How your doctor’s opinion can help you win your Alabama disability case
An opinion from your treating doctor can help you obtain Alabama Social Security disability benefits. Obtaining an opinion from your doctor is one of the most important things your Alabama Social Security lawyer can do to help you win benefits.
Under Social Security regulations, your doctor provides the most important medical opinion evidence in your case. Your doctor’s opinion may be given “controlling weight” if it meets certain requirements. In other words, the Social Security Administration will adopt the doctor’s opinion as its own.
But even if the Social Security Administration does not give your doctor’s opinion controlling weight, it must weigh the opinion using rules that recognize the special status of treating doctors. Their opinions must be given greater weight – even when they are unsupported or contradicted by other evidence – than opinions from doctors who examined you or reviewed your file, but never treated you. And whenever Social Security does not find your treating doctor’s opinion to be controlling, the decision maker must provide good reasons.
To learn what topics your treating doctor should discuss in providing a medical opinion to Social Security, see Getting medical reports from your doctor.
Acceptable medical sources
Not all health care practitioners qualify to give an opinion that will be given controlling weight. The doctor must be an “acceptable medical source.”
Acceptable medical sources are:
- Physicians (medical or osteopathic doctors),
- Psychologists (including school psychologists),
- Optometrists, and
- Qualified speech-language pathologists.
Other medical professionals fall into the category of “other sources,” whose opinions do not carry the same weight as those of acceptable medical sources. These include chiropractors, nurse practitioners, audiologists, therapists, and so forth. Opinions from these professionals can never be given controlling weight, but Social Security will consider them.
For your doctor’s medical opinion to be given controlling weight, it must meet the following requirements:
- The doctor must be both an acceptable medical source and a “treating source.” This means you must be seeing the doctor because you have a medical need for treatment or evaluation and not just to obtain a report for your disability case.
- Your treating doctor’s opinion must be a “medical opinion” – an opinion about the nature and severity of your impairments and your physical or mental restrictions.
- Your treating doctor’s opinion must be well supported by medically acceptable clinical and laboratory diagnostic techniques. “Medically acceptable” means that the clinical and laboratory diagnostic techniques that your doctor uses are in accordance with medical standards that are generally accepted within the medical community as the appropriate techniques to establish the existence and severity of your impairment.
- Finally, your treating doctor’s opinion must be not inconsistent with other substantial evidence in the case record. The medical opinion need not be consistent with all other evidence as long as no other substantial evidence contradicts or conflicts with the opinion. An administrative law judge may need to consult a medical expert to decide whether your doctor’s medical opinion is not inconsistent with other substantial evidence in the case record.
Thus, when your treating doctor’s opinion is 1) well-supported by medically acceptable clinical and laboratory diagnostic techniques and 2) is not inconsistent with other substantial evidence in the case record, it must be given controlling weight, i.e., Social Security must adopt it.
Treating doctor’s opinion entitled to deference
Even if your doctor’s opinion is not entitled to controlling weight that doesn’t mean that the Social Security Administration will disregard it. An opinion that is not entitled to controlling weight must be weighed by evaluating factors set forth in Social Security regulations. Once it is weighed, the opinion may be entitled to deference. The administrative law judge may even decide to adopt it, even though the judge is not compelled to do so.
The factors used to evaluate the weight to be given a treating doctor’s opinion are:
- How long you have been treating with the doctor and how frequently the doctor has examined you. The longer and more extensive your relationship with the doctor, the more weight the opinion is likely to be given.
- How much medical evidence the doctor presents to support the opinion. The more supporting medical evidence, such as laboratory and test results, the doctor can cite, the more weight the opinion will be given.
- How consistent the opinion is with all the other evidence in your case. The more consistent the opinion is with the rest of the evidence, the more weight it is entitled to.
- Whether your doctor is a specialist. The opinions of a specialist in your particular impairment are generally given more weight than those of a general practitioner.
- Other factors that tend to support or contradict the medical opinion. Social Security will consider, for example, your doctor’s understanding of the Social Security disability program or familiarity with non-medical information in your case.
Help from a knowledgeable Alabama Social Security lawyer
Educating your doctor about the treating doctor’s role and obtaining a medical opinion that is entitled to controlling weight requires the attention of a skilled Alabama Social Security disability lawyer. If you live in Blount, Etowah, Jefferson, or St. Clair County Alabama, you are not already represented by a disability lawyer, and you want my evaluation, briefly describe your claim using the form to the right.
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