Why Have I Been Denied Social Security disability benefits when my Doctor has said I’m Disabled?

We are many times called by individuals who have been denied their Social Security disability claim (whether it be on their initial claim, reconsideration or at hearing) despite what they inform us is their doctor’s supportive letter.   It is not uncommon to see a disability claimant simply asking their doctor for a letter describing their disability, or a note that says they remain unable to work, and then they are surprised to find that they have been denied nonetheless.

The Social Security Regulations spell out a 5 step evaluation process that is rather complex, and in order to obtain useful information from a medical provider, it’s important to know what needs to be proven in order to qualify for benefits.  First and foremost, one needs to prove that they are suffering from a medically determinable severe impairment in accordance with Step 2 of the sequential evaluation process.  If one has not established through objective medical examination and/or testing that a medically diagnosed condition exists, any opinions from one’s treating doctors that one may be somehow limited in their ability to work cannot even be considered.

Once a medically determinable impairment has been established, it’s important to understand that the Social Security Administration (SSA) has a set of regulations that governs what evidence can be considered (and in what way).   For Social Security disability claims that have been filed on or after March 27, 2017, the Social Security rules have been amended so as to make clear the Agency’s position that no source opinion (whether it is from one’s own medical doctor or from a consultative examiner SSA sends one to, is automatically entitled to a greater weight of consideration).  For claims that have been filed prior to March 27, 2017, a treating source’s opinion is entitled to great weight and deference if in fact it “is well-supported by medically acceptable clinical and laboratory diagnostic techniques” and it is not inconsistent with substantial evidence in the record. 

As a practicing Social Security lawyer in Maine, Massachusetts and New Hampshire for 28 years, what is clear is that if a medical provider is left to determine what is relevant in terms of their opinions without some guidance from an experienced Social Security disability attorney, they are likely to miss the mark.  While many doctors and disability claimants alike believe a statement that one remains disabled from working would help to prove a claim, SSA’s regulations make very clear that such opinions are not worth much weight given they don’t provide guidance as to why SSA should find one “disabled” under their rules.   There can be many different interpretations as to what constitutes being “disabled” from working.  Whereas, Social Security’s regulations are voluminous in defining what they determine to be “disabled” under their rules.

In keeping with this notion, SSA has promulgated  20 C.F.R. §1527(d)  which spells out that certain opinions are not considered “medical opinions” entitled to considerable weight if they address “issues reserved to the Commissioner because they are administrative findings that are dispositive to a case.”  Medical providers are not considered to be experts in the vocational analysis necessary as part of determination that a disability claimant is “disabled” under Social Security’s rules, or with reference to the medical criteria that needs to be found in order to meet a medical listing of impairment (that would likewise direct a finding of “disabled”).

With that in mind, SSA wants to see that a medical provider is addressing specific issues that will be of importance to the Agency in making a determination under the sequential evaluation process.  Therefore, we utilize functional capacity questionnaires that outline such important factors as: what is the nature and length of contact, what are the medically diagnosed opinions, what clinical or objective signs support these diagnoses, what are the symptoms the patient experience (including an indication of severity and frequency), what treatment efforts have been made and to what extent has it proven helpful (including medications and their side effects), and then a full assessment of the physical abilities the claimant might have if called upon to go to do so in a competitive work environment, that is, 8 hours a day, 5 days a week.   The types of functional abilities include such things as sitting, standing, walking for a period of time (and in an 8 hour day total), pushing, pulling, lifting, carrying, along with the extent to which they would need to take unscheduled breaks,  recline or lie down during the day or miss coming to work entirely.

Understanding what needs to be proven in a Social Security disability case is not obvious, even to a skilled lawyer who doesn’t specialize in the handling of Social Security disability claims.  If you remain long-term disabled from working, don’t try to handle your case alone: call an expert who has the experience and knowledge to guide you through the process.   Contact the Law Offices of Russell J. Goldsmith at 1-800-773-8622.