Developing Medical Evidence for Social Security Disability Without a Doctor

Your attorney may be able to develop medical evidence using consultative exams and testimony from you and a medical expert.

The medical evidence needed to establish a medically disabling condition includes office records of physicians who have treated you, diagnostic test results, hospital records, and statements from your doctors describing your functional limitations. Medical records are of the utmost importance in Social Security because most cases are decided on the basis of medical evidence alone. To develop medical evidence to support your case, you need to see a doctor.

Won't Social Security send me to a doctor?

While some disability applicants are sent to a Social Security disability doctor to fill in a gap in the medical evidence, it is not common for someone who is sent to a  consultative exam to be approved for benefits. Therefore, it's  critical that you see your physicians regularly and follow their treatment plans.

The most important advice we give clients is that they must be receiving treatment for any medical condition they believe has any impact on their ability to work. It is not enough to say that  you are disabled and unable to work.   Medical evidence of continuous medical treatment must be submitted to support your allegation of disabling symptoms.  

This is important for several reasons: first, practically speaking, it is very difficult to convince an administrative law judge (ALJ) that your medical condition is disabling if you are not receiving treatment for that condition. Second, even if an untreated medical condition is clearly disabling, it would be impossible to prove whether the condition would improve and allow them to work if appropriate treatments were followed. (This is why it's important to comply with treatment recommendations.)

What if I have not been seeing a physician?

The bottom line is that if a client simply refuses to seek medical attention, or makes excuses for not doing so, no one can help them.

However, there are obviously situations where it is not the client’s fault (altogether anyway) that he or she has had sporadic medical treatment. The most common of these situations is when he or she does not have medical insurance, or has not had medical insurance at some point in the past.   Also, clients who have had to move frequently have not had the opportunity to establish a regular treating relationship. Finally, the nature of some clients' medical condition prevents them from receiving treatment (for example, a client whose mental or emotional impairment makes them distrustful of physicians, or those who are in denial that they have an impairment).  

How can I prove disability if I haven't seen a doctor?

In such cases, it can still be possible to prove disability. However, you'll likely need to appeal to the disability hearing level and hire a lawyer to represent you. A disability lawyer can obtain whatever records are available and have the client "fill in the gaps" with testimony (answering prepared questions posed by the lawyer), and/or hire a medical specialist to review the records that are available and give a medical opinion as to the likely course of the client's medical condition during the time or times they were not in treatment.

The bottom line here is that even though Social Security will require evidence of treatment, even if you have had sporadic treatment you can turn that trend around now and develop evidence that will help the judge decide the case in your favor.

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