WHAT YOU NEED FROM YOUR DOCTOR TO PROVE DISABILITY
THE BURDEN TO PROVE DISABILITY IS ON YOU
Your doctor can help you prove to the SSA that you have a severe medical condition. You need the help of your doctor, because the burden to prove that you deserve benefits is on you. Submitting medical evidence is important, but statements from your doctor about how your medical condition prevents you from working are valuable evidence for your case. If so, then what is it that you really need from your doctor to win SSDI and SSI benefits?
This article will discuss everything you and your doctor can do to improve your chances of winning SSD and SSI benefits. Pay attention, because when you submit the proper evidence to the SSA, it will help them grant your case. Additionally, it might mean that you don’t have to wait two years for an SSA decision in your favor.
MAKE SURE TO GIVE YOUR DOCTOR’S CONTACT INFORMATION TO THE SSA
Once you file an application for SSDI and SSI benefits online at the Social Security’s website, you will have the opportunity to give a list of your doctors to the SSA. Make sure that you give the SSA the correct address, phone number, and name of all of your doctors. Likewise, if you have been in the hospital or a rehabilitation facility, make sure you include that information too.
The reason you want to give all of this information to the SSA is they will start asking for copies of your medical records. They will do this even if you provide them a copy of your medical records. However, they don’t always collect everything. So, you must be wary. For example, if you had a back operation one year before you allege your disability began, the SSA probably won’t get a copy of that operation.
Usually, the SSA only collects records from the time after you stop working. If you have a history of a severe medical condition, like multiple back operations, get a copy of all your operative reports. Then, submit them to the SSA. If you have a lawyer, then inform them of your medical history. They should collect those records for you. Learn more about how to build medical evidence for your case. If you have a medical condition that is a compassionate allowance make sure your doctor sends that information to the SSA.
DO YOU NEED MEDICAL RECORDS FROM ALL OF YOUR DOCTORS?
Yes. You need to submit medical records from all of your doctors. Some lawyers will tell you that you only need to submit medical records from the doctors who are treating your most severe medical condition. However, we do not believe this is the best course of action. When the SSA looks at your case to decide whether or not to pay you benefits, they are not looking at just one medical condition. They are looking at your health as a whole.
For example, if you believe you cannot work due to symptoms from your Diabetes Type II, then you should submit evidence from the doctor who treats you for that illness. However, in addition to your diabetes, you may have obesity, pain from a back condition, and an anxiety disorder. You may think these lesser conditions don’t matter. But they do.
Every medical condition matters, because each symptom may keep you from doing certain kinds of work. If you have a back condition that causes pain, you may no longer be able to sit at work during an eight hour day. Similarly, if you have anxiety, you might not be able to work with groups of people or the public. If you don’t submit those records, then the SSA will not consider the symptoms you have from your other medical conditions. Learn more about the importance of medical records here.
WHAT TO DO WHEN YOU GET A TEN DAY LETTER?
If you receive a denial at any stage of the application process, make sure the SSA has a copy of all of your medical records. For example, you may receive a letter that states your doctor has not sent your medical records to the SSA. The letter might only give 10 days to respond. Please don’t worry about the 10 day letter. Yes, you should try to comply with getting a copy of your records into the SSA in the 10 time frame. However, you can always call the SSA and ask them to give you more time.
Instead of worrying, use your time to collect the medical records from your doctor and submit them to the SSA. Also, please remember that letters do cross in the mail. If you know your doctor sent your records, then call and ask the SSA if they got them. Sometimes, the records arrive after the SSA sends out the 10 day letter.
Your burden to submit all of your medical records doesn’t end at the application or appeal stages. In fact, you must update all of your medical records prior to your hearing. There is a specific 5 day rule that applies to the hearing. All of your updated progress notes, medical records, and any statements from your doctor must be submitted to the ALJ 5 working days prior to your hearing. To learn more about the 5 day evidence rule, read here.
WHAT KIND OF TESTING DO YOU NEED TO SUBMIT TO THE SSA FROM YOUR DOCTOR?
