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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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IL disability attorneyFibromyalgia is one of the more difficult medical conditions to address in the context of applying for Social Security disability insurance. The medical definition of fibromyalgia, according to the U.S. Centers for Disease Control and Prevention, is a “condition that causes pain all over the body (also referred to as widespread pain), sleep problems, fatigue, and often emotional and mental distress.” While fibromyalgia can manifest itself through these symptoms, there is no simple medical “test” that can diagnose a patient with the condition.

As a result, Social Security administrative law judges (ALJs) tend to discount subjective complaints of pain by disability applicants as insufficient to prove their fibromyalgia prevents them from working. Illinois courts have repeatedly told Social Security, however, that ALJs cannot require such “objective” tests to confirm a fibromyalgia diagnosis.

Appeals Court Rejects Widower's Appeal of Social Security Decision

At the same time, an ALJ may consider additional objective evidence when evaluating the “severity” of fibromyalgia under the Social Security Administration's disability listings. A recent decision from the U.S. Seventh Circuit Court of Appeals here in Chicago, Gebauer v. Saul, illustrates this principle in greater detail. This sad case actually involved the widower of a woman (the decedent) who died suddenly while her application for disability benefits was still pending.

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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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