This the is the third part of an article entitled Medical Source Statements, which discusses how your Nampa Social Security Attorney can use these statements to help win your Social Security disability claim. You may want to also read the other parts of this article, starting with “Medical Source Statements — Part I” before continuing. For more information, contact a Social Security Attorney in our Nampa Idaho office. This article covers SSR 96-2p, which is entitled “Giving Controlling Weight to Treating Source Medical Opinions” and provides your Nampa Social Security attorney with the criteria judges must use to evaluate the opinions of your doctors.
Social Security must evaluate every medical opinion they receive. (20 C.F.R. ßß 404.1527(d)) The judge may not skip or simply mention a medical opinion. Rather, every medical opinion triggers the requirement of evaluation. It is not unusual for a single treating source to provide medical opinions about several issues; for example, at least one diagnosis, a prognosis, and an opinion about what the individual can still do. Although it is not necessary in every case to evaluate each treating source medical opinion separately, judges must always be aware that one or more of the opinions may be controlling while others may not. (20 C.F.R. ßß 404.1502).
Your Doctors Opinion On What You Can Do (Residual Functional Capacity)
What you can still do despite your impairment(s) is called your residual functional capacity or RFC. 20 C.F.R. ßß 404.1545 defines residual functional capacity as
(a) General — (1) Residual functional capacity assessment. Your impairment(s), and any related symptoms, such as pain, may cause physical and mental limitations that affect what you can do in a work setting. Your residual functional capacity is the most you can still do despite your limitations. We will assess your residual functional capacity based on all the relevant evidence in your case record. (See ß 404.1546)
Social Security has reserved certain determinations for itself to make. One of these is what your residual functional capacity is. In spite of being reserved to Social Security judges, your residual functional capacity is something on which your treating doctor may legitimately give a medical opinion. And if a treating source gives a medical opinion concerning your residual functional capacity, that opinion may be entitled to controlling weight.
Multiple Limitations in a Treating Source Statement
Your doctors (and other acceptable medical sources) may give medical opinions on more than one of your limitations. The judge is not required to address each of these individually, unless one opinion is entitled to controlling weight while another may not be. For example, the record may be well established that you have difficulty sitting for long periods of time. There is an MRI showing you have severe stenosis in your lower back and your medical records clearly demonstrate physical examinations documenting your lack of flexion and pain. Your doctors opinion on how long you can sit may be entitled to controlling weight while his opinion on your ability to use your fingers my be entitled to little or no weight because he never treated your hands. For this reason, be sure to discuss all of your severe symptoms with your doctor every time your go—even if you sound like a broken record.
SSR 96-2p has a requirement that the judge must provide specific reasons for the weight he or she gives to the treating source’s medical opinion and the reasons must be sufficiently specific to make clear not only the weight given but the reasons for that weight. If your doctor’s opinion is not contradicted by another doctor, the judge must provide clear and convincing reasons for rejecting it. Even if your doctor’s opinion is contradicted by another doctor, the judge may not reject this opinion without providing specific and legitimate reasons supported by substantial evidence in the record.
The opinion of an examining physician is weighted more heavily than the opinion of a nonexamining physician, and the judge must provide clear and convincing reasons for rejecting the uncontradicted opinion of an examining physician, and even if contradicted by another doctor, can only be rejected for specific and legitimate reasons that are supported by substantial evidence in the record. Andrews v. Shalala, 53 F.3d 1035, 1043 (9th Cir. 1995).
The opinion of a nonexamining physician cannot by itself constitute substantial evidence that justifies the rejection of the opinion of either an examining physician or a treating physician.
The ALJ Must Provide Legitimate Reasons for Discounting a Treating Source Opinion
Courts have ruled that a Social Security judge my not discount a treating physician’s medical opinion without providing specific and legitimate reasons for doing so. See Rollins v. Massanari, 261 F.3d 853, 856 (9th Cir. 2001). The ALJ may not reject the opinion of a treating physician, even if it is contradicted by the opinions of other doctors, without providing specific and legitimate reasons supported by substantial evidence in the record. An examining physician’s opinion only constitutes substantial evidence if the physician relied on independent clinical findings that differ from the findings of the treating physician. Moreover, even if a treating physician’s opinion is no longer entitled to controlling weight because there is substantial evidence in the record contradicting the opinion, the opinion is still entitled to deference and must be weighed using all the factors provided in 20 C.F.R. ß 404.1527. In many cases, a treating source’s medical opinion will be entitled to the greatest weight and should be adopted, even if it does not meet the test for controlling weight.
In the Ninth and Eleventh circuits, where an ALJ has failed to properly reject a treating (or examining) source’s opinion, the federal court will accept that source’s opinion as true, as a matter of law. If the records is fully developed, the court will reverse the ALJ’s decision and remand for immediate payment of benefits, instead of for a rehearing. The record is fully developed if:
- At step three of the sequential evaluation, the treating source’s medical opinion establishes that the claimant’s impairment meets or equals a listed impairment; or
- At step five of the sequential evaluation, the treating source’s medical opinion establishes that a claimant has an RFC which is disabling under the grids or based on VE testimony; or
- At step five of the sequential evaluation, the treating source’s medical opinion establishes the claimant’s inability to sustain a regular and continuous work schedule.
Substantial evidence is “more than a mere scintilla.” It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. This means that the evidence that is inconsistent with the medical opinion does not have to be overwhelmingly convincing. It only needs to be enough that a reasonable mind would accept a conclusion that is contrary to the conclusion expressed in the medical opinion.
Any kind of medical or nonmedical evidence can satisfy the substantial evidence test. A treating source’s medical opinion on what an individual can still do despite his or her impairment(s) will not be entitled to controlling weight if substantial, nonmedical evidence shows that the individual’s actual activities are greater than those provided in the treating source’s opinion.
This article on 96-2p is continued on the link below. Be sure to ask a Nampa Social Security Attorney in our office about getting a medical source statement to your doctors.
Originally posted 2014-08-25 17:18:59.