This article discusses an actual Social Security disability claim that was denied and appealed to federal court. I'll discuss the facts of the case and the judge's decision from 2015, then look at a few lessons to be learned.
The claimant, Nevida Cypress, worked as a school janitor until mid-2011 when she applied for disability benefits, initially based on carpal tunnel syndrome and depression. The claimant later provided evidence that she suffered from several other impairments, including back problems, joint pain, diabetes with neuropathy, and obesity.
To support the claimant's disability case, the claimant's treating nurse practitioner provided a written opinion that she was unable to work due to problems standing and lifting. Nevertheless, the administrative law judge (ALJ) found that the nurse practitioner's opinion was of "little significance," and that the claimant's Residual Functional Capacity (RFC) allowed her to perform work at the "light" exertional level (which involves standing for up to six hours in an eight-hour workday). Based on the testimony of Social Security's vocational expert, the ALJ found the claimant capable of performing light jobs such as housekeeper or cafeteria attendant.
Cypress appealed the denial of benefits to the Appeals Council and then in federal district court, but both upheld the ALJ's determination. Finally, she appealed her case to the Eighth Circuit Court of Appeals.
In upholding Social Security's denial of benefits, the Eighth Circuit agreed with the administrative law judge that the nurse practitioner's opinion was not entitled to significant weight. The judge wrote:
Ultimately, the question of whether an individual is able to work is a legal issue, not a medical one, the judge found. While Social Security's "treating physician rule" means that treating providers' opinions are generally entitled to significant weight, those opinions must deal with medical issues. The judge took issue with the fact that the nurse practitioner's opinion focused on whether she thought Cypress was disabled. Because "disability" is a legal term that is precisely defined in Social Security regulations, treating medical providers generally are not qualified to offer an opinion that a person is disabled for purposes of a disability claim.
The judge also determined that the ALJ's RFC finding was supported by substantial medical evidence. In particular, the claimant's MRIs revealed only mild problems, and on examination the claimant had full range of motion and muscle strength in her hands and wrists. Moreover, the judge found that the claimant's carpal tunnel syndrome was not as severe as alleged because she had refused a carpal tunnel release surgery.
The judge affirmed the district court's decision denying Social Security benefits.
Some employers require that employees who miss time due to illness must bring a doctor's note confirming that they were unable to work. While this might be good enough for some employers, it's not good enough for Social Security.
As this case shows, it's essential for your treating physician (or other medical professional) to offer specific opinions regarding your work-related limitations, such as your ability to sit, stand, walk, lift, carry, reach, balance, stoop, and bend. If you require breaks due to pain, fatigue, or other symptoms, your doctor should estimate the frequency and duration of those breaks, and why they are medically necessary. The more your treating provider can explain his or her opinion by citing to objective medical evidence, the better for your disability case.
Your disability attorney will work with your doctor to obtain a written statement or completed RFC form that outlines your work-related limitations in sufficient detail. Many physicians don't understand the disability process and what is necessary for a finding of disability; it is up to you and your attorney to educate them.
A secondary lesson to be drawn from this case is that failing to undergo surgery (or failing to follow any treatment prescribed by your doctor) can damage your disability case. While there are exceptions, especially for high risk or unaffordable surgeries, Social Security will generally expect you to undergo a relatively straightforward procedure, such as a carpal tunnel release, if your doctor recommends it.
Read the full text of this case, Cypress v. Colvin, 807 F.3d 948 (8th Cir. 2015).
Update: Social Security updated its regulations in 2017 (after this case was decided) to change the "treating physician rule" that is mentioned in this article. Social Security no longer automatically gives significant weight to a treating doctor's opinion. Instead, a claims examiner or ALJ will evaluate a doctor's opinion to see if it is supported by medical evidence and consistent with information from other doctors and nonmedical sources.