DDS and Claims Involving Chronic Pain

Disability Determination Services (DDS) is the state agency that makes the initial and reconsideration determinations on Social Security disability claims. 

I saw three different claims denied at the reconsideration level this month. All involved chronic pain. All were productive people prior to developing debilitating medical conditions. All had terrific medical source statements from the treating physician, which were ignored by DDS.  I just don't understand these denials. I expect all three of these claims to be granted at the hearing level.

There seems to be a real disconnect at DDS when evaluating disability claims that involve chronic pain. For some claimants, such as those with back problems or those with fibromyalgia, it is the chronic pain that prevents that person from working.

Maybe there is an empathy gap at DDS, or perhaps better training is needed. I don't know. There certainly seems to be a disregard (or a skewed interpretation) of Social Security regulation 20 C.F.R. 404.1527(d)(2) and related Social Security Ruling 96-02p, which require that controlling weight be given to a treating physician's opinion, if that opinion is not inconsistent with the case record.   

The relevant section of 20 C.F.R. 404.1527(d)(2) states:

If we find that a treating source's opinion on the issue(s) of the nature and severity of your impairment(s) is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in your case record, we will give it controlling weight.

There is no real issue in these cases of the doctor's opinions being "well-supported by medically acceptable clinical and laboratory diagnostic techniques." Of course they are. Rather, the issue is whether the doctor's opinion is "not inconsistent with the other substantial evidence in your case record."

"Not inconsistent" means that a "treating source medical opinion need not be supported directly by all of the other evidence (i.e., it does not have to be consistent with all the other evidence) as long as there is no other substantial evidence in the case record that contradicts or conflicts with the opinion." See Social Security Ruling 96-02p.

My feeling is that treating source opinions are not being given the proper analysis at DDS. My feeling is that they are being disregarded. And that is one reason why I expect a different result for these claims at the hearing level.

{update Feb. 4, 2010 - all three of these claims have now been granted at the hearing level. One was granted after a hearing, and the other two were granted "on the record" without a hearing.}

Comments

[Tomasz Stasiuk]

I see the same thing every day. The same evidence that DDS ignores at the initial decision level WINS cases at the hearing level.

I don't think I have seen 1 example of an opinion I have submitted to DDS changing their mind once the staff physician has already stated that the person is not disabled.