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b2ap3_thumbnail_diagnosis.jpgIn Social Security disability cases, agency officials are not allowed to “play doctor.” Instead, administrative law judges (ALJs) are expected to look at the medical evidence presented to them. And if two doctors offer different medical assessments of a disability applicant, it is the ALJ's job to resolve that conflict.

ALJ Unable to Resolve Cause of Disability Applicant's “Exploding Head Syndrome”

Here is a recent Illinois disability case, John L. v. Berryhill, where the ALJ did not do that. In this case, the plaintiff applied for Social Security disability benefits seven years ago. At a 2015 hearing, an ALJ considered medical evidence related to the plaintiff's sleep parasomnia, i.e., his sleep disorder.

A sleep specialist diagnosed the plaintiff with “possible exploding head syndrome.” This refers to a rare type of parasomnia “in which affected individuals awaken from sleep with the sensation of a loud bang,” according to a 2013 report from the National Institutes of Health. The plaintiff told the specialist that he “heard sounds when he was sleepy 4 to 5 times a day or when he shifted his attention.”

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IK diability attorneyA key step in the Social Security disability process is the determination of an applicant's “residual functional capacity” or RFC. The RFC is designed to account for an applicant's physical and mental limitations in assessing what type of work, if any, they are still able to perform. If Social Security fails to account for a particular limitation in performing an RFC, the agency needs to explain why.

Social Security Cannot Reject Disability Applicant's Testimony without Explanation

For example, if a disability applicant says he requires a cane to walk or get around, the RFC needs to account for this limitation. Alternatively, the Social Security administrative law judge (ALJ) overseeing the case must explain why the applicant's testimony is inconsistent with the other evidence in the record–i.e., that the applicant does not medically require a cane. What the ALJ cannot do is simply ignore the testimony regarding the need for a cane without explanation.

In fact, an Illinois federal magistrate recently returned a disability case to Social Security precisely for this reason. The plaintiff in this case applied for disability benefits in 2014. An ALJ conducted a hearing in 2017. Following the hearing, the ALJ denied the plaintiff's application.

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IL disability lawyerWe often come across Social Security disability cases where an administrative law judge (ALJ) improperly tries to “play doctor.” In the most serious cases, the ALJ will simply ignore medical evidence outright if it poses a potential hurdle to finding the applicant is not legally disabled. Such actions violate both the letter and the spirit of disability law.

Magistrate: ALJ “Mischaracterized” Evidence Supporting Disability Claim

Fortunately, federal courts are ready and willing to call Social Security out on such behavior. This was the case in a recent decision, Karl B. v. Commissioner, where a magistrate judge said an ALJ “left some evidence out” of their decision because it “corroborated plaintiff's claims” in support of his disability application. The magistrate, therefore, ordered Social Security to conduct a new hearing.

The plaintiff in this case is a man in his early 50s. He previously held a number of jobs as a “car washer, loader, lot driver, sales representative, and sign holder,” according to court records. In his disability application, the plaintiff cited a number of impairments that prevented him from working, notably chronic pain and stomach problems arising from a 2001 armed robbery where he was shot. After an evidentiary hearing, a Social Security ALJ determined the plaintiff was not disabled and denied his application for disability benefits.

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