Sifting Through the Record - How Social Security is Supposed to Review Medical Opinions in the File - Wilkes-Barre, Scranton Personal Injury Lawyers

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Sifting Through the Record - How Social Security is Supposed to Review Medical Opinions in the File

In any given Claimant's record before the Social Security Administration, there are usually three different types of medical opinions. There are opinions from treating sources and non-treating sources.  The non-treating sources  opinions are divided among physicians who actually examined the Claimant and those who simply reviewed medical records and rendered opinions on the Claimant s ability to function.  In most cases, because of expenses or time, the opinions from the above mentioned sources are in a checklist format.  The issue remains how the Social Security Administration should review such opinions.

The Social Security Administration's regulations state that  [r]egardless of its source, we [the Social Security Administration] will evaluate every medical opinion we receive. 20 CFR  404.1527(d).  The Social Security Administration looks to factors to determine what weight to give the opinion. The factors are: the examining relationship, treatment relationship, supportability, consistency and specializaton.

The Social Security Administration states, [g]enerally, we give more weight to the opinion of a source who examined  [the Claimant] than to an opinion of a source who has not examined [the Claimant]. 20 CFR  404.1527(d)(1). Thus, under the Social Security Administration s own rulings, a consultative examiner's opinion should be given more weight than a physician who simply reviews medical records.

The next factor is the treatment relationship. The Social Security Administration states,  generally, we give more weight to opinions from your treating sources, since these sources are likely to be the medical professionals most able to provide a detailed, longitudinal picture of your impairments and may bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone… 20 CFR  404.1527(d)(2). Indeed, Social Security Ruling 96-2p provides the framework  which all components of the Social Security Administration must follow in order to give controlling weight to the Claimant s treating physician.  In order for an Administrative Law Judge to give controlling weight to an opinion of the Claimant's treating physician, the following factors must be met: first, the opinion must come from a treating source; second, the opinion must be a medical opinion; third, the adjudicator must find that the treating source's medical opinion was supported by medically acceptable clinical and laboratory diagnostic techniques.  Finally, the treating source s medical opinion must not be inconsistent with the other substantial evidence in the Claimant’s record.

The third factor is supportability.  This factor essentially is the third factor of the treating sources rule.  The opinion must be supported by medical signs and laboratory findings.  Obviously, the more objective support there is for the opinion, the more likely the opinion will be accepted.

Finally, the Social Security Administration will look to the specialization of the physician rendering the opinion.  Social Security states,  we generally give more weight to the opinion of a specialist about medical issues related to his or her area of specialty than the opinion of a source who is not a specialist.  20 CFR  404.1527(d)(5).  For example, a Cardiologist's opinion of the effects of his patient's cardiomyopathy on the patient's ability to lift and carry should be given more weight than to an internist who performed a ten minute examination.

The (above stated) factors are generally applied by the Administrative Law Judges.  It is obvious that the Administrative Law Judges read broad discretion in the term generally when determining which of the three opinions to accept. Nevertheless, significant grounds for appeal exist when an Administrative Law Judge rejects the opinion of a treating physician especially when the treating physician is a specialist who has had a long treating relationship with the Claimant.

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