Physician Testimony Can Clarify Disability Decisions
By Ann B. DeBellis
Determining medical disability is often an arduous process that can result in unfair and inaccurate analysis of a claimant's situation. Attorney Jan Cox of Cox Disability Law handles many of these cases and has found that when the claimant's treating physician informs the disability decision maker of the patient's medical situation, it often clarifies the outcome of the case.
"Obtaining input, information or opinion from a treating physician is not always possible or practical. However, when it happens it can be the gold standard for evidence, at least from the standpoint of the claimant's advocate," Cox says. "The ultimate decision of whether a claimant is disabled or not is reserved for the government and good, fact-based statements from a treating physician is the most persuasive evidence."
Cox says disability is not about whether the individual can go out into the work force, find a job, be hired, and successfully perform the work. "Social Security disability is a term that does not consider real world factors such as unemployment rate, hiring prejudices, job availability, transportation or geographical challenges," she says. "In order to be approved for disability, the administrative law judge must find that the claimant meets the legal definition of disability."
If a client is denied at the initial level and an appeal is filed, Cox's job is to analyze the case for merit and identify what facts can be established to show that her client meets the legal definition of disability. "That includes identifying additional medical documentation that should be admitted into evidence to establish the nature and severity of all medical impairments that impact the client's ability to perform basic work-related physical and mental functions," Cox says.
It is common, she adds, for disability cases to contain medical evidence with conflicting, confusing and/or inadequate information upon which the judge must base his findings of fact in order to identify the medical impairments, their severity, and the resulting work-related limitations.
"In these cases, the treating physician's information and opinion can be critical to having a complete record upon which the judge can base a proper decision within the regulatory standards," Cox says.
Cox represented a client in a recent case who was denied disability following a gastric bypass. She lost a lot of weight and had a body lift. The circumferential incision for the lift cut all of the superficial lymphatics that drain the lower portion of her body. Her symptoms were exacerbated by physical activity, so she filed for disability.
The initial case analysis by the disability examiner found that, on overall review of her primary care physician's records, the evidence did not support any severe symptoms or limitations. A psychological consultative examination was performed, and the patient was diagnosed with somatoform symptom disorder, a psychological disorder in which the patient experiences physical symptoms that are inconsistent with an underlying medical or neurological condition.
Paula Stewart, MD
"I was surprised by the extent of the disconnect between my client's description of her medical problems and the medical information in the file. I was particularly troubled by the somatoform disorder diagnosis," Cox says. "I met with Paula Stewart, MD, my client's physical medicine and rehabilitation physician, and learned a dramatically different account of the patient's condition and diagnosis. It turned the case around."
Stewart gave a statement to the court explaining the specifics of her patient's condition. "The cut caused lymphedema to occur below the incision line, and other physicians did not understand her condition which has caused her great discomfort that will continue for the remainder of her life," Stewart says. "Lymphedema is not well understood and often is swept up into other diagnoses and not recognized by physicians. I presented evidence of the infection that results in cellulitis, which is a superficial infection of the dermis. As in this patient's case, it can lead to permanent damage of the lymphatic system. Many patients suffer from this condition and are left with a lifetime of lymphedema."
"Lymphedema is taxing for people," Stewart says. "Patients must wear compression garments for the remainder of their lives. They are expensive and are not reimbursed by many insurers because the condition is so poorly recognized. I was able to provide adequate information about my patient's condition for the court which allowed for a correct judgement. Without that information, the judge would have had to make a determination in a vacuum."
As a rehab physician, Stewart's perspective on disability patients differs from that of most primary care doctors.
"I understand how a disability impacts a patient's life," she says. "Primary physicians better understand the impact of hypertension, high cholesterol and vaccinations. They understand health maintenance and wellness. But when a disability occurs, they may not be the best advocate on how it will impact the patient. I believe that having a physician advocate in a disability hearing is essential, but we need to be sure that the physician is fully informed of all the dimensions that are involved."
Stewart says she is always ready to defend patients who need the expert testimony of a physician who understands the medical condition and can provide information to allow a judge or jury to make an informed decision. "Otherwise, there's no justice," she says.