Can Social Security Ignore My Doctor's Opinion on Disability?

There are rules that govern when Social Security can discount your doctor's opinion.

Social Security disability claims examiners and judges often ignore doctors' opinions, for several reasons, some valid and some not so valid. Especially if you attended a consultative exam with a Social Security doctor who found little evidence that you suffer from a disabling impairment, an examiner or judge may find reasons to discount your own doctor's opinion.

Can an examiner or administrative law judge (ALJ) do this? It depends. Under Social Security's new regulations, published in 2017, an examiner or ALJ needs to give weight to your physician's opinion only when the doctor's opinion is supported by objective evidence (such as blood tests or x-rays, or at least the doctor's clinical notes) and an explanation and when your doctor's opinion is consistent with the rest of the evidence in your file.

Lack of Medical Evidence

If your medical records don't contain strong evidence such as test results, Social Security is more likely to ignore the opinion of your physician. If your doctor simply wrote a letter addressed to Social Security saying that in his opinion, you are totally disabled and can't work, and didn't include evidence or an explanation of what your limitations are, Social Security can disregard the opinion completely. It isn't your doctor's job to pass judgment on whether you meet Social Security's definition of disability. (A federal judge confirmed this clearly in a recent carpal tunnel case.)

Instead, it's your doctor's job to provide sufficient evidence of your impairments and to give details on what your capacities and limitations are. For example, if your doctor fills out a form that states whether you are limited in how long you can stand, sit, and walk; how much weight you can lift and carry; whether you can follow directions and pay attention; and so on, and if your medical records include evidence that backs up these limitations, then Social Security should give a good deal of weight to your doctor's opinion. (To avoid having an examiner or judge discount your physician's opinion, have your doctor fill out our physical capacity form or our mental capacity form.)

If your doctor has provided a detailed opinion on your limitations but it is based on your subjective complaints rather than objective evidence, that's another reason Social Security may discount your doctor's opinion (especially if the ALJ finds that you lack credibility, as happened in this claim for depression).

Contradictory Evidence

If your file contains evidence that contradicts your doctor's opinion (what disability lawyers sometimes call "bad facts"), Social Security is likely to give less weight to your doctor's opinion. For example, if your doctor's opinion was that you could no longer work because you couldn't lift over 10 pounds, but your file contains evidence that, after applying for disability, you were working a part-time job that required you to regularly lift 25 pounds, Social Security can discount your doctor's opinion.

If a claims examiner or ALJ doesn't give your doctor's opinion much weight, either because your file has a lack of objective medical evidence or includes evidence that contradicts your doctor's opinion, the examiner or ALJ needs to consider some specific factors to decide how much weight to give your doctor's opinion.

Factors Determining Weight Given to Doctors' Opinions

Here are some examples of factors examiners and judges may consider when deciding that your doctor's opinion is not very persuasive.

  • You have not been seeing the doctor for long.
  • You have seen the doctor only a few times.
  • Your last visit to the doctor was over six months ago.
  • The doctor is not that familiar with your case even though he diagnosed your illness.
  • The doctor does not have specialized knowledge or training about your specific impairment.
  • Your doctor didn't provide a good explanation for why you have certain limitations.
  • There is evidence in the file that contradicts your doctor's opinion
  • The doctor provided little objective evidence of your impairment.

When examiners or ALJs discount a doctor's opinion, they must explain their assessment of whether your doctor's opinion was consistent with other evidence in your file and whether the opinion was supported by medical evidence and your doctor's explanation. An examiner or ALJ may also discuss other factors they relied on to come to this decision, though they re not required to. You should be able to find a discussion of these factors either in your personalized notice that came with your denial letter or in the judge's written decision.

If Your Doctor's Opinion Was Ignored

If you have a doctor who supports your disability claim, who has treated you for a relatively long time, who has extensive medical knowledge of your case and your impairment, and who has recorded signs and symptoms to document your disability, Social Security should give substantial weight to his or her opinion. Contact a disability lawyer if your doctor's opinion was ignored when it should have been followed.

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