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Doctor and I disagree on my diagnosis and my ability to work

It is not unusual for some disability applicants to have a severe health condition and believe they cannot work, but when they go to the doctor to get an evaluation of their condition, the doctor disagrees. Recently on our disability forum we had a user ask, “What if my doctor believes I am not disabled enough to stop working but I disagree with them?”

Does my doctor have to state I am disabled to get benefits?

This claimant’s in a tough position. While you do not need a doctor to give you a “note” claiming that you are disabled, your medical files should contain enough evidence to prove to the SSA your condition is severe, it will last at least 12 continuous months, and you cannot work or perform substantial gainful activity. These requirements are the same for both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

So while you do not have to agree with your doctor, if they write medical notes and put them in your file and these notes clearly document why your doctor believes you CAN work, you will have difficulty winning your case. One option is to go to another doctor and see if you can get new information about the severity and limitations of your condition from the new doctor, but this can also be difficult.

What information will the SSA review to make my disability determination?

According to the SSA, they need specific evidence to establish that you have a medically determinable impairment. To prove this they will review evidence from acceptable medical sources. This includes information from:

(1) Licensed physicians
(2) Licensed or certified psychologists
(3) Licensed optometrists, for purposes of establishing visual disorders
(4) Licensed podiatrists, for purposes of establishing impairments of the foot, or foot and ankle only.
(5) Qualified speech-language pathologists, for purposes of establishing speech or language impairments only.

The SSA will also review your medical reports. Within these reports they will review your medical history, clinical findings from physical or mental status examinations, laboratory findings, diagnosis statements based on its signs and symptoms and the treatment prescribed with response, and prognosis.

Additionally, the SSA will try to determine your work abilities despite your impairment. Specifically, they will determine if any information provided by your doctor will give them evidence of certain things you cannot do. Many doctors complete what is called a residual functional capacity or RFC form to specifically list your physical or mental limitations. If you have hired a lawyer it is common for them to request this document from your treating sources.

The Bottom Line

So what’s the bottom line? If you do not have a doctor’s support it is unlikely that there will be sufficient evidence in your medical file to prove to the SSA that you do not have the ability to work. It’s time to go to a new doctor and see if they are willing to work with you to build a great case to win SSDI benefits.
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