Should you get a Statement from a Personal Physician for your SSD or SSI Disability Case?

A statement from a doctor can, in many Social Security Disability and SSI cases, make the difference between winning or losing a disability claim. But not just any statement. As a disability examiner, I found it fairly routine to receive very brief signed statements from claimants' doctors that said little more than "My patient is completely disabled and unable to work".

This type of statement is extraordinarily useless to a disability examiner (who makes the decision on an application for disability or on a first appeal, a reconsideration) or a judge at a disability hearing.

Why? Because the social security administration is very interested in receiving the opinion of a claimant's treating physician but only if it is specific enough to indicate why the physician believes that their patient is disabled and unable to work.

To satisfy SSA (the social security administration), a statement (known as a medical source statement or residual functional capacity, or RFC, statement) should be as follows:

1. It should indicate the claimant's diagnosed condition or conditions.

2. It should indicate the date of the diagnosis.

3. It should indicate the outlook, or prognosis, for the condition, or conditions.

4. Most importantly, it should indicate all the various ways in which the claimant is functionally limited and, consequently, has difficulty engaging in normal daily activities.

5. Finally, a doctor who submits a statement should be a treating physician, which is, according to the social security administration, a doctor who has an extended history of treating the claimant for their condition, as opposed to, for example, an urgent care doctor who has seen the claimant once or twice. As SSA sees it, a treating physician is qualified to give a valid opinion as to the claimant's medical condition and how the condition affects them.

Regarding item number 4, it is usually more effective and efficient for a doctor to simply complete a check-off style form that allows them to address the claimant's physical strength level, their range of motion, their postural or ambulatory limitations (walking, bending, crouching, balancing), their deficits with regard to their senses (seeing, hearing, feeling), and any other physical functional short-comings they may have.

If the claimant's condition is mental, the physician or psychologist should indicate which cognitive deficits they have. For example, do they have trouble retaining information, learning information, concentrating, getting along with supervisors or co-workers, etc.

Statements that obtain this type of detailed information are not, however, sent to a claimant's doctor or doctors by social security. When a case is being processed, they are completed (in the form of something known as a RFC form) by the doctors who act as consultants to disability examiners.

Wouldn't it make sense for social security to simply send a form to a claimant's own doctor to get their detailed opinion, especially in the format that they prefer (a check-off style form)? Yes, it would. But SSA does not do this, and it may be because it is a cost issue.

However, a competent and skilled disability attorney will nearly always try to obtain a statement from the claimant's treating physician, or physicians if they have more than one. And this is because such statements can often turn the tide in a case and effectively win disability benefits. Why are these statements effective with administrative law judges at disability hearings? Because an ALJ will typically recognize that the claimant's treating physician has an opinion that should carry weight in the decisional outcome of a case.

Medical Source statement PDF download

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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