OBJECTIVE MEDICAL EVIDENCE & OPINION EVIDENCE

IS OBJECTIVE MEDICAL EVIDENCE ENOUGH?

In a criminal trial, the accused person walks into a courtroom under the presumption of innocence:  in short, he is not guilty of any crime until the state can prove guilt.  The defendant does not have to prove that he is innocent.  The state must prove that he is not.

In a Social Security disability case, just the opposite is true.  The claimant is assumed not to be disabled until he can prove that he is. Social Security does not have to prove that the claimant is not disabled.  The claimant must prove that he is.  So, the burden of proof rests mostly upon the claimant, not upon Social Security.

I have frequently tried to explain the importance of objective medical evidence in a Social Security disability case, especially at the appeal level.  Allow me to elaborate a little more on what I mean by the term objective medical evidence and how critical it is to the success of a disability claim.

First, there is non-objective evidence.  This might include claims or allegations made by the claimant or members of his/her family.  It might also include the professional opinions of a doctor.  For example, if a doctor records in the patient's chart, "I think this patient is suffering from a dysfunctional gallbladder and liver," that is not objective evidence.  However, a HIDA Scan (hepatobiliary iminodiacetic acid scan) showing liver or gallbladder dysfunction would be objective medical evidence. So, there is opinion evidence and there is objective evidence.  Both types of evidence may be important in a disability case; however, there must be some objective evidence to establish the presence and severity of an alleged impairment.  Everything can be based merely on the doctor's opinion.

 Ideally, we want to see both objective evidence and opinion evidence.  The following would be an ideal scenario?  The doctor enters a note stating:

 "Based on a HIDA scan completed at Good Samaritan Hospital on 6/1/15 showing extremely poor liver function, and supported by a CT scan performed on 6/11/15, a diagnosis of ____ is appropriate."  (That is objective evidence).  "I feel that the patient's severe nausea, fatigue and abdominal pain is best explained by the liver problems.  This condition is probably permanent and I do not feel that the patient will be able to perform any meaningful work activity for at least the next 12 months because of the liver disease."  (The latter part of the statement is opinion evidence).  

In summary, opinion evidence from your doctor is great but it should be supported by objective evidence.

The following are almost never sufficient to win a Social Security disability claim if not supported by objective medical evidence:
  • the claimant's own testimony of severe illness, injury or limitations of function
  • the same type of testimony given by a spouse, family member of friend
  • an opinion of a medical doctor in the absence of any tests or supporting data, especially if the doctor has a very limited history of treatment with the patient.
  • Evidence exclusively from non-accepted medical sources such as nurse practitioners, chiropractors, mental health counselors, etc.
The federal regulations regarding evidentiary requirements in Social Security disability cases, in part, is found in 20 CFR 404.1527.  The amount of weight given to a doctor's evidence will depend on such factors as how long the doctor treated the patient, whether the doctor is a specialist in the disorder being treated, and other factors. 

It would do the claimant good to understand that in the eyes of Social Security, you are not disabled until you can prove that you are.

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