Consistent and Proper Medical Treatment: The “Holy Grail” of Social Security Disability Benefit Claims

By: Adam Allegro, Esq.

For anyone applying for Social Security disability benefits (be it Social Security disability insurance benefits or supplemental security income benefits), it is important to keep in mind that winning your case often depends on the medical and psychological evidence of treatment you have been receiving for your impairments.

I always remind my clients that treatment records are the “holy grail” of any disability claim, in that most Administrative Law Judges and SSA examiners evaluating whether to grant or deny a claim will not take a claimant or her/his attorney for their word about how disabling a physical or mental impairment is. Rather, the SSA weighs the records, reports, radiology testing results, and opinions of treating medical sources (medical doctors, psychologists, etc.) as the main evidence in making a decision. This is why, if a claimant has not treated with an expert medical professional, the SSA will often schedule a “consultative examination” with an independent doctor of their choosing to evaluate a claimant and determine whether they feel the untreated condition claimed has any merit.

So, for example, if a claimant suffers from severe depression, post-traumatic stress disorder, and has difficulty sleeping and constant fatigue throughout most days, these symptoms could easily prevent them from being able to work. However, if the claimant has not been treated by a clinician (and most importantly, a psychologist or medical professional specializing in mental impairment diagnosis and treatment) the SSA will be much more likely to deny her/his disability claim. Further, even if the claimant has been seeing a family doctor or primary care physician for these mental impairments, a judge will likely determine that, because this type of doctor lacks the specialty of a licensed psychologist, the family doctor’s records will hold less weight and be viewed as much weaker evidence than a specialist’s records would.

The same idea applies to a claimant that has spotty records of treatment. For example, if a claimant has treated with a doctor for a back injury and COPD in 2008 but then discontinues treatment and does not see the doctor again until 2010 for these conditions, it will be very difficult for the SSA to accept that the effects of these problems were severe and disabling during the time period in between visits, given that the claimant arguably did not need to seek treatment for a large period of time. As such, it is also very important to maintain what is referred to as a “longitudinal history of treatment” or, more simply put, consistent and regular treatments beginning from the point when you are claiming disability began and continuing up to the present.

Overall, it is important, whenever possible, to seek treatment from a specialized medical or psychological professional with experience and knowledge of your given illness and to continue to regularly and repeatedly treat for your condition in order to greatly increase the chances of winning a Social Security disability benefits claim. However, treating regularly and properly is not only important for helping you to win your disability claim but also to aid in improving your own health. Seeking the medical or psychological care that you may need will not only be strengthening your claim for benefits but also help you to manage your pain, mental impairments, or other symptoms and thereby maximize your ability live a happier and healthier life.