Will SSA Penalize You for Choosing NOT to Undergo Surgery?

If you are pursuing Social Security disability due to orthopedic problems like chronic neck or back pain, or due to a systemic disease inflammatory bowel disease you may find yourself faced with a decision about whether or not to undergo surgery.

Surgery of any type is inherently dangerous and if you have been diagnosed with other medical problems (co-morbidities) like diabetes, obesity, cardiac problems or breathing issues), surgery may be even less desirable.

What does Social Security policy say about how a disability adjudicator or judge should evaluate your case if surgery has been recommended but you have decided against an operation?

Social Security issues policy statements that address questions like these in Social Security Rulings. Rulings are roughly equivalent to case law precedent in judicial matters and rulings set out specific guidelines about how SSA adjudicators and judges must evaluate specific issues that arise in claims.

Social Security ruling 18-3p specifically discusses how decision makers should address "failure to follow prescribed treatment." https://www.ssa.gov/OP_Home/rulings/di/02/SSR2018-03-di-02.html

More specifically, SSA can deny benefits if a claimant refuses to follow doctor's orders with good reason. The ruling gives examples of what constitutes a good reason to refuse prescribed treatment. Examples of good reasons include:
- religious beliefs
- cost
- disagreement among medical providers
- high risk of loss of life or limb
- intense fear of surgery
- concern about addiction to opioid medications

You must, however, make your reasons known to your provider. In my experience the more specific you can be the better. In the case of orthopedic surgery to the neck or back you should research the risks associated with the offered surgery and explain to the doctor (in writing if possible) why these risks are unacceptable.

Perhaps you had a prior surgery that did not go well. Or perhaps there is a very real chance that you could end up worse off after surgery than before.

In addition to doing what you can to get your reasons for refusing surgery into the medical record, you should express openness to alternatives to surgery. For example, many orthopedic surgeons will refer patients who don't want surgery to a pain management physician. The pain management physicians might offer injections, physical therapy, opioids, non-opioids as well as alternative treatment like massages, yoga or aquatherapy.

In my experience disability judges are much more sympathetic to a claimant who refuses surgery when that claimant makes a good faith effort to address chronic pain with other therapies.

If you refuse surgery but also do not take any action, you may find that your judge will equate inaction with lack of severity. This is especially true if you are able to perform activities of daily living like housekeeping, cleaning or caring for pets or children.

Want more information about how Social Security decision makers decide cases? Leave me a comment on this video or visit me online at https://ssdAnswers.com.

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