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IL disability lawyerWhen applying for Social Security disability benefits, it is important to remember that the officials who will rule on your claim are not themselves doctors or medical experts. Social Security regulations require officials to carefully consider the medical evidence, as well as your own testimony regarding your symptoms, in making a decision. It is improper for Social Security to “play doctor” on its own accord or rule in a way that is not supported by the actual medical evidence presented.

Illinois Magistrate Orders New Hearing for Disability Applicant, Citing Multiple Legal Errors

Let's take this recent decision from a federal magistrate judge here in Illinois, Matthew DS v. Saul. In this case, Social Security denied the disability application of a man (the plaintiff) who suffers from “inflammatory arthritis, rheumatoid arthritis, and obesity.” Following a hearing, a Social Security administrative law judge (ALJ) determined these impairments did not qualify the plaintiff for the disability benefits.

The magistrate judge, however, found that several aspects of the ALJ's decision were not supported by the medical evidence. Among the problems cited by the magistrate:

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IL disability lawyerWhen you apply for disability benefits, Social Security will consider the medical opinions of your treating physician as well as non-examining consultants. These consultants basically review your medical records and offer a separate opinion as to your physical or mental impairments. In some cases, a Social Security administrative law judge (ALJ) may decide the non-examining doctors provide a more complete or accurate view of your condition than your own physician.

Magistrate Orders New Hearing on Deceased Man's Disability Claim

But what if a non-examining doctor reviews the exact same information as your treating physician and simply offers a different opinion? For instance, could a consultant look at the tests performed by your doctor and tell the ALJ they mean something different then what your doctor concluded?

A recent decision from an Illinois federal magistrate judge, Mary T. ex. rel. Falauren T. v. Saul, presented just such a scenario. This case sadly involves a now-deceased applicant for disability benefits. The applicant's mother actually continued the case following her son's death.

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IL disability lawyerSocial Security often denies applications for disability benefits based on the testimony of “agency consulting physicians.” These are doctors who review an applicant's medical records without personally examining or treating the applicant. In some cases, a Social Security administrative law judge (ALJ) will give greater weight to the opinions of the agency consultants over the treating physicians. This is permitted under Social Security regulations, provided the consultant's opinions are consistent with the available medical evidence.

Appeals Court Questions Social Security's Conclusions Regarding Disability Applicant's Ability to “Reach Overhead”

Here is an example of a case where an ALJ improperly credited an agency consultant. In Gibbons v. Saul, the plaintiff applied for disability benefits approximately seven years ago. The plaintiff suffered from severe chronic pain in his neck, shoulders, and arms. Several doctors provided medical evidence with respect to the plaintiff's condition.

A critical issue was whether or not the plaintiff was capable of reaching overhead. According to Social Security regulations, a person is capable of performing “sedentary work,” and therefore does not qualify for disability benefits, if they can lift up to 10 pounds.

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