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When you seek social security disability benefits, you have to prove that you qualify under the law for those benefits.  In order to do this, you are going to have to submit medical evidence to the SSA.  This is especially true if you are having to file an appeal for benefits or go to a hearing. So, you have to understand how the SSA looks at medical evidence in social security disability cases.  Usually, that makes the biggest difference in the outcome.

Medical evidence in social security disability cases are categorized as objective, opinion, or “other” medical evidence.  Objective medical evidence is medical signs, laboratory findings, and testing.  Medical opinion evidence consists of statements from your doctor about your functional abilities.  If your doctor writes a report about why you can’t work anymore, that is opinion evidence.  “Other medical evidence” includes judgments about the severity of your conditions, clinical findings and even your diagnosis.

Claims Filed Before March 27, 2017

A reviewer or a judge at the SSA is usually going to give more weight to the opinion of a doctor who has examined you.  This is especially true if the doctor has been treating you for a long time.  If that doctor’s opinion is consistent with the other medical evidence in your record, it’s even better.  In that situation, a judge might give the doctor “controlling weight.”  This means that doctor’s opinion is more important than any other doctor’s opinion in your case.

When considering the medical evidence in social security disability claims, the SSA will look at the length of time you have treated with the doctor who gave an opinion about your impairment.  The longer you have treated with that doctor, and the more times you have seen that doctor, the more weight the SSA will give that doctor’s opinion.  This is because that doctor is in a better position to know you and your conditions than any other doctor.  So, duration and continuity of care is important when putting your medical evidence together for the SSA to review.

Another important factor in the SSA’s review of your doctor’s medical opinions is the knowledge the doctor has about your impairments.  The types of treatment that doctor has provided, the tests  ordered, and the extent of that doctor’s examinations are important.  Whether the doctor is a specialist in your medical condition matters too.  You don’t want to present evidence of your spinal impairments from your ear, nose and throat doctor.

Claims Filed After March 27, 2017

After March 27, 2017, the fact that a doctor is your treating doctor and knows you well doesn’t mean much.  No doctor receives any special weight.  Instead, medical evidence in social security claims will be examined through a set of factors.  The most important factors are supportability and consistency.

Factors In Considering Medical Evidence In Social Security Disability Claims

The first factor is supportability.  This is a question of how relevant the objective medical evidence is to the doctor’s opinion.  A judge will look at whether or not the MRI or the blood work supports the doctor’s opinion.  Is the doctor’s opinion supported by the rest of the medical evidence?  Is the doctor’s opinion a reach?  The question of whether the evidence supports that doctor’s opinion is a significant factor in weighting that medical evidence.

The second factor is consistency.  Consistency affects how persuasive a medical opinion is to a reviewer.  Is the doctor’s medical opinion consistent with the other medical evidence in the case?  Do other doctors in the record share the same opinion?  The more consistent the opinion is with the other medical evidence, the more persuasive it is.

The third factor is the relationship with the claimant.  What type of relationship does the doctor who issued the opinion have you?  This factor takes into consideration how long you have treated with the doctor.  Does the doctor understand your medical history?  Has the doctor treated you many times over a long period?  The purpose of the treatment you received from the doctor can help demonstrate what the doctor knows about you.  The kind of treatment and tests ordered can help show how active the doctor has been in your care.  And, of course, a doctor who has examined you will be more meaningful than one who hasn’t.

Specialization is the fourth factor.  A doctor who specializes in your medical condition may be more persuasive than one who is not.  Specialists have advanced education in specific conditions and may be more influential than another doctor you have seen. 

The last factor is simply everything else, or other factors.  Maybe one doctor has an understanding of the SSA’s disability requirements.  Evidence could show that a particular doctor knows your medical history better than the others.  Either of these could be a factor that a judge could take into consideration when deciding which medical opinion to rely on in making a decision in your case.

See A Doctor Regularly

Medical evidence in social security disability claims is the most important evidence you can have.  This evidence helps you get through each stage of the sequential evaluation process at the SSA. It is important to be seeing a doctor while your application for benefits is being processed.  This allows a judge to get a good sense of how you are right now.  And you can see from these factors above that a doctor who sees you a lot can be very persuasive in your case.