I cannot describe the dread and foreboding that I experienced, when first reading SSA’s new approach to evaluating medical opinions. I feared it would result in even more denials for truly disabled claimants, and sadly, it has.
On January 18, 2017, SSA published the “Revisions to Rules Regarding the Evaluation of Medical Evidence.” [1] These updated rules became effective on March 27, 2017 and apply to claims filed on or after that date.
Your doctor knows best? Not anymore.
Social Security used to give the opinions of treating physicians more deference because, after all, these are doctors who actually treat the Claimant and best understand their patient’s limitations. However, that is no longer the case.
SSA no longer gives your treating doctor’s medical opinion “controlling weight.”
What does this mean for your claim?
Even though your doctor may have treated your conditions for years, their opinion is no longer given “controlling weight” when considered by Social Security.
The old rule:
“Treatment relationship.
Generally, we give more weight to opinions from your treating sources, since these sources are likely to be the medical professionals most able to provide a detailed, longitudinal picture of your medical impairment(s) and may bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone or from reports of individual examinations, such as consultative examinations or brief hospitalizations.
If we find that a treating source’s opinion on the issue(s) of the nature and severity of your impairment(s) is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in your case record, we will give it controlling weight…”[2] (emphasis added)
However, under SSA’s new rule, the opinion of the treating physician is not as persuasive as it was under the old rule. The new rule will consider what the medical opinion says, but isn’t required to trust a treating doctor’s opinion more than the opinion from a non-treating doctor.
The new rule:
“We revised the factors for considering medical opinions and prior administrative medical findings in final 404.1520c and 416.920c to both emphasize that there is not an inherent persuasiveness to evidence from MCs, PCs, or CE sources over an individual’s own medical source(s), and vice versa, and to highlight that we continue to consider a medical source’s longstanding treatment relationship with the individual.”[3] (emphasis added)
Why is this a problem?
Consider that SSA often sends claimants to undergo “consultative exams” by doctors who work for SSA. These are not doctors who have treated the claimant before. They often spend a few minutes doing a cursory exam, and then write an opinion for Social Security.
Many claimants complain that the consultative doctor will not even examine or discuss the areas of the body, or conditions, that cause the most suffering. IE: a claimant with lower back pain might have an x-ray and exam of his upper back. This happens far too frequently.
Yet, the opinion from this consultative doctor may be just as persuasive (or more so) as the opinion from your own treating doctor who has actually spent a great deal of time evaluating and treating your conditions.
My opinion:
Surely, I am not the only one who sees the absurdity of this. There is a conflict of interest, here. SSA can now choose to rely on the opinion of a doctor that THEY pay, over the opinion of a claimant’s treating doctor.
SSA has a finite budget, and a continually growing number of claimants. It is my opinion that SSA has an interest in denying as many people as possible. This rule allows them justify even more denials to folks who are truly disabled and should qualify for benefits.
I don’t want to scare anyone into thinking that SSA will disregard any and all medical opinions. I don’t believe this is the case. However, we are starting to see medical opinions from treating doctors discarded in favor of consultative opinions.
Social Security Disability is a broken system. Every effort to fix this program seems to make things worse for those very people that SSDI/SSI was designed to help.
If you have any suggestions on how to fix this Social Security Disability mess, please comment below!
Thank you and best wishes.
-Deborah L. Hardin, Managing Attorney
*Visit these pages for more info on the rules discussed above: [1] SSA’s Revisions To Rules Regarding The Evaluation Of Medical Evidence. https://www.ssa.gov/disability/professionals/bluebook/revisions-rules.html [2] Code of Federal Regulations § 404.1527. Evaluating opinion evidence (old rule). https://www.ssa.gov/OP_Home/cfr20/404/404-1527.htm [3] Federal Register, Vol. 82, No 11. Wednesday, January 18, 2017. Rules and Regulations. https://www.ssa.gov/disability/professionals/bluebook/documents/Medical Evidence Final Published.1.18.17.pdf
Originally published: November 13, 2017
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