How Much Weight is a Treating Doctor’s Opinion Given?

If you are applying for SSDI benefits in Fresno, you may be curious how much weight your treating doctor’s opinion is given. In a recent Social Security Disability case in the Southern District of California, the plaintiff sought judicial review of a Social Security Commissioner’s denial of his application for disability insurance benefits.

The plaintiff argued that the administrative law judge had made a reversible error by not properly weighing a non-examining doctor’s opinion, among other things.

The case arose when the plaintiff was 47. He had been working as a sheet metal mechanic and stopped working in 2013 because of various health conditions, including degenerative disc disease, obesity, obstructive sleep apnea, and anxiety. A tumor had been surgically removed from his neck in 1991, and then he went through back surgery.

He got medical care from the Department of Veterans Affairs, which rated his service-linked disability at 30%. The rating was increased to 70% in 2014.

The plaintiff was treated and examined by doctors not at the VA. He got physical therapy. He was treated by a neurologist and a spinal cord injury specialist.

He applied for disability insurance benefits, and his application was denied. He asked his claim to come before an administrative law judge. At the hearing, he testified, as did a reviewing medical expert and a vocational expert. The plaintiff claimed he could only walk, sit, or stand for an hour at a time. The expert doctor testified as to physical labor the plaintiff couldn’t perform.

The administrative law judge found he wasn’t disabled under the Social Security Act. His request for review was denied, and he asked for judicial review.

The administrative law judge had concluded that the claimant’s impairments didn’t equal the seriousness of the impairments set forth in the regulations and that he had the residual functional capacity to do light work with certain restrictions. The administrative law judge had given great weight to the non-examining expert doctor’s testimony. The judge decided those findings were consistent with his own evaluation of the plaintiff’s residual functional capacity and were also supported by listed impairments.

The district court reasoned that when addressing doctors’ opinions, the administrative law judge’s written assessment combined the opinions in a confusing way. The administrative law judge determined that the findings were inconsistent with the medical record, which showed the claimant’s condition had greatly improved with physical therapy. The objective testing had shown minor alterations that didn’t necessitate surgery or cause gait alterations. Therefore, the administrative law judge didn’t give much weight to those opinions.

The district court explained that the administrative law judge’s evaluation of the record was unclear. It adopted the assumption that the administrative law judge hadn’t given much credit to the treating doctors’ testimony.

The administrative law judge had found that the VA disability ratings didn’t prove much. The administrative law judge determined that the plaintiff’s medically determinable impairments could reasonably be anticipated to cause the symptoms. He also decided the plaintiff was able to do jobs that existed in significant numbers in the United States economy.

The district court explained that the Social Security Act distinguishes among the opinions of three types of doctors:  (1) treating doctors, (2) doctors who examine but don’t treat, and (3) doctors who don’t treat and don’t examine. The treating doctor’s opinion is entitled to more weight than non-treating doctors. A treating doctor’s opinion has controlling weight if it’s supported properly by medically acceptable clinical and lab techniques and isn’t inconsistent with other substantial proof in the case record.

When a treating doctor’s opinion is contradicted, it doesn’t have controlling weight but isn’t necessarily rejected. The opinion is supposed to be weighed by looking at factors such as how long the treatment relationship was, how frequent exams were, whether the opinion is bolstered by signs and lab findings, and whether the opinion is consistent with the record.

In this case, the district court found that the administrative law judge had failed to offer valid and particular reasons to discount a treating doctor’s opinion. The administrative judge had cherry-picked the record to show it was inconsistent. For this and other reasons, the court sent the case back down for further proceedings.

Many people find it difficult to obtain Social Security Disability benefits. An experienced Social Security lawyer may make a difference to the outcome of your case. If you believe you may need to apply for Social Security Disability benefits in Fresno, contact Peña & Bromberg, PLC at 559-439-9700 or via our online form.

 

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