Getting Your Doctor's Opinion Into Your Social Security Disability File and Making it Count

Your doctor's opinion is a very important part of your Social Security disability case. Social Security often relies on doctor's opinions to help decide whether a disability applicant meets the requirements of a disability listing or whether the applicant has the residual functional capacity (RFC) to continue to work.

Whether Social Security will rely on your medical provider's opinion depends on the provider's credentials, how the provider writes his or her opinion, whether it is consistent with other information in your file, whether medical evidence in your file supports the provider's opinion, and possibly your relationship (and history) with your provider.

Your Provider's Credentials

Social Security will review everything that you submit for your case, but they may disregard medical evidence that does not come from an "acceptable medical source." Acceptable medical sources are:

• licensed medical or osteopathic doctors
• licensed optometrists, for purposes of establishing visual disorders only
• licensed podiatrists, for purposes of establishing impairments of the foot, or foot and ankle only, depending on individual state licensing restrictions
• qualified speech language pathologists, for purposes of establishing speech or language impairments only, and
• licensed or certified psychologists (including unlicensed school psychologists when the claimant alleges intellectual disorder, learning disabilities, and borderline intellectual functioning).

And for claims submitted after March 27, 2017, physician assistants (PAs), advance registered nurse practitioners (ARNPs) (also known as advanced practice registered nurses, or APRNs), and licensed audiologists are considered acceptable medical sources.

If your treating doctor is not an acceptable medical source, Social Security may either disregard the doctor's opinion or it may just use the provider's information to establish the severity of your impairment. For example, you may submit a letter from your chiropractor saying that you have degenerative disc disease that meets a disability listing, but Social Security will disregard that opinion. However, if the chiropractor goes on to say that he or she has been treating you for years and that you cannot sit or stand for more than 30 minutes at a time, Social Security could use that information to decide how severe your condition is. (If you are trying to get disability for degenerative disc disease, you will also need a diagnosis from an acceptable medical source such as an M.D. and medical evidence such as an MRI.)

The Contents of Your Doctor's Opinion

Social Security refers to any letter or statement from a doctor as a "medical source statement." Unless your medical source statement describes your diagnosis, your symptoms, your treatment history, and the limitations imposed by your condition, then you may not win your case even though your doctor thinks you are disabled.

For cases filed after March 26, 2017, Social Security has changed the rules so that your treating doctor's opinion is no longer given special weight. Instead, the agency now evaluates all medical opinions—including those from Social Security's consultative examiners (doctors paid by Social Security)—based on their persuasiveness.

To help your doctor or nurse's opinion be persuasive, it needs to do more than state your diagnosis and whether you are disabled. First, your doctor should refer to the medical tests or clinical notes that support your doctor's opinion. If there is evidence in your file that doesn't support your doctor's opinion, your doctor should address why the evidence isn't necessarily inconsistent with the doctor's opinion.

The doctor's opinion should also specify whether and how you meet a disability listing. For example, if you are trying to prove that your six-year-old child meets the listing for intellectual disorder, it would be helpful to have a doctor describe the behaviors they have seen in your child indicating severe impairments in social functioning, personal functioning, concentration, and/or cognitive and communicative functioning.

Your medical source statement should also describe your functional limitations. If you can't lift much weight, can't sit or stand for very long, have problems walking or using your hands, are afraid to leave your house, can't remember instructions, or can't get along with coworkers, it's essential that your doctor details those limitations. Your doctor must also explain what evidence he or she relied when coming up with your limitations.

Finally, if you have been receiving treatment or taking medications for your condition, your medical source statement should indicate whether any of the treatments or medications were effective. You need to show that you are unable to work in spite of treatments and medications. If there are side effects to any of your medications, the medical source statement should describe them. For example, if the only effective treatment for your condition is a medication that makes you too drowsy to function, then Social Security needs to know that.

Your Relationship With Your Doctor

Social Security sometimes gives more weight to the opinion of a doctor who has treated you regularly for a long period of time. If the doctor whose opinion you are offering has only reviewed your records and never examined you in person, or if you have only seen the doctor for the purpose of getting an evaluation to help you with your disability case, then Social Security may give the opinion less weight, all other factors being equal.

RFC Assessment Forms

It can be difficult for doctors to write good medical source statements. Instead of asking the doctor to write a letter, it is better to get the doctor to fill out a Residual Functional Capacity (RFC) form. RFC forms are relatively long and involved, so the doctor might charge a fee to do it. However, the fee is probably worth it; if you use an RFC form, you will be certain that the doctor includes the right amount of detail and covers all of the important questions. See these samples of mental and physical RFC Assessment forms.