May 21, 2015

Why Are Medical Records So Important to My Social Security Disability Claim?

Whenever I talk about the keys to a Social Security disability claim, I emphasize the importance of medical records.  Medical records are important because the Social Security Administration (SSA) cannot find you disabled under its rules without finding that you have a “medically determinable impairment.”  In other words, you must be able to provide acceptable medical evidence, such as objective test results or treatment notes showing diagnoses from acceptable medical sources, that proves that you have a medical condition that prevents you from being able to work.

Why are Medical Records Important?

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While the SSA will most likely send you for an independent consultative examination to determine your diagnoses and symptoms, it is important to have medical records showing that you have been diagnosed and treated on your own.  I have often seen decisions in which an Administrative Law Judge (ALJ) has concluded that a claimant’s impairment must not be as severe as he or she is alleging because the claimant did not receive significant medical treatment for it.

Medical records are helpful in proving that you are disabled because they contain the diagnoses and clinical findings of medical providers who have treated you on a regular basis.  If those diagnoses and findings come from a doctor who specializes in treating your condition, Social Security will likely give them significant weight in determining whether your condition prevents you from working.

What Kinds of Medical Records are Important?

The most valuable records I can submit on behalf of my clients are objective test results.  X-rays, MRIs, nerve conduction studies, pulmonary function tests, and other tests give hard data showing the severity of certain conditions.  In fact, with appropriate test results it may be possible to show that you are disabled without even having to talk about whether you can perform work-like activities.  If Social Security has a section in its Listing of Impairments that addresses your condition, it may include provisions that allow you to show you are disabled by showing that your results on certain tests fall above or below a cutoff number.

Of course, some conditions cannot be diagnosed using objective testing.  Migraine headaches, fibromyalgia, and most mental disorders fall into this category.  For other conditions, such as diabetes, some immune system disorders, and epilepsy, Social Security requires more than just objective test findings; you must also show that your symptoms occur at a particular level of severity or frequency in order to qualify as disabling conditions.  In these cases, it is vital to have treatment notes, preferably from specialists, showing consistent treatment and compliance with doctors’ orders.

How Are Medical Records Obtained for the Hearing?

When I represent someone who is appealing the denial of a claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, one of my most important jobs is to make sure that all of my client’s medical records are submitted to Social Security.  In the initial stages of a claim (on the initial application and at the request for reconsideration level), Social Security requests and pays for medical records associated with your claim.  At the hearing level, though, if you have representation, your attorney or representative is responsible for ensuring that all of your records have been submitted.

The process of requesting medical records sounds simple, but it is something of an art.  The average wait time for a hearing in Indiana right now is about fifteen months.  After the Office of Disability Adjudication and Review (ODAR) receives your hearing request, it prepares your file for the ALJ by sorting and labelling the existing evidence in exhibits.  However, the bulk of the waiting time is spent, well, waiting.  Therefore, my office typically waits until the hearing is scheduled before we request updated medical records for your file.  We have to balance several factors.  First, every time we request records, we typically have to pay a $20 copying fee in addition to a per-page fee, so we do not want to request medical records multiple times.  Second, if we request and submit your records too early, we might miss out on important information from records that are created within the few months prior to your hearing.  Third, if we request your records too late, we will not receive them in time to submit them prior to the hearing; we want the ALJ to have all of the records available with plenty of time to review them prior to your hearing.  Since some medical providers can take a month to respond to our request for records, we typically begin requesting records about six to eight weeks prior to your hearing.  We then follow up on a regular basis to ensure that our request has been received and is being processed.

Many of my clients half-jokingly tell me that they can’t work, in part, because they spend so much time going to all of their doctors’ appointments.  It is my duty as their attorney to ensure that all of that time they spend in treatment is documented for the ALJ at their hearing.  Ensuring a complete hearing record is a meticulous, time-consuming effort, but it is one of the most important things I do for my clients.

 

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