Treating Physician Rule
The opinion of the treating physician is entitled to controlling weight. It will decide whether you get paid, if it cannot be discredited. If you do not have your own doctor, then the consultative examiner’s (CE) opinion will control. However, a treating physician’s opinion is accorded controlling weight only if the opinion is “well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record.” 20 C.F.R. § 404.1527(d)(2).
Evidence from a treating physician is not the only medical evidence that a claimant may present. Non-medical evidence, such as testimony or reports from chiropractors and physical therapists, is also admissible. Medical-related evidence, such as the testimony of personal friends, concerning what they have observed is also probative and admissible. The ALJ must consider all such evidence. The ALJ is charged with the duty to weigh all of the evidence in the record to reach a fair decision.
On occasion, the ALJ may find the evidence of a non-treating source more persuasive than that of the Treating Physician. The opinion of a treating physician “must be given substantial or considerable weight unless `good cause’ is shown to the contrary.” Good cause is shown when the:
“(1) treating physician’s opinion was not bolstered by the evidence;
(2) evidence supported a contrary finding; or
(3) treating physician’s opinion was conclusory or inconsistent with the doctor’s own medical records.”
If the ALJ can give specific reasons for failing to give the opinion of a treating physician controlling weight, and those reasons are supported by substantial evidence in the record, then there will be no reversible error.
Nancy J. Thomas v. Carolyn W. Colvin, Acting Commissioner of Social Security
The 7th Circuit Court of Appeals ruled that a Social Security Administration (SSA) Administrative Law Judge (ALJ) in the Office of Disability Adjudication And Review (ODAR) committed reversal error when he omitted fibromyalgia from a woman’s list of impairments. This omission was not supported by the evidence. The Federal Circuit Court reversed denial of her application for supplemental security income (SSI).
Nancy Thomas , the claimant, was diagnosed with Graves’ disease in 2006, an autoimmune disease affecting the thyroid gland. Over the next four years she complained of headaches, shortness of breath, fatigue, pain in her neck, depression, intolerance to heat and cold, and other symptoms. She saw two doctors before filing for SSI, where she saw a state medical examiner (ME). The Social Security Administration denied her application for SSI in 2011. It took six years for her to get her benefits.
She went back to one of her treating doctors, who diagnosed her with fibromyalgia and prescribed Lyrica to help. Another doctor completed a disability questionnaire which stated she had been diagnosed with Graves’ disease and moderate fibromyalgia causing muscle and joint pains and these conditions “substantially limit” Thomas’ ability to engage in substantial gainful activity (SGA).
Thomas appeared before an ALJ a year and half after her initial denial of SSI and he denied her claim. The ALJ admitted Thomas suffered from Graves’ disease, degenerative changes of the left shoulder and lumbar spine, and dysthymic disorder, but did not acknowledge fibromyalgia because neither of her treating physicians (TA) who had diagnosed her and and who supported her was a rheumatologist. The SSA ALJ also thought Thomas’ symptoms were not severe enough and at most caused minimal limitations to Thomas’ ability to work. The District Court upheld the verdict.
(THE ONLY PERSON WHO DOES NOT GET SSI IS THE PERSON WHO DOES NOT APPEAL)
Thomas appealed, claiming the ALJ’s omission of her fibromyalgia diagnosis were unsound and the conclusion about the severity of her physical impairments is not back up by evidence.
In a per curiam decision heard by Chief Judge Diane Wood and Judges William Bauer and Michael Kanne, the 7th Circuit Federal Court ruled the ALJ overlooked a second set of criteria when deciding whether Thomas had fibromyalgia, which includes a history of widespread pain and repeated occurrence of symptoms. Thomas supplied this evidence, refuting the SSA’s claim that overlooking this set of criteria was harmless error.
The 7th Circuit also agreed with Thomas that the ALJ’s claims about the severity of her symptoms were not backed up by sufficient evidence. It ruled the ALJ put too much weight on the testimony of the government’s two doctors who examined Thomas and not enough on Thomas’ Treating Physicians and her testimony.
(IF YOUR TREATING PHYSICIAN SAYS THAT YOU ARE DISABLED, THE SSA MUST PAY YOU BENEFITS. THAT IS THE RULE!)
“In finding Thomas not credible to the extent that she described more than minimal limitations, the ALJ relied on the seeming lack of objective evidence supporting Thomas’s subjective account of her symptoms, but, as discussed earlier, the ALJ skipped over the substantial findings of Thomas’s treating physicians and physical therapist that showed that her impairments indeed would limit her ability to perform Substantial Gainful Activity SGA,” the panel wrote in remanding the case for further proceedings.
The case is Nancy J. Thomas v. Carolyn W. Colvin, Acting Commissioner of Social Security, 15-2390. (By Scott Roberts, June 23, 2016.)