Tuesday, February 23, 2010

Primary Care Physicians

It is generally accepted that the disability opinion of a specialist is entitled to greater weight than a general practitioner. In the Social Security Disability context, that principle is codified in a regulation that gives more weight to the opinion of a specialist about medical issues related to his or her area of specialty than to the opinion of a source who is not a specialist.

For a variety of reasons, this had led many people to disregard seeking medical support from their primary care physician (“PCP”), who usually is a general practitioner, such as an internist or family doctor. Depending upon a claimant’s impairments, an internist could be the specialist whose opinion is entitled to extra weight.

A woman seeking Supplemental Security Income (“SSI”) benefits retained me just prior to her hearing. The claimant’s internist diagnosed her with diabetes, hypertension, anemia, hyperlipidemia, cataracts, osteoarthritis, Lyme Disease, and osteopenia. There are medical specialists for each of those impairments. However, when no single impairment is disabling, the PCP, in this case an internist, is the appropriate specialist for treating the combination of all the impairments.

I obtained a detailed functional assessment from the claimant’s internist that showed the claimant lacked the ability to perform sedentary work. The Administrative Law Judge agreed that an internist was the appropriate specialist under the circumstances, and approved SSI benefits because he gave controlling weight to the internist’s opinion.

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