Medical evidence is usually the key to obtaining Social Security disability benefits. Your best source of credible medical evidence is generally your own doctor. But what if your doctor is an internal medicine generalist and not a specialist? Can Social Security disregard your doctor's views simply because they lack specialized training or experience with respect to your particular disability?

Judge Rejects Social Security's Excuses for Rejecting Primary Care Doctor's Diagnosis

A federal judge here in Illinois recently confronted these questions. The plaintiff in this lawsuit seeks Social Security benefits due to a number of physical and mental impairments. Of particular note, the plaintiff suffers from “lumbar disc abnormalities” that restrict his ability to sit, stand, and walk.

One of the key steps in applying for Social Security Disability Insurance benefits is receiving a functional capacity evaluation (FCE). This is basically a test designed to objectively assess your ability to perform different degrees of work, taking into account your physical and mental impairments. An FCE generally places you into one of five categories, ranging from “ability to perform heavy work” to “unable to perform sedentary work.”

ALJ Fails to Meet “Minimum Articulation” Standard

Social Security officials are expected to take an FCE into account when deciding whether or not to grant your application for disability benefits. Although a Social Security administrative law judge (ALJ) does not have to accept the FCE's findings at face value, he or she must point to specific reasons for discounting or disregarding the evaluator's opinions. It is not enough for the ALJ to simply state he or she disagrees with the FCE's conclusions.

Social Security disability regulations are quite clear about how an administrative law judge (ALJ) is supposed to treat medical evidence: “Regardless of its source, we will evaluate every medical opinion we receive.” This does not mean the ALJ must accept every medical opinion offered. Rather, the regulations require Social Security to consider any expert testimony regarding the applicant's disability and reconcile any potentially conflicting or contrary evidence. Still, the ALJ cannot simply refuse to acknowledge a medical opinion just because he or she disagrees with it.

Appeals Court Finds ALJ “Failed to Confront” Medical Evidence

No matter what the regulations say, however, many ALJs are far too eager to take shortcuts, especially when they have preemptively decided to deny a disability claim. Consider a recent decision by the U.S. Seventh Circuit Court of Appeals here in Chicago. A 67-year old man first applied for Social Security disability benefits five years ago. The plaintiff, a military veteran and former insurance agent, told Social Security he has been unable to work since 2011 due to a variety of severe impairments, including “his spinal arthritis, hip and knee pain, and impaired hearing.”