If you're applying for Social Security disability benefits, your chances of success improve greatly if your case is supported by your treating doctor (the physician who sees you regularly). That's because the Social Security Administration (SSA), recognizing that treating physicians often possess unique insight into their patients' conditions, has promulgated rules that generally require claims examiner and judges to give substantial weight to the opinions of treating doctors.
However, Social Security will not automatically defer to the judgment of your doctor. Administrative law judges (ALJs) and other adjudicators must consider a number of factors when considering how much weight to give your treating physician's opinion, including the nature and length of your treatment relationship and the medical evidence supporting your doctor's conclusions. In practice, judges routinely ignore the opinions of treating physicians, relying instead on doctors consulting for Social Security who have either performed one brief exam or never examined the disability applicant.
To minimize the chances that the SSA will disregard your doctor's opinion, it's important to understand how the SSA evaluates the medical opinions of treating doctors, and what kinds of medical opinions the agency tends to find persuasive.
Under the SSA's "treating physician rule," your treating doctor's opinions are entitled to "controlling weight" (meaning the doctor's opinion rules) if the following two criteria are met:
SSA regulations require ALJs to assign weight to all medical opinions, and to specifically address the factors above when explaining the level of weight assigned (for example, substantial weight, little weight, no weight). Failure to provide good reasons for disregarding a treating physician's opinion is one of the most common reasons that the Appeals Council reverses or remands (sends back) a denial of benefits by an ALJ.
Oftentimes a physician who wishes to support his patient's disability case will offer to write a letter regarding the patient's condition. Unfortunately, because most doctors don't understand the disability process or what issues they need to address, these letters tend not to be very helpful (in particular, if the doctor simply states that the patient is, in his or her opinion, disabled). The question of whether the claimant is "disabled" is for Social Security to decide, not physicians. "Disability" is a legal rather than a medical term, and physicians' opinions on this matter are not given any special consideration.
On the other hand, when denying benefits, ALJs occasionally state in their decisions that "No physician has ever found this claimant to be disabled." Despite this inconsistency, it's safe to say that your doctor's opinion as to whether you're "disabled" is not nearly as important as his or her opinions on the nature and extent of your work-related limitations. Your disability attorney should be able to provide your doctor with a Residual Functional Capacity (RFC) form that will address all the issues relevant to your case if your doctor fills it out completely.
For Social Security to give your doctor's opinion a great deal of weight, make sure your doctor fills out the RFC forms in detail. In an RFC form for a claimant with physical limitations, the doctor should specify the individual's exertional (strength-related) limitations, including the ability to lift, carry, sit, stand, and walk. Non-exertional restrictions should be addressed as well, especially those related to reaching, handling, bending, stooping, climbing, and crawling. Any environmental restrictions, such as exposure to dust, odors, or extreme temperatures, should also be noted.
In a mental RFC form, the treating physician or psychologist should address the patient's ability to understand, remember, and execute simple and complex instructions; maintain attention and concentration; interact with co-workers and the general public; and stay on-task for an entire eight-hour workday without excessive breaks.
In both mental and physical RFC forms, the doctor should address attendance and punctuality, and in particular, the question of whether the patient would miss more than two days of work per month for medical reasons.
Perhaps most importantly, the physician completing the RFC form must provide a medical basis for any of the above limitations the doctor includes. Doctor who merely check the boxes on a form without citing any treatment notes, medical imaging, blood tests, or other evidence to support their opinions is not being nearly as helpful as they could be. You can get a physical RFC form here and a mental RFC form here.