Wednesday, May 20, 2009

Problems in Getting Disability Forms Completed by a Doctor

The following comments were recently left on a page of this blog and I've posted the response below.

What do you do when your Dr leaves, moves to another state before he rec'd the forms to fill out. His PCP has been following my husband for over 5yrs & recently dx'd with Sarcoidosis in 2007 he knows everything from the beginning for this terminal mystery disease & I don't think it's fair for another dr who has never treated my husband to fill out the forms.

The lawyer we hired I feel is at fault, they've known for 2mo before the hearing May 29th. I called them to make an appt with & the asst said that if they need anything they'll contact us, never happened. They sent us the forms to give to his dr, the lawyer waited too long to get his dr the paperwork, now my husband is screwed with his case....Any help is greatly appreciated, like I said we're only 3wks away. My husband has several dx'd problems, DM II extremely high sugars (last night his sugar was HI),HTN, Sarcoidosis of the lungs,liver & spleen, fevers, fatigued,SOB, oughing, sleep apnea,depression & has dx'd by SSI dr that he is also Bi-polar.Thanks again for your help.

Sarkie's wife

First of all, I want to apologize for taking so long to respond. I've been shuttling back and forth between cities due to a family situation.

This is a tough situation. I am not sure what to tell you with regard to options. There is always a chance that the doctor who replaced your husband's regular physician could complete the form with input from the PCP. If the new doctor is not comfortable with that, then there is not much you can do. You could always find out where your husband's doctor relocated to and express mail him the forms with a return express envelope. Of course, I would contact him to see if he would be willing to do this for your husband.

Barring any of the suggestions above, you may just have to have the new doctor complete the forms. You can always have your attorney review them before having them included in your disability case file. If the statement does not help or support a finding of disability, your attorney may discard them.

A doctor's statement (hopefully captured in the form of a residual functional capacity statement) could certainly help your husband's disability claim, however it may not be that your husband's disability claim will hinge upon such a statement, or that one may be absolutely necessary, particularly if your husband has objective medical evidence which strongly supports his claim for disability.

If this is the case, essentially that his records can allow the disability decision maker to conclude that his functional limitations rule out the ability to engage in his past work or some other form of work at the SGA income level, he will mostly likely be approved with or without a statement from his physician.

Having said that, of course, I don't want to minimize the real value and usefulness of a detailed, objective statement from a physician. These statements can often help to clarify and make plain how impaired and limited a claimant really is. And they can serve to win cases provided the statement is supported (not out of line with) by the rest of the medical record.

The ALJ disability hearing is the best chance an individual, who's been previously denied at the initial claim and reconsideration levels, has of being approved for disability. National averages show that about two thirds of all individuals who attend a disability hearing will be approved for benefits.

You're right, of course. It would be better to have his treating physician of the last five years submit his RFC statement, especially if he's seen your husband in the relatively recent past. I've had situations before where I've had to track down doctors who have relocated and it can be worthwhile.

If this physician has not seen your husband in several months, however, there's no reason why (assuming that you can locate this physician) you can't obtain and submit two residual functional capacity statements---i.e. from the doctor who moved and from whoever the current doctor is...provided this is possible, of course.

Good luck on the situation.

Return to the Social Security Disability SSI Benefits Blog

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