People who apply for Social Security Disability due to back problems are often denied benefits because they do not have the right medical documentation. So what does the Social Security Administration (SSA) consider proper medical documentation? The answer to this is documented in their description of acceptable medical treatment sources.
If you are trying to get your claim for Social Security Disability Insurance benefits approved, you must understand what is and what is not an “acceptable” medical treatment source under the Social Security Act and regulations. Contact the Law Offices of Sara J. Frankel & Associates today for a free consultation on your SSDI and or SSI claim.
Acceptable Medical Treatment Sources
Patients with back pain often seek the help of a chiropractor for relief. In some cases, chiropractors are sought after the patient’s primary care physician has exhausted all conventional forms of treatment. Fortunately, chiropractic treatments often bring relief. But unfortunately, it is not the most helpful for Social Security disability benefit claims.
Under the SSA’s rules, chiropractors are not considered “acceptable” medical treatment sources for either treatment or medical opinions. The bottom line is that Social Security will not consider a chiropractor’s opinion regarding whether or not an applicant has a severe “medically determinable” condition.
How a chiropractor’s opinion could be used in a disability case
SSA may not bother to obtain the treatment notes of a chiropractor. But if the records are provided to them by the claimant or their attorney, SSA will usually review chiropractors’ records to assist them in determining how severe of an effect the condition has on the claimant, and they will review any imaging results from a chiropractor, like X-rays.
Keep in mind though, a disability examiner or administrative law judge (ALJ) does not have to explain in their determination or decision how they assessed any evidence from a chiropractor or if that evidence impacted their assessment.
What About Consultative Exams?
In light of the above, if you are applying for Social Security disability benefits, and your primary source of medical treatment has come from a chiropractor, the disability examiner or ALJ assigned to your case may request that you attend what is called a consultative examination, or CE.
Consultative examinations are sometimes referred to as Social Security medical examinations. SSA hires independent medical doctors or nurse practitioners to conduct these exams and provide “acceptable” medical opinions for disability claims.
What happens during a CE?
Consultative examinations are not usually very comprehensive, and do not usually take more than about 20 minutes from start to finish (although depending on your medical conditions, the appointment may also involve undergoing x-rays at the same office, or even a separate second appointment to undergo an x-ray at a different facility). Consultative examinations are basically a way for Social Security to gather the minimal recent medical evidence necessary from an “acceptable” medical source to allow them to make a determination or decision in your case.
As you can imagine, the results of these very brief examinations do not typically result in favorable determinations or decisions in benefit claims. These consultative examiners are not your personal medical care providers, they do not know you and are not as familiar with your medical conditions, symptoms and limitations as are your own providers. Therefore it is best to have your own treatment sources who are “acceptable” medical treatment sources.
How Can You Increase Your Chances of Having Your Disability Claim Approved for Back Pain?
It is best for claimants suffering from back pain to treat with a physician (MD or DO), specifically a specialist physician. If your physician agrees, you can also continue to treat with a chiropractor at the same time if you are finding that treatment to be helpful.
You should follow all your doctor’s instructions for treatment (i.e. taking medications as prescribed, undergoing recommended diagnostic tests and courses of physical therapy), and do not stop any prescribed treatments without discussing your reasons for wanting or needing to do so with your physician first.
You should ask your doctor to include in their treatment notes information about your levels of pain, functional limitations and restrictions on your activities of daily living.
Residual functional capacity assessment
It is extremely important for your treating physician, not a chiropractor, to complete what is called a residual functional capacity assessment or RFC form. This form is a checklist of different everyday activities that you can or cannot perform and your limitations in performing them. For example, the form asks your doctor to rate your ability to lift and carry, stand, sit, and walk, and if you have any restrictions of your range of motion. A well completed RFC form is an important addition to your disability application evidence.
An experienced disability attorney will assist you by drafting these forms, obtaining completed forms from your doctors, and submitting them to SSA at the appropriate time, along with copies of the doctors’ records.
Getting your Social Security Disability Claim Approved: A Takeaway
Back pain and the resulting limitations can severely impact your quality of life and ability to earn a living. To increase the chances of having your claim approved, you can not rely solely on a chiropractor’s opinion. Even if you are having some relief from or improvement of your symptoms with chiropractic treatment, you should also continue or seek out treatment with a physician, and make sure your physician completes the necessary documentation to give your claim the best chances of approval.
Attorney Sara J. Frankel has over 29 years years of experience handling Social Security disability claims. As a former staff attorney at the Social Security Administration, she knows the law from an inside perspective. She can advise you as to the best types of specialist physicians to see for your specific health conditions, and help obtain completed RFC forms and medical records from your doctors to provide to SSA.
If you are trying to get SSDI and or SSI benefits, you need a team of doctors and an experienced disability lawyer at your side. Contact the Law Offices of Sara J. Frankel & Associates today at 508-730-1451 for a free consultation on your disability claim.