimants face.  Ultimately, the physician’s decision as to whether they will comment on their patient’s condition will have lasting, potentially devastating consequence.  If you or someone you know remains disabled from working and requires a zealous Social Security disability lawyer, contact the Law Offices of Russell J. Goldsmith at 1-800-773-8622.