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What a Doctor Must Write for a Michigan SSDI Claim to Use It
A letter from a treating physician stating that a patient is disabled and cannot work is the document Michigan claimants most often bring to a first meeting, and it is the document Social Security’s rules give the least room to. The agency is required to make that finding itself, and a statement that makes the finding for the agency is set aside without analysis.
20 C.F.R. § 404.1520b(c)(3) lists statements on issues reserved to the Commissioner as evidence that is “inherently neither valuable nor persuasive,” and the first item on the list is a statement that a claimant is or is not disabled, able to work, or able to perform regular or continuing work. For claims filed on or after March 27, 2017, the agency will not provide any analysis of how it considered such a statement.
What the rules do value is a medical opinion, which 20 C.F.R. § 404.1513 defines as a statement from a medical source about what a claimant can still do despite their impairments and whether they have specific work-related limitations.
Neumann Law Group asks treating providers for the second kind of document on every Michigan Social Security Disability claim it handles, from Detroit to Traverse City, because the first kind is discarded by rule before anyone weighs it. The distinction is one of form, and a provider who is told the form will usually supply it.
An Opinion Describes Function, a Conclusion Decides the Case
A medical opinion is a statement from a medical source about what a claimant can still do despite their impairments and about impairment-related limitations in four areas of work activity. The regulation names them.
- Physical demands. Sitting, standing, walking, lifting, carrying, pushing, pulling, and manipulative or postural functions such as reaching, handling, stooping, or crouching.
- Mental demands. Understanding, remembering, maintaining concentration, persistence, or pace, carrying out instructions, and responding appropriately to supervision, co-workers, or work pressures.
- Other demands. Seeing, hearing, and the use of other senses.
- Environmental conditions. The ability to adapt to conditions such as temperature extremes or fumes.
The reserved list in § 404.1520b(c)(3) is the mirror image. Alongside statements that a person is disabled or unable to work, it includes statements that an impairment is or is not severe, that it meets or equals a listing, that it prevents past relevant work, that a grid rule is or is not met, and, in item (v), statements of residual functional capacity made in the programmatic terms of Appendix 2’s exertional levels “instead of descriptions about your functional abilities and limitations.” A note that a patient is limited to sedentary work is on the reserved list. A note that the patient can lift 10 pounds occasionally and sit for 30 minutes before standing is a medical opinion.
How the Agency Weighs a Medical Opinion Since 2017
For claims filed on or after March 27, 2017, 20 C.F.R. § 404.1520c governs, and its first sentence removes a rule many Michigan claimants still expect. The agency will not defer to, or give any specific evidentiary weight, including controlling weight, to any medical opinion, including one from the claimant’s own medical sources. A treating physician’s opinion is no longer presumed to control.
It is evaluated for persuasiveness under five factors, and the regulation says which two are most important. Those two are supportability and consistency, and the agency must explain in its decision how it considered each of them for every medical source. The remaining factors, which it may consider without explaining, are the relationship with the claimant, including the length, frequency, purpose, and extent of treatment and whether the source examined the patient, the source’s medical specialty, and other factors such as the source’s familiarity with the rest of the record and with the program’s evidentiary requirements. Evidence received after an opinion was written can make it more or less persuasive.
Most treating-provider forms are prepared without the person completing them knowing that supportability and consistency are the test, and a form written to that test is worth more than one written to sympathy. The rules that decide what a form has to say are what we go over with new clients first. If that is where your situation sits, call us at (800) 525-6386.
Supportability and Consistency, in Practice
Supportability is defined by the source’s own work. The more relevant the objective medical evidence and supporting explanations a medical source presents to support the opinion, the more persuasive the opinion will be. A checkbox form that records limitations and cites nothing scores low on the only factor the source controls. The same form that cites the imaging, the examination findings, and the test results behind each limitation, with a sentence explaining why the finding produces the limit, scores high.
Consistency is measured against everything else in the file, including evidence from other medical sources and from nonmedical sources such as the claimant’s own function report and statements from family or former supervisors. An opinion contradicted by the same provider’s treatment notes fails both factors at once, and a note reading “doing well” in the chart the month before the form was signed is exactly the inconsistency an adjudicator will cite. A denial that recites a provider’s letter and gives it no weight has applied § 404.1520b(c)(3) correctly, and the appeal, on the 60-day track described on our SSDI denial page, is the place to replace the letter with an opinion.
The Request That Gets a Usable Opinion From a Provider
The request is for a functional statement rather than a verdict. It should give numbers and durations for the physical demands, describe concentration, pace, and response to work pressures in a psychiatric case using the four areas of mental functioning the listings themselves use, which are set out on our mental health conditions page, and state the objective basis for each limitation in the provider’s own words.
Two of the lesser factors can be supplied at the same time. A source who has treated the patient for years and examined them regularly should say so on the form, because the relationship factor rewards exactly that. A source who has been given the imaging and the prior records has the familiarity with the rest of the file that the last factor asks about, and an opinion written with the whole record in front of the provider is far less likely to contradict it.
Asking a Treating Provider for the Right Document
A doctor willing to help a patient’s claim usually writes the wrong document because nobody has told them what the right one looks like, and the difference is a page of specifics. At Neumann Law Group, we supply that page to treating providers for Social Security Disability claimants across Michigan. Call our office at (800) 525-6386, or contact us online, and we will talk it through with you.