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Social Security Cannot Rely on Incomplete “Expert” Analysis of Medical Records

Posted by on in Social Security Disability

disability benefits, disability applicant, Chicago Social Security disability lawyer, analysis of medical records, chronic painSocial Security often justifies denying disability benefits on the basis of expert testimony from state-agency physicians. These are doctors who do not personally treat a disability applicant. Rather, they are supposed to review all of the relevant medical records and offer an informed analysis to the administrative law judge (ALJ) conducting the disability hearing. What ALJs are not supposed to do is assess the medical evidence themselves, as they are not doctors and may not play one for purposes of a legal proceeding.

Seventh Circuit Renews Criticism of Social Security's Approach to Fibromyalgia Patients

Of course, that does not stop them from trying. The U.S. Seventh Circuit Court of Appeals in Chicago recently ordered Social Security to conduct a new disability benefits hearing in a case where the ALJ not only played doctor, but also relied on an incomplete analysis of the applicant's medical records. To compound the problems, the applicant's principal disability in this case is fibromyalgia, a severe pain disorder that Social Security often does its best to pretend does not exist.

The plaintiff in this case has an extensive medical history documenting her fibromyalgia over the past seven years. Among other evidence, a nurse-practitioner performed an MRI on the plaintiff in 2014. According to the Seventh Circuit, the results of the MRI were “illuminating,” as it showed an abnormal narrowing of the plaintiff's spinal canal and “worsening” damage to her back and neck. These findings were consistent with the plaintiff's fibromyalgia diagnosis.

Yet the two state-agency doctors who reviewed the plaintiff's medical records never looked at this MRI. But the ALJ assigned to the case did “consider” the MRI and—despite the handicap of having no formal medical training or licensing—decided it was no big deal. Ultimately, the ALJ decided the plaintiff's fibromyalgia was not serious enough to find her legally disabled. The ALJ relied upon the incomplete analysis performed by the state-agency doctors, disregarding the assessment of the plaintiff's treating physicians.

The Seventh Circuit found the ALJ's conduct unacceptable. First and foremost, the appeals court said an ALJ may not independently analyze an MRI “without an expert opinion interpreting the results.” This error alone justified granting the plaintiff a new hearing.

In addition, the Court chastised the ALJ for using “objective medical evidence” to discredit the plaintiff's subjective complaints of disabling pain. As the Seventh Circuit has said in prior cases, fibromyalgia by its nature “cannot be evaluated or ruled out by using objective tests.” ALJs often dismiss fibromyalgia complaints as nothing more than applicants exaggerating symptoms, but the Court said the ALJ needed to develop “a more fulsome record about [the plaintiff's] testimony of pain before discounting it.”

Are You Unable to Work Due to Chronic Pain? We Can Help

Fibromyalgia affects approximately 10 million people in the United States, most of them women. In many cases the chronic pain is severe enough to keep patients from working. If you are in that position and need advice from a qualified Chicago Social Security disability lawyer, contact Pearson Disability Law, LLC today.


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