The role of medical evidence in SSDI cases and how a lawyer can help

On behalf of Jason Baril at Law Offices of Ogle, Elrod & Baril PLLC

Both the Social Security Administration and the applicant have responsibility to develop the medical record.

Monthly Social Security Disability Insurance payments can provide the financial safety net a person needs when disability prevents him or her from working. But if the Social Security Administration does not have the objective medical evidence it requires to support a finding of disability, an SSDI application is likely to be denied.

When an SSDI application is filed with the SSA, the agency creates a file for all of the documentary evidence gathered in support of the claim. If the claimant meets the work history requirements that give him or her insured status, the inquiry turns to proof of disability.

To be disabled for SSDI purposes, a claimant must be unable to work because of a severe medically determinable physical or mental impairment, or combination of impairments, that has lasted or is expected to last at least 12 months or result in death. Medical impairment is defined in the Social Security Act as that resulting from “anatomical, physiological or psychological abnormalities” shown by “medically acceptable clinical and laboratory diagnostic techniques …”

Disability turns mostly on objective medical evidence, although other sources of information about the limitations an impairment causes in activities of daily living or vocational tasks, as well as the impact of subjective symptoms like fatigue or pain, are also relevant.

While the claimant has the broad legal burden to prove SSDI eligibility, which is based on a preponderance of evidence, the agency also has the responsibility to gather medical evidence and develop the medical record. So for practical purposes, both the agency and the claimant gather and submit medical records to the claimant’s SSA file.

Particularly important is evidence from the claimant’s treating physicians, which is given great weight by the SSA. While normally the SSA (at the application and reconsideration stages it may contract with a state disability determination agency to perform these tasks) will request medical records from treating sources as identified by the claimant, practically speaking, the claimant should check his or her file to be sure records from treating physicians have been received.

This kind of file management is often done by a claimant’s SSDI attorney. Consultation with and representation by a lawyer can make all the difference in the creation of a robust record to support a finding of disability. For example, claimant’s legal counsel may ask a treating doctor to write a letter of support of the SSDI claim or fill out a questionnaire designed to clarify necessary evidence of disability.

The SSA has the duty to develop the record by ordering consultative medical examinations in some circumstances. For example, in addition to physical impairment, a claimant may exhibit symptoms of depression, anxiety or another mental impairment that is untreated. The agency should request a medical assessment of the symptoms, but if the SSA does not do so, the claimant’s lawyer can either push for the agency referral, or arrange privately for assessment.

If the application is denied, there are three levels of agency appeal: reconsideration, an administrative hearing and an Appeals Council review. The medical record can be enhanced during any of these stages, so even if an attorney was not involved initially, a claimant can retain legal counsel to step in with assistance with developing the record at any point.

Should the claim still be denied after exhausting all four levels of SSA consideration, the matter may be appealed to federal court, although no evidence is admissible in court.

From Knoxville, Tennessee, the attorneys at the Law Offices of Ogle, Elrod & Baril PLLC, represent SSDI claimants in the Knoxville area and nationwide.