A Change to the Treating Physician Rules
Until 2017, the Social Security Administration (SSA) used to afford special dignity to medical opinions generated by a Claimant’s treating physician. In 2017, this changed, and the SSA adjusted it’s approach. All medical opinions whether from a treating physician or an independent reviewer are now evaluated on the same basis, with an eye toward how evidence-driven they are, and how consistent they are with the record as a whole. This rule prevents a Claimant’s long term treating physician from “gaming the system” by writing opinion statements that are highly favorable even if not supported by underlying treatment records. This rule also starts Consultative Examination (CE) reports (SSA’s hired physicians) with equal dignity to a Claimant’s treating physician records. Historically, CE reports tend to be quite unfavorable toward Claimants, but the upshot of the rule change is that many of these CE reports are so remarkably far afield of the Claimant’s body of records that they are easy to discount.
The new rules also give guidance what an adjudicator should do when confronted with multiple medical records that, while divergent, are consistent with the other evidence on file and otherwise well-supported. In these cases, the SSA directs adjudicators to look toward the length of the treatment relationship between Claimant and physician, as well as determining whether one of the physicians is a specialist in the field about which they are issuing opinions. These additional determinants will help establish which records are to be afforded the most weight when evaluations occur.
Supportive Treating Physician Records
I often recommend that clients discuss the fact that they are filing disability with their treating physician. This way, a Claimant can gauge how supportive the physician will likely be, as well as signaling to the physician that the records which come from the treatment will be scrutinized by the SSA. If a treating physician exhibits a strong aversion to their patient declaring disability, this is likely a signal that their records will probably not be helpful, and could even hurt the Claimant’s case. Should this happen, someone who is seeking disability would be well-served to evaluate their other choices of physicians. In the alternative, if a treating physician indicates their support, it would be worth discussing whether or not they would provide written opinions about their patient’s functional limitations and residual functional capacity for work. Residual Functional Capacity forms, Psychiatric Review Technique forms, and letters of support can make a huge difference in whether a case succeeds or fails.
Electronic Health Record Complications
Most physicians have integrated some form of Electronic Health Records into their practice. While this creates easily store-able, shareable, and reproducible data, I have seen it lead to problematic ends. Many systems carry data forward such as check box selections, system evaluations, and other entries. Additionally, many systems pre-populate forms with “normal” entries and then allow the physician to adjust entries that they determine to be abnormal. Where this can cause problems is in cases where the physician prefers to write narrative without checking each line item in their medical records. This can cause EHR narrative to become disconnected with Historical Data or Body System data. Many doctors will change this if the inconsistencies are pointed out, but it definitely underscores the need to read physician notes to ensure that the rest of the records support those notes.
If you are pursuing a Social Security Disability or SSI case, it is vital that you gather and examine every page of your the record generated by every treating physician from the claimed period of disability. If this seems like an overwhelming task, contact The Law Firm O’Brien & Feiler for assistance, and if you have questions about the terms used in this note, please visit our online glossary.