Obviously, the type of medical evidence you need to submit from your doctors will depend upon your medical conditions. However, as a general rule, you should submit medical evidence from your primary doctor, any experts that you see, and operative reports. Also, you should submit any sort of medical testing that you may have had.
PHYSICAL CONDITIONS
If you are filing for benefits based on a severe physical condition, then you will need to submit the following medical information:
- copies of MRIs, CT scans and X-rays
- reports that talk about the findings from the above listed tests
- operative reports and epidural steroid injection reports
- medication list that includes the dosage amounts and side effects
- admission and discharge statements from the hospital
- progress notes from pain management visits
- physical therapy therapy records
- letter from your doctor about your ability to work
- chiropractic visits (although these are not as important as medical evidence from your doctor)
- Physical Residual Functional Capacity Assessment (these can be filled out by your doctor or your doctor can send you to physical therapy for a test)
MENTAL CONDITIONS
Mental conditions can also keep you from working. For example, you may have an Anxiety Disorder or Obsessive Compulsive Disorder. If you file for benefits based on a mental illness, then you should submit the following medical information to the SSA:
- progress notes from you psychologist, doctor, and treating counselor
- a one time psychiatric evaluation
- medication list that includes the dosage amounts and side effects
- progress notes from any hospital stays
- progress notes from any outpatient clinics that you attend (this includes group therapy progress notes)
- a listing letter from your treating doctor that states your mental illness meets a listing and that you cannot work
- Mental Residual Functional Capacity Assessment completed by your counselor
- Mental Residual Functional Capacity Assessment completed by your psychologist
- Mental Residual Functional Capacity Assessment completed by your psychiatrist
- if drugs or alcohol are part of your mental problem, then you need a statement from your treating doctor that they are not a factor in your mental illness
COMBINATION OF PHYSICAL AND MENTAL CONDITIONS
If your application for benefits is based on a combination of medical conditions, then you still need to provide specific medical evidence to the SSA. That evidence needs to prove that you cannot work due to all of your conditions. For example, if you file for SSDI and SSI benefits based on osteoarthritis, diabetes type 2, and depression, then you need to give the SSA information about all three conditions.
- progress notes from all of your treating doctors
- progress notes from pain management visits
- physical therapy therapy records
- letter from your doctor about your ability to work
- Physical Residual Functional Capacity Assessment from your treating doctor
- Mental Residual Functional Capacity Assessment from your counselor that you see on a weekly basis
- Mental Residual Functional Capacity Assessment from your psychologist
- Mental Residual Functional Capacity Assessment from your psychiatrist
- copies of MRIs, CT scans and X-rays
- reports from the doctor that talk about the findings from the above tests
- surgical reports, epidural steroid reports
- medication list that includes the dosage amounts and side effects you have from the medications
YOUR DOCTOR CAN HELP PROVE YOU MEET SSA’S LISTINGS
The Social Security Administration has a list of medical conditions that qualify for benefits. This list of conditions is known as the “listings” or the “blue book.” If you have a condition on the list, then your lawyer should ask your doctor to fill out a listing form. Our website has many articles on specific diseases and medical conditions that are part of SSA’s listings.
For example, back pain and spinal conditions are found under listing 1.15. To meet SSA Listing 1.15 you must document a back condition that is causing nerve root compression. When a nerve root is damaged this results in pain, muscle spasms, and loss of sensation in your legs or arms. According to the SSA, to meet the listing you must also document muscle fatigue, muscle weakness, sensory changes, decreased deep tendon reflexes, or sensory nerve deficit on a nerve test. Next, you must also show that due to the spinal condition you use a wheelchair, a walker, or two canes or crutches.
Most people, even those who have had multiple back operations, do not meet listing 1.15. The SSA has made the listing too difficult to meet by requiring two canes or two crutches in order to walk. They are saying, in essence, that you will need to use your arms to support yourself, so you cannot use your arms to work.
The back listing didn’t used to be as difficult to meet, but it is now. Therefore, since most people do not meet or equal the listing, they turn to the third way to win benefits. The third way uses your residual functional capacity and a vocational analysis of your ability to work. To learn more why a vocational expert is coming to your SSA hearing, read here.
