UPDATE ON TREATING PHYSICIAN RULE IN SOCIAL SECURITY DISABLITY CASES

In a previous blog it was noted that if a Social Security disability Claimant has obtained an opinion from his or her treating physician that is supportive of disability and is consistent with the overall medical evidence, then that opinion should be given deference by the Administrative Law Judge (“ALJ”) over any opinions submitted by Social Security’s medical consultants or consultative examiners. This is why it is so important for Social Security disability claimants to speak with his or her treating physician to make sure that physician will support them in their pursuit of disability benefits. A recent decision has further entrenched this rule. The Court in Gayheart v. Comm’r of Soc. Sec, 710 F.3d 365, 375-376, 379 (2013), clarified the application of the treating physician rule:

Treating-source opinions must be given “controlling weight” if two conditions are met: (1) the opinion “is well-supported by medically acceptable clinical and laboratory diagnostic techniques;” and, (2) the opinion is not inconsistent with the other substantial evidence in [the] case record.” 20 C.F.R. § 404.1527(c)(2). If the Commissioner does not give a treating-source opinion controlling weight, then the opinion is weighed based on the length, frequency, nature, and extent of the treatment relationship, as well as the treating source’s area of specialty and the degree to which the opinion is consistent with the record as a whole and is supported by relevant evidence. 20 C.F.R. §§ 404.1527(c)(2)-(6).

Gayheart, 710 F.3d at 376. The Court’s opinion was also notable because it faulted the ALJ for applying greater scrutiny to the treating-source opinions than to the consultative doctor’s assessments. Id. at 379. The Court indicated that if an ALJ fails to give a treating source opinion controlling weight, the ALJ is required to do more than simply identifying a conflict with any non-treating and non-examining doctors’ opinions. The reason for this, the Court explained, was that otherwise the treating-physician rule “would have no practical force because the treating source’s opinion would have controlling weight only when the other sources agreed with that opinion. Such a rule would turn on its head the regulation’s presumption of giving greater weight to treating sources because the weight of such sources would hinge on their consistency with non-treating, non-examining sources.” Id. at 377. Accordingly, and to reiterate, it is extremely important that Social Security disability claimants be aware of the treating-physician rule and educate their doctors about why medical opinions from a treating physician are critical to their disability claim.