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IL disability attorneyWhen a person makes a Social Security disability claim, the decision about whether to award benefits will usually depend on the medical examinations they receive, as well as evaluations that are meant to determine whether they have the ability to work. In these cases, the opinions of a person’s regular doctor, who is known as a “treating source physician,” are given a great deal of weight. This is because a treating physician will have established a relationship with the patient that gives them a better understanding of their physical condition and their capabilities to perform work. However, in some cases, disability claims are improperly denied because Social Security does not properly consider the opinions of a treating source physician.

Appeals Court Vacates Denial of Benefits Based on Failure to Give Weight to Treating Physician’s Opinion

One recent case in Illinois demonstrates how Social Security may deny benefits without properly considering the opinions of a treating source physician. In Hargett v. Commissioner of Social Security, the United States Court of Appeals considered a situation in which an applicant had been denied benefits by an administrative law judge (ALJ), and this decision was upheld by a federal magistrate judge.

The plaintiff applied for disability benefits based on a number of impairments, including type 2 diabetes, chronic obstructive pulmonary disease, curvature of the spine, and high blood pressure. He had been receiving treatment from his primary care physician, who referred him to a physical therapist for a functional capacity evaluation (FCE). This evaluation found that while he had the lifting capacity to perform “medium-strength” work, he was unable to stand for more than five minutes, could not walk for more than a tenth of a mile, could not balance well while walking or standing, and could not crouch or stoop. The primary care physician signed off on the results of this evaluation.

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IL disability attorneyWhen reviewing Social Security disability applications, an administrative law judge (ALJ) needs to weigh the evidence offered by various medical experts. As a general rule, the ALJ should give more weight to the testimony offered by a doctor with respect to their own specialty as opposed to someone who is not. For example, if a disability applicant is unable to walk, you would credit the testimony of an orthopedic surgeon over, say, a dermatologist.

This might sound like just basic common sense. Yet there are many cases where ALJs will disregard the specialist's view in favor of a non-specialist's view–especially when the latter is willing to say the applicant's condition does not really qualify them for disability benefits. Such decision-making not only defies common sense, but it is also often in direct contravention of Social Security regulations.

Let's take this recent disability case from here in Illinois, Kathy P. v. Saul. The plaintiff in this case applied for Social Security disability benefits about five years ago. Although she suffers from a number of physical and mental impairments, the critical issue here involves her mental disorders and frequent migraines. In support of her claims, the plaintiff presented expert testimony from her treating psychiatrist. Based on her extensive treatment history, the psychiatrist told Social Security that the plaintiff “was unable to meet competitive standards for several abilities such as completing a normal workday and workweek without interruptions, accepting instructions and responding appropriately to criticism from supervisors, and dealing with normal work stress.”

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IL disability attorneyEven if you are unable to return to your previous job due to a medical condition, Social Security will not award you disability benefits unless it is satisfied that you are incapable of performing any type of meaningful work. The opinions of your treating physician are often critical towards proving this is the case. Of course, some Social Security administrative law judges may try to “play doctor” and attempt to disregard (or misrepresent) the views of your actual physicians.

Take this recent decision from a federal magistrate judge here in Illinois, T.D.B. v. Saul. The plaintiff in this case previously worked as a registered nurse. In 2007, she suffered a serious wrist injury when she was attacked by a patient. The plaintiff's physician subsequently diagnosed her with chronic regional pain syndrome (CRPS). By 2010, the physician concluded the plaintiff had “reached maximum medical improvement,” which is a legal term used in connection with workers' compensation proceedings. At the time, this meant the plaintiff would be limited to “full-time sedentary work.”

In 2012, however, the treating physician revised this diagnosis. In a separate letter to the workers' compensation insurance adjuster assigned to the plaintiff's claim, the doctor said the plaintiff was “essentially unemployable,” i.e., she was no longer medically capable of returning to work in any capacity on a full-time basis.

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