Your Treating Doctor

This should go without saying, but obviously, doctors haven’t gotten the message.  There is Normal People Land, there is Social Security Land; and then – there are doctors. The thing to remember is Social Security disability is a legal thing not a medical thing. The definition of Work has a specific legal meaning. Lawyers who do not practice in this area and your garden variety doctors, have no idea what it means in Social Security Land. Medical conditions and limitations are the evidence part of, “Based on the evidence we have, you do not qualify under our rules.”  There are five legal steps that go into deciding whether a person can “work” at the person’s last job or if there are any other jobs the person can do. See FAQs, Doctor’s only know about your medical conditions, obviously a very important component.

Many doctors, I’m guessing 70%, refuse to do anything helpful for Social Security claimants. For whatever reason, they have gotten it into their heads that Social Security has its own doctors and that should be enough.  The Social Security Agency do have contracts with doctors who “consult” with patients. They are referred to as Consultative Examiners.  It’s worse for people who do not have obvious physical impairments (like joints, knees, hands, hips, feet, hands, neck arms) but who have Lyme’s disease, Lupus, COPD, inflammatory arthritis (RA), breathing disorders (asthma, emphysema)  and now Post-Acute Covid Syndrome (also known as long Covid, or long haulers) because they need to see the medical records and not just visual observation.

A typical examination takes less than 30-minutes.  If the claimant can get on/off the table; tie/untie their shoes; sit “comfortably” in a chair;  the report the Consultative Examiner provides is more often than not that the claimant can stand and walk at least 6-hours; and, can lift/carry at least 25-pounds.  Why?  Because the Consultative Examiner may not consider little details like age.  The Consultative Examiner has no medical records to review before writing the report and has no more than 30-minutes to get to know the claimant.

It is rare to get a report showing significant physical limitations.  I have had clients ages 18-years to 65 years old have bone-on-bone knees; nerve root impingement at several discs in the spine; Carpal Tunnel neuropathy shown on nerve conduction studies get reports finding No Limitations sitting, No Limitations standing or walking and the ability to lift up to 50-pounds.  It isn’t that the Consultative Examiners are quacks or are liars, cheats and thieves, it’s that The Rules limit what Consultative Examiners can consider when making the report.  Your own Treating Doctor is not limited by those Rules.

What we need to know, in Social Security cases, is how long a person can stand or sit; how much they can lift and carry; whether they can use their hands to manipulate objects. However, doctor’s typical response to the question is, “The patient can’t work.”  The doctor needs to explain the patient’s conditions and the negative impact, if any, on the patient’s ability to perform physical and/or mental tasks of work. If a doctor, for whatever the reason, refuses to help (typically by completing a form), there are things we can do to get the same result.

What I don’t get is why doctors won’t take the time to complete these forms; or only complete them for several hundred dollars. Kaiser Permanente has an actual policy which prevents their doctors from completing the forms.  The rationale is, “you can get it from the medical records.” Well, not really.  Only the doctor can say what the records mean. If they don’t, the Social Security Judge is free to make whatever conclusions they want. Many times, I have had doctors refuse to help while claiming “of course this patient is disabled.”  When the claimant loses, I have the patient/client give a copy of the Judge’s decision to the doctor. All of those doctors have written letters which we can use at the Appeals Council. Eventually, the claims get reversed – but the case goes back to the same Judge who denied it in the first place. And it can be denied and appealed; denied and appealed; over and over.  In 2017, I had a client who started the claim in 2009. It took almost 7 years before the case was won.