Do I Need to See a Specialist to Qualify for Disability Benefits?

 Posted on June 06, 2018 in Already Applied for Disability Benefits

Medical evidence is usually the key to obtaining Social Security disability benefits. Your best source of credible medical evidence is generally your own doctor. But what if your doctor is an internal medicine generalist and not a specialist? Can Social Security disregard your doctor's views simply because they lack specialized training or experience with respect to your particular disability?

Judge Rejects Social Security's Excuses for Rejecting Primary Care Doctor's Diagnosis

A federal judge here in Illinois recently confronted these questions. The plaintiff in this lawsuit seeks Social Security benefits due to a number of physical and mental impairments. Of particular note, the plaintiff suffers from “lumbar disc abnormalities” that restrict his ability to sit, stand, and walk.

The plaintiff's primary care physician explained that due to his condition, the plaintiff could not walk more than two blocks and could not sit or stand for more than 15 minutes at any given time. This, combined with his “mood issues” and chronic pain, render him “disabled” and unable to work.

The Social Security administrative law judge (ALJ) assigned to review the plaintiff's initial application gave “little weight” to the doctor's opinions, however, citing the fact he was an internal medicine doctor who did not specialize in “neurological and orthopedic” impairments. The ALJ also cited the doctor's lack of familiarity with the Social Security Administration's “evidentiary requirements” in disability hearings as grounds for discounting his medical opinions.

On appeal, a U.S. district judge said the ALJ's reasons were insufficient and warranted granting the plaintiff a new disability hearing. The judge explained that while the ALJ has the discretion to decide “what specific weight to give” a treating physician's opinion, that assignment must be consistent with the available medical evidence. The fact the treating physician is not a specialist is not, in and of itself, relevant. Here, the judge noted there was “no specialist on record contradicting” the treating physician's conclusions. And while it might be beneficial to have a specialist's views, a primary care physician is nevertheless “fully capable of evaluating whether a patient can walk, sit, push, pull, or perform everyday movements.”

As for the treating physician's unfamiliarity with Social Security rules, the judge found this rationalization especially “dubious.” The judge noted there is no legal requirement for a healthcare provider to “be familiar with Social Security regulations.” Indeed, to infer such a requirement exists would make it impossible “to find any reliable medical expert testimony at all.”

Get Help from a Chicago Social Security Disability Lawyer

It is always important to present Social Security with as much credible medical evidence as possible in support of your disability claim. But Social Security cannot fabricate additional requirements just to avoid awarding you benefits. An experienced Cook County disability benefits attorney can help you in presenting your case to Social Security and, if necessary, fight an improper decision against you in the courts. Contact Pearson Disability Law, LLC, at 312-999-0999 to schedule a free consultation with a member of our team today.

Source:

https://www.ssa.gov/planners/disability/qualify.html