The Social Security Administration has recently announced some important changes to its rules about how SSA will consider opinion evidence from doctors, therapists and other professionals. The changes will apply to all claims for disability benefits filed on or after March 27, 2017.
For many years, Social Security has been required to give greater weight in the disability evaluation process to the opinion of a claimant’s treating physician about the disability claimant’s work-related limitations. A “treating physician” is a medical doctor (M.D.) or osteopath (D.O.) or Ph.D. level psychologist who has an ongoing relationship caring for the claimant as a patient, as opposed to doctors who may have just seen the claimant briefly, or for a consultation, or in some cases never seen the claimant at all. So, for example, under the current rules if the treating physician has said the claimant can only lift 5 pounds, but a consultant has given an opinion that the claimant can lift 20 pounds, Social Security should evaluate the claim based on the treating doctor’s opinion rather than that of the consultant. As you might imagine, this could make a big difference in whether or not SSA might find that a claimant can work given their limitations.
Under the new rules, SSA will not have to automatically give the greatest weight to the treating physician opinion. Instead, SSA will focus on the “persuasiveness” of evidence from each medical source and whether the evidence is “supportable” and “consistent.” SSA will not have to explain its reasons for choosing one opinion over another as thoroughly as is now required by the rules, either. Many Social Security advocates and attorneys fear that this rule change will lead to SSA relying more heavily on the opinions of consultants retained by SSA to perform disability exams or to review medical records without even examining the claimant. This could mean fewer applicants will receive disability benefits.
In addition, the new rules will not require SSA to consider evidence that a claimant has been awarded disability by other agencies such as the Veterans Administration or workers compensation programs. While SSA can consider the medical reports on which the other agency’s decision was based, SSA is no longer required to consider the fact that a claimant meets another program’s disability requirements in making its decision about disability under the Social Security program.
One aspect of the changes may be good for disability applicants, however. Under the new rules, SSA will consider opinion evidence from Physician Assistants and Nurse Practitioners in the same manner as opinions from physicians. This change will be a big help for those whose treatment is provided by nurse practitioner clinics. This aspect of the new rule also recognizes recent changes in medicine that mean most hands-on care is provided by Physician Assistants and Nurse Practitioners, who are also generally more accessible to give opinions for a disability claim.
Many Social Security practitioners believe these rules changes may result in litigation, but for the time being, the rules will go into effect for any claim for disability benefits filed on or after March 27, 2017. If you are considering filing for disability, but have not yet done so, you should consider filing for benefits before these new changes go into effect. While our office does not file new claims for disability, we are always happy to consult with you if you claim has been denied and you need to appeal. Please call us if we can help you with a claim that has been denied.