My Doctor Says I’m Disabled. Why Was I Denied Social Security Disability Benefits?

My Doctor Says I’m Disabled. Why Was I Denied Social Security Disability Benefits?

One of the most frustrating conversations we have with prospective clients goes something like this:

“My doctor says I’m disabled. They told me I can’t work and filled out paperwork saying I am disabled. So why did Social Security deny my claim?”

It is a fair question. After all, your doctor knows your medical condition better than anyone else. Your doctor has treated you, examined you, reviewed your test results, and understands the symptoms you deal with every day. They know you and what you can and cannot do better than anyone except you, so why doesn’t the Social Security Administration simply accept your doctor’s opinion and approve your disability claim?

The answer lies in how Social Security evaluates disability claims.

Social Security Does Not Award Benefits Based Solely on a Diagnosis

One of the most common misunderstandings about Social Security Disability claims is the belief that a diagnosis automatically results in benefits.  Unfortunately, that is not how the system works.  Social Security is not simply asking “What medical condition do you have?”  Instead, what Social Security is really asking is “How does your medical condition affect your ability to perform work activities on a regular and sustained basis?”

Two people can have the same diagnosis and receive very different disability decisions. For example, two individuals may both have degenerative disc disease, multiple sclerosis, or heart disease. One may still be capable of working while the other may not. Because of this, Social Security focuses heavily on functional limitations rather than diagnoses alone.

Doesn’t My Doctor’s Opinion Matter?

Absolutely. Your doctor’s opinion can be extremely important, and they do carry weight-but not dispositive weight as the Social Security Administration is not required to automatically accept a doctor’s statement that a person is “disabled.”

This surprises many claimants, but under current Social Security regulations (see 20 CFR §404.1520c(c)), the Administration evaluates medical opinions based upon the following factors:

(c) Factors. We will consider the following factors when we consider the medical opinion(s) and prior administrative medical finding(s) in your case: (1) supportability; (2) consistency; (3) Relationship with the claimant-which encapsulates the (i) length of treatment relationship; (ii) frequency of examinations; (iii) purpose of the treatment relationship; (iv) the extent of the treatment relationship; (v) whether the physician actually examined claimant and (vi) whether the physician is a specialist.

In other words, Social Security is often more interested in why your doctor believes you cannot work than simply accepting the conclusion itself.

What Does “Supportability” Mean?

Supportability refers to whether the doctor’s opinion is supported by medical evidence.  Examples may include:

• physical examination findings;
• MRI results;
• X-rays;
• laboratory testing;
• nerve conduction studies;
• treatment notes; and
• other objective medical evidence.

Generally speaking, opinions supported by detailed medical findings tend to carry more weight than opinions that simply state a conclusion.  The Administration worries that a claimant’s family doctor will bend over backwards to help their clients and will parrot whatever their patients tell them and they want objective evidence to support the opinion of your treating physicians.

What Does “Consistency” Mean?

Consistency refers to whether the doctor’s opinion matches the rest of the evidence.  Social Security looks at:

• treatment records;
• specialist records;
• hospital records;
• consultative examinations;
• diagnostic testing; and
• other medical evidence.

If a physician states that a claimant cannot sit, stand, or walk for any meaningful period of time, but the medical records consistently document normal examinations and minimal complaints, Social Security may conclude that the opinion is not consistent with the overall evidence.  This is why it is so vitally important that claimants are honest with their doctors.  Saying things like “I’m fine” is rarely totally truthful-and reads badly in medical records.  Patients rightfully assume that their doctor knows what they mean when they say “I’m ok,” because they have spent months/years detailing their problems-but the Administration may look at such statements as proof that the person is not terribly afflicted.  Always be truthful, but don’t sugarcoat what you are going through-even though you have told them time and time again.

What Is a Residual Functional Capacity (RFC)?

Even if your doctor believes you cannot perform your previous job, Social Security must still determine what activities you are capable of performing. This assessment is known as your Residual Functional Capacity, or RFC.

An RFC evaluation attempts to determine:

• how long you can sit;
• how long you can stand;
• how much weight you can lift;
• whether you can use your hands effectively;
• whether you can concentrate and maintain sufficient attention;
• and what work-related activities you can still perform despite your impairments.

The RFC assessment often becomes one of the most important issues in a disability claim, as long as it is supported by your medical records.

What If My Doctor Writes a Letter Saying I’m Disabled?

Many claimants believe that obtaining a letter from their physician stating that they are disabled will guarantee approval. Unfortunately, that is rarely the case. A simple statement that “My patient is disabled” or “My patient cannot work” is generally not enough by itself.  What is often more important is a detailed explanation describing:

• specific functional limitations;
• objective medical findings;
• treatment history;
• medication side effects; and
• why those limitations prevent sustained employment.

Why Was I Denied If I Really Can’t Work?

There are many reasons a disability claim may be denied, including:

• insufficient medical evidence;
• gaps in treatment;
• inconsistent medical records;
• unfavorable consultative examination findings;
• questions regarding work activity;
• disagreements regarding functional limitations; or
• Social Security concluding that other work can still be performed.

A denial does not necessarily mean Social Security believes you are healthy, it simply means that the Administration was not convinced, based upon the evidence before it, that you met the legal definition of disabled under either the Listings or Grid Rules.

Social Security looks beyond diagnoses and even beyond a physician’s conclusion. The Administration evaluates medical evidence, functional limitations, Residual Functional Capacity, and the consistency of the evidence as a whole.

If your Social Security Disability claim has been denied, even though your doctor believes you cannot work, it may be helpful to speak with an attorney experienced in handling disability claims.

At Powell and Denny, we have spent decades helping disabled individuals throughout Alabama navigate the Social Security Disability process and present the evidence necessary to support their claims.

If you or someone you care for has recently been denied Social Security Disability benefits, or if you just have questions about your right to disability benefits, please do not hesitate to contact and speak with one of the experienced  Social Security Disability Lawyers at Powell and Denny today for a free consultation; and remember, virtual appointments are available through Zoom so you can meet with one of the attorneys of Powell and Denny from wherever you live. And remember, there is no fee unless you win.

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