YOUR DOCTOR CAN HELP PROVE YOUR RESIDUAL FUNCTIONAL CAPACITY (RFC)
The SSA is going to read your medical records and come up with a residual functional capacity assessment (RFC) of what they think you can physically do in an 8 hour day. The RFC defines your limits after taking into account all of your medical conditions.
In terms of physical functions, the SSA defines your ability to sit, stand, walk, and lift, during the course of an 8 hour workday. Likewise, the SSA will include your ability to carry, pull, and push. Find out more about how the SSA defines work here.
In terms of mental limits, the SSA will determine if you have trouble with memory, focus, or learning new tasks. Additionally, your mental condition can impact your ability to use your skills, such as reading or doing math. Mental illness can also impair your ability to get along with other workers, your boss, or the general public.
It will help you if your doctor also submits an RFC form for you. An RFC form can be about your physical limits and also about mental limits. The main thing to keep in mind is that the medical evidence must support the opinion of your doctor about your RFC. For example, progress notes from the doctor must show the same limits as those on your RFC form. If the RFC from contradicts the progress notes, then the SSA will refuse to give weight to the medical opinion of your doctor.
EXAMPLES OF WHAT YOUR DOCTOR SHOULD PUT IN A PHYSICAL RFC FORM
Here are some physical limits that are important for your doctor to include on a physical RFC form:
- how many pounds you can lift at one time and throughout an eight hour work day
- minutes you can sit at one time in an office chair
- the number of minutes you can stand at one time in one position, like in a line at the store
- how far you can walk before needing to sit down
- do you need to lay down during a 9-5 day and if so, for how long
- if you have breathing problems in a work environment with dust or fumes
- are you unable to stoop, bend, kneel, crouch, crawl, use a ramp, or reach in all directions
- being unable to use your hands to pinch, type, turn, push, pull, or use tools
- trouble seeing objects or loss of ability to hear
- the need to avoid heights or dangerous machines
One reason to hire an SSD attorney is that we have years of experience asking doctors to fill our physical RFC forms. It is also important to get your doctor to write a letter about your physical limits and how your condition prevents you from working a 40 hour work week. For example, if you have Post-Polio syndrome, you will need your doctor to discuss your symptoms in a letter to the SSA. Hire a lawyer with experience to obtain this important information for you.
EXAMPLES OF WHAT YOUR DOCTOR SHOULD WRITE IN A MENTAL RFC FORM
The mental RFC assessment is also crucial to winning your SSDI and SSI benefits. If you cannot focus or finish tasks, you will not be able to keep a job. Employers need workers that can follow instructions and keep up with production. You will need to show the SSA that your mental illness impacts your ability to do work tasks and use any work skills that you might have. Here are some of the main mental issues your doctor should address:
- can you understand, remember, and carry out simple instructions
- are you able to deal with other workers and your boss
- how do you react to criticism or changes at work
- can you deal with the general public
- can you remember instructions
- will your emotions or behavior cause problems for other workers
- do you have audio or visual hallucinations
- can maintain appropriate dress and normal standards of cleanliness
- will you miss too much work
- do you need too many extra breaks during a work day
- will you be off task too much during an eight hour day
Before your mental health doctor fills out the RFC form, you should talk to them about how your mental illness impacts you on a daily basis. If you have lost a job in the past due to your mental illness, make sure your doctor knows about it. Also, make sure your counselor or doctor understands how your panic attacks keep your from being a good employee. For more information on mental conditions the judge must consider, read here.
SHOULD YOUR DOCTOR BE A WITNESS AT YOUR SSA HEARING?
If your doctor fills out the RFC forms and also writes complete progress notes, then chances are they will not need to testify at your SSA hearing. However, if you have a complex medical case or your doctor volunteers to testify, you should ask your lawyer if it is a good idea to have them attend your hearing.
At times, it can be smart to have your doctor testify. For example, if you have a complex medical condition, like Multiple Sclerosis or Huntington’s disease, your doctor can come to the hearing and testify about your symptoms. Similarly, if you have psychosis due to schizophrenia, you may not be able to testify properly on your own behalf. That would be an example of when it is wise to have your doctor testify to your mental symptoms.
