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IL disability attorneyThere is a tendency among Social Security officials to take claims involving psychological impairments less seriously than those involving physical impairments. Legally, this should not matter. If a person is unable to work due to a documented mental disorder, they are just as entitled to disability benefits as someone with a physical impairment. Unfortunately, that is not always the reality.

Illinois Magistrate Orders a New Hearing, Criticizes ALJ for “Playing Doctor”

Take this recent decision from an Illinois federal magistrate judge, Anthony S. v. Saul. In this case, a 55-year-old man (the plaintiff) applied for disability benefits, citing a number of psychological impairments, including post-traumatic stress disorder and bipolar disorder. After a hearing, a Social Security administrative law judge (ALJ) determined these impairments did not prevent the plaintiff from performing some types of “light work” and denied his disability claim.

The magistrate, who reviewed the case after the plaintiff sued the Social Security Administration, noted the ALJ failed to “explicitly” state a “single theory” to explain the decision to deny benefits. Based on the content of the ALJ's decision, however, the magistrate interpreted rationale as that the plaintiff was “malingering,” i.e., the “intentional production of false or grossly exaggerated [] psychological symptoms.”

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IL benefits attorneyEven if you have a physical or mental impairment that qualifies you for Social Security disability, the government will cease paying those benefits if you reach “medical improvement.” In other words, if a doctor determines your impairments no longer prevent you from working, Social Security will find you no longer qualify as legally disabled. In some cases, Social Security may even determine you have already reached medical improvement by the time it considers your disability benefits application.

Federal Court Finds Social Security Officials Improper “Playing Doctor” Once Again

But as with all such determinations, Social Security must rely on the actual medical evidence presented. Agency officials are not supposed to engage in conjecture or render their own non-expert medical findings. Yet we continue to see cases where Social Security administrative law judges improperly “play doctor,” particularly in situations where a disability applicant has a difficult-to-diagnose impairment.

Consider this recent case, Brown v. Saul. The plaintiff in this case suffers from hand tremors. In part due to this impairment, the plaintiff applied for disability benefits in 2014. Following a hearing in 2016, an ALJ determined the plaintiff was disabled–but only for the period between March 2014 and July 2015. After July 2015, the ALJ found the plaintiff achieved medical improvement because he “did not suffer from tremors after that point.”

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IL disability lawyerIt is a well-established rule in Social Security disability cases that the agency's administrative law judges (ALJs) are not allowed to “play doctor.” That is to say, the ALJ is a layperson, not a doctor or a medical expert. Therefore, when assessing an applicant's disability claim, the ALJ must rely on testimony or evidence offered by such experts rather than trying to diagnosis the claimant themselves.

Court Cites ALJ's Failure to Call Medical Expert in Ordering New Disability Hearing

Unfortunately, this rule is not always so easy to implement in practice. As an Illinois federal magistrate judge observed in a recent disability case, Michelle M. v. Saul, it is often difficult to distinguish “playing doctor” from “merely noting or summarizing the evidence.” Indeed, the magistrate observed that “there do not appear to be many clear rules to determine when the doctor-playing line is crossed.”

This particular case illustrated the problem. The plaintiff here applied for disability benefits alleging a number of physical impairments, including chronic pain in her back, hands, and feet. But as the magistrate explained, the plaintiff's treating physicians have been able to make a “single consistent diagnosis” to explain the cause of her problems. Additionally, the plaintiff received significant treatment after her disability hearing before the ALJ, and as a result, there were “200 pages of treatment records” submitted after the hearing.

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