My doctor doesn’t support my getting Social Security for disability. What should I do?

By / Social Security Disability Benefits / 53 Comments

Get tips on what to do if your doctor doesn’t think you should get Social Security or SSI for disability. Find out about changes in the law regarding the value of attending physician statements and learn how a lawyer can help prove you’re disabled without your doctor saying so.

The Importance of Your Physician’s Opinion Has Changed
For claims filed before March 27, 2017, your attending doctor’s and your specialist’s support were very important to the success of your Social Security and/or Supplemental Security Income (SSI) disability claim because the attending physicians’ opinions were given special weight if the opinions were well supported.

That changed somewhat on March 27, 2017, when new claims filed March 27, 2017, or later began to be evaluated under some new guidelines. Among them is that your doctors’ opinions will be treated the same as any other medical opinion obtained in the course of your claim review. This means that if you are sent by Social Security for a consultative examination by an independent physician, your attending doctors’ opinions will be given no more weight than those of the consultant who has seen you once, unless there is something in your medical records or the reports makes your doctor’s opinion better supported than the consultant’s. Similarly, your physicians’ opinions are treated the same as the opinions of a medical expert physician who testifies at your hearing or reviews your medical records and other medical evidence in file. No extra value is given for your physician knowing you. So, your doctor not supporting your disability claim with a statement that you are disabled or that you cannot work may not matter as much as it once did. Nonetheless the more supportive information you can get from your doctors the better, even if that only includes the doctors’ medical records for you.

What to Do When Your Doctor Doesn’t Support Your Disability Claim
The first action is to ask your doctor his or her reasons for not supporting your claim. Ask in a “just-want-to-understand” way, not in a confrontational manner. It may be that he or she does not understand Social Security’s definition of disability and thinks you must be totally disabled. When you or your lawyer explains that disability does not mean that you cannot work at all but rather that you cannot sustain full-time work to earn $1,260 a month (2019 rate) and that disability only has to be expected to last a year for you to be eligible, the doctor may agree that you are disabled as defined by Social Security law or at least be willing to provide information for SSA to make a decision. If you are blind, the benchmark level of earnings is $2,100. Earnings can be reduced by the amount of any Impairment-Related Work Expenses (IRWEs) before they are counted in evaluation for SGA.

Another possibility is that the doctor who is treating you for one condition does not know about other medical conditions you have or doesn’t know how they limit you. It may be that you are not disabled from all occupations based on just one of your medical conditions—even the most serious or recent one—but that you are disabled under Social Security’s rules when all your limitations from multiple conditions are considered.

Here’s an example: Perhaps you are claiming disability due to a recent lower back injury, but you also had rotator cuff surgery several years ago and have long-standing, upper-body lifting and range-of-motion restrictions. In addition, let’s say you have an irreversible, partial hearing loss that limits your ability to hear and understand speech in certain situations. When the long-standing limitations are added to your recently developed low-back problems, you may be unable to work due to all the conditions combined. In such a circumstance, you or your attorney representative can present your case to show how your total limitations from all causes disable you and why no one of your doctors has the total picture.

Letting your doctor know about other conditions may increase willingness to provide information; however, don’t expect a back doctor to make a statement about your hearing. For that you would need a current hearing test and a statement from the audiologist or ENT doctor about how the test results translate into hearing challenges in daily life.

Other Possible Evidence
If the doctor has kept good records about your diagnosis and treatment, the records may speak for themselves to reveal your limitations without your doctor stating them. However, if your doctor agrees that you have limitations and/or has told you not to engage in certain activities or movements, he or she may be willing to make a statement of what your limitations are without making a judgment as to whether those limitations constitute disability. If that is the case, especially if your records do not mention limitations or restrictions your doctor has placed on you verbally, it is worth a try to ask your doctor to write up a statement or complete a Physical Residual Functional Capacity (RFC) statement or a Mental Health Residual Functional Capacity (RFC) statement regarding your specific limitations and what causes them.

When All Else Fails
If the physician continues to decline to support your claim in any way, rely on the records. If the doctor refuses to release records, discuss with a Social Security attorney whether it is worth trying to get a court order. Whether or not you get the records or a statement from your physician, gather and submit as many other types of applicable records and statements as possible. This website’s articles on the Disability Claims Process, articles Applying for Disability Benefits, and claim-supporting forms may assist you in identifying the types of evidence that could be helpful to your claim. Finally, consider strategizing with an experienced Social Security attorney.

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