However, most of the time, your lawyer will probably not want your doctor to testify at your hearing. There are many reasons for this. First, it can be very expensive. Most doctors are not willing to take time away from their medical practice to testify in court. If they are willing to testify, they usually want to be paid for their time. The cost of having a doctor testify is usually more money than most people can afford.
Second, if your doctor volunteers their time, the SSA judge might dismiss their opinion stating because they do not know SSA’s rules. Once again, the question about whether your doctor should testify is really a question for your attorney. If your attorney does want the doctor to be there, then your attorney should meet your doctor to discuss the questions that will be asked at the hearing. If you have questions about the wait time for a hearing and the judge’s decision, read here.
WHAT TO DO IF YOU CAN’T AFFORD A DOCTOR
Now that you know you need the help of your doctor to win SSD and SSI benefits, you may need to find a good doctor. This may be harder than it sounds. Especially if you don’t have medical insurance. Many people cannot afford to go to a doctor. They can’t go because they have never had medical insurance or they lost their insurance when they became unable to work. One option is to have the SSA send you to a free SSA exam with one of their doctors. A better option is to find your own doctor.
At Cannon Disability Law, our goal is to help you find a doctor who will support your SSD claim. On this website we offer you many helpful options. For example, we have a list of free and low cost health services in Utah. We also have a list of free and low cost health services in Nevada. Similarly, if you don’t have insurance and need a free or low cost doctor in Idaho, read here. We also have a list of free health services in Colorado.
The most important steps you can take toward winning benefits is to find a doctor, visit the doctor, and get ongoing treatment. When you have a doctor, you will get the treatment you need for your illness. And, if you can’t work, then the doctor should help you by telling the SSA that fact. If you don’t find a doctor on our lists, then call or contact us online at Cannon Disability Law. Speak to one of our attorneys or our staff today. We will do what we can to help you find a doctor that supports your claim for benefits.
HIRE US. WE WILL HELP YOU WIN YOUR BENEFITS.
If you have already sent in medical evidence from your doctor, you may be wondering whether the SSA will ever approve your claim for SSD and SSI benefits. If you need help, call Cannon Disability. We are the only law firm helping SSD and SSI clients in Utah, Nevada, California, and Idaho with over 30 years of experience. As an example of our experience, we are rated in the top three SSD lawyers in the state of Utah.
If you need to know how to check on the status of your benefit application, then read here. Our article will show you how to do that. If you are our client, call us, because we can do that for you.
We are also rated in the top three SSD lawyers in the state of Nevada. Find out more about our Nevada legal experience here. We also help clients in many other states. Many of our clients live in Idaho, Colorado, and California. Idaho SSD benefits information can be found here. Likewise, information about Colorado benefits is here. Finally, California benefits information can be found here. Wherever you live, we will help you get your SSDI benefits and fight for the benefits the SSA owes you.
WIN BENEFITS WITH THE HELP OF YOUR DOCTOR & CANNON DISABILITY LAW
If you want to learn more about the lawyers and staff at our law firm, then read our About Us page. For instance, Andria Summers has over 21 years experience in Social Security law. She can also help you with your Medicare plan. Additionally, she has won thousands of SSD cases.
Dianna Cannon has been helping SSD and SSI clients for thirty years. Brett Bunkall also has years of experience helping people obtain their benefits. We are experts. You can trust us to help you win your SSD and SSI benefits. Contact us today. Put our experience to work for you and we will help you and your doctor win the benefits that you deserve.
At our law firm, our lawyers have won over 20,000 SSDI and SSI cases. This means that we have helped over 20,000 people to win Medicaid and Medicare benefits too. Also, in 30 years we have won over $100 million in back due and ongoing benefits for our clients. You are three times more likely to win your benefits if you hire an attorney.
However, you need to hire an attorney who has legal experience and understands the law. Hire a law firm that focuses only on Social Security law. Put our experience to work for you. We can help you win, with the support of your doctor, your SSDI and SSI benefits.
