Having a persuasive doctor's letter about your medical limitations can make or break your Social Security disability case. The Social Security Administration (SSA) often relies on doctors' opinions to help decide whether a disability applicant meets the requirements of a listed impairment or has the residual functional capacity to do full-time work.
Not all doctors' letters are persuasive, however. Social Security can't disregard a treating doctor's opinion, but the agency can give it less legal weight if it's inconsistent with the rest of your medical record or doesn't describe your symptoms in enough detail. The length and frequency of your treatment history, as well as your doctor's credentials, are also considered.
Doctor's opinions are important whether you're seeking state short-term disability, have a private long-term disability insurance policy, or are applying for Social Security disability benefits. But neither government programs nor private insurers will accept a doctor's letter without question as the sole basis for paying out benefits. You'll need to establish that your doctor has the appropriate credentials and that the opinion is supported by medical evidence.
Social Security reviews everything that you submit for your case, but they don't have to take into consideration medical evidence that isn't from acceptable medical sources—providers who have the authority, education, and knowledge to interpret medical evidence. They include:
Physician assistants, nurse practitioners, and audiologists were added to the list of acceptable medical sources on March 27, 2017, so if your disability application was filed before that date, they won't be considered acceptable medical sources for your claim.
If your treating provider isn't an acceptable medical source, Social Security can't give weight to their medical opinion, but the agency can still use the provider's notes to help determine how severe your condition is. For example, the SSA will disregard a letter from a chiropractor that says you meet the listing criteria for degenerative disc disease, but can limit you to sit-down jobs based on the chiropractor's observations about your range of motion.
Social Security called any letter or opinion from a doctor a "medical source statement." Unless your medical source statement describes your diagnosis, symptoms, treatment history, and limitations, then your doctor's opinion may not be persuasive. A letter from your doctor simply stating that you're disabled isn't going to cut it.
When writing their medical source statement, your doctor should refer to the medical tests or clinical notes that support their opinion. If there's evidence in your file that doesn't support your doctor's opinion, they should acknowledge the evidence and explain how they accounted for it in their opinion.
Your doctor's letter should also discuss whether you meet a disability listing—a class of conditions that Social Security considers especially serious—and your functional limitations. Make sure your doctor's letter includes the maximum amount of weight you can lift; how long you can sit, stand, and walk; and whether you must avoid other movements (such as bending or typing). If your disabling condition is related to your mental health, the letter should discuss how well you can remember instructions, concentrate on tasks, and get along with coworkers.
Finally, your medical source statement should indicate how effective your treatments have been in relieving your symptoms. Any side effects you have as a result of medications should be included, especially if they would have an impact on your functioning at work. For example, if you're taking medication for high blood pressure that makes you drowsy, the SSA needs to know.
Social Security usually gives more weight to medical source statements from your treating doctor—the physician or psychologist who sees you regularly. Prior to 2017, the SSA was especially deferential to statements from treating doctors, frequently giving them "controlling weight" and adopting the doctor's opinion as the agency's own.
Since March 27, 2017, however, all medical source statements are evaluated based on how well they're supported by and consistent with the medical record as a whole. But the SSA can still consider factors such as how long and how often you've seen your treating doctor when determining how persuasive the doctor's medical source statement is.
"Well-supported" means that the doctor's opinion is backed up by objective medical evidence, such as lab tests, MRIs, or exam results. For example, if you have an X-ray showing severe arthritis in your hands and your doctor says that you can only occasionally use your hands to pick up small objects, Social Security will likely find that opinion well-supported. But if your X-rays don't show anything wrong and your doctor says you can't use your hands at all, the agency probably won't take the doctor's opinion very seriously.
"Consistent" means that the opinion isn't an outlier among the evidence, including other medical opinions and your own statements. For example, if you're seeing several providers for treatment of PTSD—including group therapy, individual counseling sessions, and medication management—a letter from your psychologist stating that you aren't able to interact appropriately with coworkers is likely consistent with the medical record. But if your clinical notes indicate that you have an active social life with minimal PTSD symptoms, Social Security will probably find that the psychologist's opinion isn't consistent with the record.
While Social Security no longer formally addresses the frequency of your doctors' visits (your "longitudinal history"), the agency can find opinions from doctors more persuasive the longer and more involved they are in your treatment. An statement from a doctor who you've seen every month for the past ten years is probably going to be more convincing to the SSA than one from a doctor who you've seen only several times.
Opinions from doctors who specialize in the area of medicine dealing with your impairment are also generally more persuasive than those that aren't. For example, having your gastroenterologist (a doctor who focuses on digestive problems) write a statement about your limitations from a traumatic brain injury wouldn't have as much sway as a neurologist might.
Keep in mind that your doctor's area of expertise and treatment relationship aren't as important for a medical opinion as being supported and consistent with the record. But these factors can be the "cherry on top" for your disability application, as having a good treating specialist's opinion in the file typically strengthens your case.
Updated February 9, 2024