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IL benefits attorneyEven if you have a physical or mental impairment that qualifies you for Social Security disability, the government will cease paying those benefits if you reach “medical improvement.” In other words, if a doctor determines your impairments no longer prevent you from working, Social Security will find you no longer qualify as legally disabled. In some cases, Social Security may even determine you have already reached medical improvement by the time it considers your disability benefits application.

Federal Court Finds Social Security Officials Improper “Playing Doctor” Once Again

But as with all such determinations, Social Security must rely on the actual medical evidence presented. Agency officials are not supposed to engage in conjecture or render their own non-expert medical findings. Yet we continue to see cases where Social Security administrative law judges improperly “play doctor,” particularly in situations where a disability applicant has a difficult-to-diagnose impairment.

Consider this recent case, Brown v. Saul. The plaintiff in this case suffers from hand tremors. In part due to this impairment, the plaintiff applied for disability benefits in 2014. Following a hearing in 2016, an ALJ determined the plaintiff was disabled–but only for the period between March 2014 and July 2015. After July 2015, the ALJ found the plaintiff achieved medical improvement because he “did not suffer from tremors after that point.”

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IL disability lawyerIt is a well-established rule in Social Security disability cases that the agency's administrative law judges (ALJs) are not allowed to “play doctor.” That is to say, the ALJ is a layperson, not a doctor or a medical expert. Therefore, when assessing an applicant's disability claim, the ALJ must rely on testimony or evidence offered by such experts rather than trying to diagnosis the claimant themselves.

Court Cites ALJ's Failure to Call Medical Expert in Ordering New Disability Hearing

Unfortunately, this rule is not always so easy to implement in practice. As an Illinois federal magistrate judge observed in a recent disability case, Michelle M. v. Saul, it is often difficult to distinguish “playing doctor” from “merely noting or summarizing the evidence.” Indeed, the magistrate observed that “there do not appear to be many clear rules to determine when the doctor-playing line is crossed.”

This particular case illustrated the problem. The plaintiff here applied for disability benefits alleging a number of physical impairments, including chronic pain in her back, hands, and feet. But as the magistrate explained, the plaintiff's treating physicians have been able to make a “single consistent diagnosis” to explain the cause of her problems. Additionally, the plaintiff received significant treatment after her disability hearing before the ALJ, and as a result, there were “200 pages of treatment records” submitted after the hearing.

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IL disability lawyerIn assessing disability claims, Social Security looks at whether or not you have an “impairment” that is considered “severe” enough to prevent you from working. A Social Security administrative law judge (ALJ) is also expected to consider symptoms that, while not qualifying impairments in and of themselves, may exacerbate such an impairment. In particular, the ALJ needs to determine how your symptoms and impairments, taken as a whole, may restrict the type of work you are able to perform, if any.

Social Security Failed to Consider Leg Weakness in Assessing Illinois Woman's Disability Claim

To illustrate these principles in greater detail, here is a recent case, Ramona G. v. Saul, where the ALJ failed to properly consider an applicant's symptoms. The plaintiff, in this case, applies for disability benefits three years ago. The main issue raised in the plaintiff's application was her back impairment. In conjunction with this impairment, the plaintiff also presented medical evidence that she suffered from weakness in her right leg.

The ALJ determined that this leg weakness was not itself a “medically determinable impairment” under Social Security regulations. The ALJ went on to deny the plaintiff's application for disability benefits. In response, the plaintiff filed for judicial review with an Illinois federal magistrate judge.

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