The importance of a fully developed medical record in SSDI cases

Both the Social Security Administration and the claimant have the duty to develop the medical record.

Social Security Disability Insurance claims are often denied or held up because of insufficient medical evidence in the application file. Both the Social Security Administration and the person filing for SSDI have the legal duty to fully and fairly develop the medical record, but in reality and far too often the necessary supporting medical evidence is not submitted.

SSDI is the federal disability insurance program into which Americans pay through payroll deductions (along with contributing to the more well known Social Security retirement program). A person who meets certain work history requirements (having worked fairly recently and enough quarters over the years to be SSDI eligible) must also be disabled from working to get monthly SSDI payments.

But being disabled for SSDI purposes has a very specific definition: the claimant must be unable to work because of a severe physical or mental medical impairment or combination of impairments expected to last at least one year or result in death.

So, when someone becomes unable to work for medical reasons, he or she should consider whether SSDI is an option. Discuss the situation with an experienced SSDI attorney to assess whether a claim is in order. Legal counsel will assist with an initial application, but can also become involved on appeal (there are three levels of appeal within the agency after the initial application is denied, followed by a right to appeal to the federal courts).

Medical evidence can be submitted at every level of agency appeal, but not to the court. Ideally, sufficient evidence can be submitted earlier rather than later so the claim is approved sooner and benefits can be paid.

The agency has the duty to gather a claimant's medical records from treating doctors and may also send a claimant to a consulting doctor of the agency's choosing for further assessment.

But a claimant should not rely on the agency to adequately develop the medical record because historically it often does not do a sufficient job. Many claims are unnecessarily denied on initial application requiring what can be a drawn-out appeals process.

Having a lawyer from the start will greatly aid in gathering medical records. The SSA must give great weight to the opinion of a treating physician, who is likely to know the claimant best from a medical perspective and has had the opportunity over time to see the medical condition evolve.

The claimant's attorney can not only be sure the medical records of the treating doctor are obtained, but also may give the treating physician a questionnaire or ask him or her to write a letter on the claimant's behalf. The lawyer can ask specific important questions like:

  • How does the medical condition impact activities of daily living?
  • Does the medical condition limit the ability to lift, stand or sit for long periods?
  • Does the condition cause fatigue, pain, concentration problems or confusion?

Any laboratory tests, hospital admissions, therapy and similar services should also be assessed for record collection by the lawyer. If the claimant has symptoms that have not been medically assessed, the lawyer can refer the claimant for evaluation to see if there are additional diagnoses contributing to the disabling condition.

For example, after a serious illness or accident, a patient can develop depression or anxiety that further exacerbates problems with working.

The SSDI lawyers of Manring & Farrell with offices in Columbus, Lebanon and Lima, Ohio, represent SSDI and VA claimants across the state.