How Not Complying With Treatment Affects Your Disability Case

The Social Security Administration (SSA) wants to see that you've tried most, if not all, available remedies for your medical impairment before you file for disability benefits. The agency awards benefits to people with impairments that prevent them from working despite medical treatment, so having a condition that's stubborn enough that you can't fix it medically—despite following your doctor's recommendations—strengthens your claim that the condition is preventing you from working.

When your doctors recommend a course of treatment that could help you feel better, and you don't follow their advice, the SSA doesn't know whether the treatment would have worked well enough for you to return to work. If you don't have a good reason why you didn't follow "doctor's orders," Social Security will deny your claim based on failure to follow prescribed treatment.

When Social Security Can Deny Benefits for Medical Noncompliance

If you don't comply with treatment, take prescribed medication, or undergo recommended surgery, Social Security can deny your application for disability benefits if the treatment, medication, or surgery would be expected to improve your symptoms to the point where you could work full-time.

Your doctor might ask you to make what the SSA refers to as "lifestyle changes" like dieting, exercise, and quitting smoking. Such recommendations aren't considered prescribed treatment, so you won't be denied benefits if your doctor tells you to stop eating meat and you don't. (Because lifestyle changes can be especially difficult to make, the agency won't penalize you if you aren't able to keep them up.)

You also don't have to follow the treatment recommendations of any doctors but your own. Any treatment suggested by a doctor or examiner who helps Social Security decide disability claims won't be considered when determining whether you've complied with medical treatment.

Good Reasons for Failing to Comply With Treatment

The SSA can't deny you benefits for noncompliance without considering whether you had a good reason for refusing treatment. An agency regulation (SSR 18-3p) provides examples of good reasons for not following prescribed treatment:

• you can't afford the treatment
• side effects of a prescribed medication are worse than your symptoms
• you have a debilitating fear of a recommended surgery
• your religion prohibits a prescribed treatment
• your doctors disagree about what the proper course of treatment should be
• you're unable to understand the consequences of noncompliance
• a previous major surgery was ineffective and the same surgery was prescribed again
• opioids were prescribed and you're worried about the addiction risk, and
• the proposed treatment has a high risk of amputation or death.

If the SSA denies your application for failure to follow treatment and you have a good reason, such as the ones listed above, let the agency know. Social Security will sometimes reach out to you if they have a question about potential noncompliance, but if you take the initiative, you'll have a better chance of having your application approved on reconsideration or at a hearing.

When Can Social Security Deny My Claim if I Declined Recommended Surgery?

Social Security has the ability to deny your application if your treating doctor prescribed a surgery that's expected to restore your ability to work and you don't follow through. But because surgery can be a particularly invasive treatment, the agency understands that many factors can make surgery an unappealing option, and won't hold them against you.

However, you'll need to make sure that the SSA knows the full reason why you're refusing to have the surgery. Your medical documents should contain evidence that you understand why the surgery was prescribed, what the predicted outcome of the surgery is, and are aware of the effects of refusing the surgery. The evidence you'll need to provide depends on your reason for declining the surgery:

• If you have an intense fear of the surgery, your doctor will need to provide a written statement that your fear is a "contraindication" to the surgery—meaning that having the surgery would cause you more harm than good. Simple anxiety over the procedure isn't enough.
• If the surgery is against your religion, you'll need to show that you're affiliated with a religion that has views on surgery ordinarily known to people who are familiar with the religion's teachings (for example, Jehovah's Witnesses).
• If you're unable to afford the surgery, you'll need to show that you don't have the financial resources to pay for the procedure and you've looked into all possible low- or no-cost treatment options.
• If you received conflicting advice about whether to undergo the surgery, make sure Social Security has all the doctor's opinions so they can see that no medical consensus was reached.
• If you previously had an unsuccessful surgery for the same impairment—for example, you had a failed spinal fusion and your doctor recommended a revision—you should provide treatment records showing that the original surgery didn't improve your condition.
• If your doctor recommended a high-risk surgery (such as organ transplants or a coronary artery bypass), you can decline based on the extreme or unusual nature of the procedure.
• If you were prescribed cataract surgery in one eye that carries a high risk of complications, and your other eye already has severe vision loss, you can decline the surgery to avoid the potential for blindness.
• If your doctor recommends amputation resulting in the loss of a limb, you don't need to go through with the surgery.

The above list isn't exhaustive—Social Security evaluates reasons for declining surgery on a case-by-case basis. And if you refuse surgery but comply with alternative treatment recommendations from your doctors, the SSA won't deny you benefits based on failure to follow prescribed treatment.

When Mental Illness Results in Noncompliance

Anxiety and depressive disorders are some of the most common conditions where failure to follow prescribed treatment is an issue. Being unable to keep appointments or remember to take prescribed medications is often a symptom of these disorders. (This is especially true for people with bipolar disorder during a manic episode.)

Social Security is generally more understanding of noncompliance for applicants with mental disorders, but only to a certain degree. Getting a medical source statement from your regular psychiatrist, psychologist, or counselor can help show the agency that your failure to follow prescribed treatment is a symptom of your disabling mental condition.

Provide Complete Information About Your Treatment

At each stage of the disability determination process, Social Security will ask you to provide information about which medical providers you've been seeing and when you've seen them. Some applicants list only the doctors who they think are important to their disability application and inadvertently leave out key sources who can establish that you comply with your recommended treatment.

Cast a wide net when telling the SSA about your medical history. Include not just medical doctors but also chiropractors, physical therapists, pain clinics, nurse practitioners, social workers, and anyone else who has evaluated you or provided treatment. You don't have to submit your dental records if you're applying for disability due to heart disease, but if you're on the fence about which providers to include, err on the side of giving more information, not less.

You should also give the agency information about any alternative remedies that help you treat your condition. Let the SSA know about any over-the-counter medications, massage therapy, acupuncture, exercise, or meditation that you use to relieve your symptoms.