In a recent hearing, my client Brenda told the administrative law judge, "I have severe anxiety and panic attacks that don't let me get out of the house much."
The ALJ asked, "How often do you have these attacks?" Brenda replied, "Almost every day. At least 4 or 5 times a week."
The ALJ asked, "Have you had any mental health treatment for this problem?" Brenda replied, "No, not really. My primary care doctor gives me Lexapro but doesn't help much."
Two months later the ALJ issued a denial decision. In the decision he noted that Brenda claims to have severe panic attacks but that he found her testimony only partially credible because she did not seek any mental health treatment. In short, her report of severe symptoms could not be supported by the examination or treatment of a clinical psychologist or psychiatrist. The fact that Brenda's primary doctor had prescribed Lexapro did not convince the judge that she had severe psychological symptoms.
The attitude of most judges is, "If it is not thoroughly documented in the medical record, then it did not happen." This applies to physical symptoms as well as psychological symptoms. If you complain of severe back pain or chronic migraines, there must be medical evidence to support it.
The Social Security regulations state clearly that a severe impairment must be medically determinable - and demonstrated by objective medical evidence. A fleeting reference in the medical record is not sufficient. For example, if your doctor records in your chart, "Patient says that she has frequent headaches." That is not enough. There should be examination as to the cause of the headaches. Their frequency, duration and severity level must be described. Medical treatment and management must be attempted. Otherwise, the complaint simply will not be taken seriously.
While medical evidence from all accepted medical sources must be considered by Social Security, more and more they want to see specialists involved in complicated medical issues. For example, if you have Fibromyalgia, they would prefer a diagnosis and treatment by a rheumatologist. If you have heart disease, they would prefer you see a cardiologist. Seizures should be managed by a neurologist.
There are many reasons why a claimant cannot get comprehensive medical treatment. Lack of financial resources and not having health insurance are among the primary reasons. In spite of that, Social Security demands objective medical evidence for alleged impairments. Objective medical evidence includes X-rays, MRI, laboratory tests, etc. It can also include comprehensive examinations by a specialist. (Evidence from specialists is given more weight than evidence from general practitioners).
This is a little exaggeration, but not much. If I walk over to the window during a hearing and say to the judge, "Your Honor, today is Thursday and the sun is shining." He will look at me and say, "Where do you find that in the medical record?"
The ALJ asked, "How often do you have these attacks?" Brenda replied, "Almost every day. At least 4 or 5 times a week."
The ALJ asked, "Have you had any mental health treatment for this problem?" Brenda replied, "No, not really. My primary care doctor gives me Lexapro but doesn't help much."
Two months later the ALJ issued a denial decision. In the decision he noted that Brenda claims to have severe panic attacks but that he found her testimony only partially credible because she did not seek any mental health treatment. In short, her report of severe symptoms could not be supported by the examination or treatment of a clinical psychologist or psychiatrist. The fact that Brenda's primary doctor had prescribed Lexapro did not convince the judge that she had severe psychological symptoms.
The attitude of most judges is, "If it is not thoroughly documented in the medical record, then it did not happen." This applies to physical symptoms as well as psychological symptoms. If you complain of severe back pain or chronic migraines, there must be medical evidence to support it.
The Social Security regulations state clearly that a severe impairment must be medically determinable - and demonstrated by objective medical evidence. A fleeting reference in the medical record is not sufficient. For example, if your doctor records in your chart, "Patient says that she has frequent headaches." That is not enough. There should be examination as to the cause of the headaches. Their frequency, duration and severity level must be described. Medical treatment and management must be attempted. Otherwise, the complaint simply will not be taken seriously.
While medical evidence from all accepted medical sources must be considered by Social Security, more and more they want to see specialists involved in complicated medical issues. For example, if you have Fibromyalgia, they would prefer a diagnosis and treatment by a rheumatologist. If you have heart disease, they would prefer you see a cardiologist. Seizures should be managed by a neurologist.
There are many reasons why a claimant cannot get comprehensive medical treatment. Lack of financial resources and not having health insurance are among the primary reasons. In spite of that, Social Security demands objective medical evidence for alleged impairments. Objective medical evidence includes X-rays, MRI, laboratory tests, etc. It can also include comprehensive examinations by a specialist. (Evidence from specialists is given more weight than evidence from general practitioners).
This is a little exaggeration, but not much. If I walk over to the window during a hearing and say to the judge, "Your Honor, today is Thursday and the sun is shining." He will look at me and say, "Where do you find that in the medical record?"
My partner expresses the same truth a bit more eloquently when he says,"The idea you should use in preparing for a disability hearing is this: If it is not in the medical record, it did not happen."
"There is the truth you can prove and there is the truth you cannot prove."
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