The “treating physician” rule – providing that the opinion of a Social Security disability claimant’s treating physician is entitled to substantial weight, unless contradicted by other substantial evidence – is an important tool in many disability benefits cases and one that is often the subject of posts on this blog. In Ash v. Commissioner of Social Security, a Magistrate in the District Court for the Southern District of Ohio explains how to determine whether a particular doctor qualifies as a “treating physician.”
In 2006, Plaintiff Christopher Ash filed a claim for Social Security disability benefits, asserting that he’s been unable to work since May 2003 due to obesity, arthritis of the feet, knees and spine, depression and a variety of personality disorders. The Social Security Administration (SSA) denied the claim.
Following an administrative hearing before an SSA Administrative Law Judge (ALJ), the ALJ determined in a June 2009 decision that Plaintiff was not disabled for the time period between May 2003 and November 2008, during which Plaintiff’s age category was a “younger person.” The SSA sorts disability benefits claimants into specific age categories which it then uses to determine the claimant’s ability to work in spite of any impairments. During this time, the ALJ determined that Plaintiff retained the residual functional capacity (RFC) to perform sedentary work. However, the ALJ granted benefits from November 2008 forward, when Plaintiff turned 50 and his age category became “closely approaching advanced age.”
On appeal, the Magistrate found that the ALJ failed to take into account the opinion of Dr. Borders, a psychiatrist who diagnosed Plaintiff with major depression and intermittent explosive disorder and determined that he was disabled as a result. While a treating physician’s conclusion that a claimant is disabled “is not determinative of the ultimate issue,” according to the court, it must be taken into consideration. The Magistrate noted that “The weight given such a statement depends on whether it is supported by sufficient medical data and is consistent with other evidence in the record,”
The judge rejected the SSA’s argument that Dr. Borders should not be considered Plaintiff’s treating physician. The Social Security regulation codified at 20 C.F.R. § 404.1502 explains to claimants that a “treating” source is “your own physician, psychologist, or other acceptable medical source who provides you, or has provided you, with medical treatment or evaluation and who has, or has had, an ongoing treatment relationship with you.”
The Magistrate found there was “no question” that Dr. Borders could qualify as Plaintiff’s treating psychologist. Dr. Borders saw Plaintiff at least a handful of times in 2006 and 2007, discussing his symptoms and prescribing medication. That Plaintiff saw social workers and counselors on a more frequent basis at the facility where he also met with Dr. Borders was not out of the ordinary, according to the Magistrate, because a psychiatrist is “more likely to be involved in medication management than individual counseling.” Furthermore, the Magistrate concluded, any gaps in Plaintiff’s treatment with Dr. Borders over the relevant time period appear to have been due to financial reasons.
Accordingly, the Magistrate ruled that “it was incumbent on the ALJ to deal with [Dr. Border’s] opinion in some way.” Because the ALJ did not address Dr. Border’s opinion, the Magistrate recommended that the case be remanded for further proceedings.
The information that a treating physician provides has a huge impact on a Social Security disability claim. To help establish a claim for Disability, a claimant’s treating doctor should provide a clear statement, ideally a narrative, detailing how the claimant’s medical conditions impact on his or her ability to function in a work environment or perform activities of daily living. Many doctors are reluctant to involve themselves with the paperwork necessary for a successful claim, but an experienced Social Security disability attorney can assist in making sure that the claimant’s medical records are clear and complete and that the doctor provides some kind of statement in which he or she provides insight into a claimant’s functional limitations.