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b2ap3_thumbnail_disability_20200401-004725_1.jpgSocial Security disability is a form of insurance. This means that you can only apply for benefits if you are actually covered–insured–at the time you became disabled. In most cases, your “date last insured” for disability purposes is five years after you left your last job.

Appeals Court: Social Security May Not Ignore Medical Opinions Rendered After Date Last Insured

But can Social Security consider a medical diagnosis or opinion rendered by your doctor after your date last insured (DLI) when assessing your disability claim? The U.S. Seventh Circuit Court of Appeals here in Chicago recently addressed this question in an unpublished decision, Marquardt v. Saul. The plaintiff in this case applied for disability benefits based on his lupus and related impairments.

The plaintiff's date last insured was July 2013. In his application to Social Security, the plaintiff said his lupus rendered him unable to work prior to this date. However, he also submitted two reports from his treating neurologist, which were prepared in 2015 and 2016, respectively. These reports established the plaintiff suffered from cognitive defects as a result of his lupus. These defects, in turn, limited the plaintiff to performing “single-task jobs with breaks and no distractions.”

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IL disability lawyerAs a general rule, your own doctor knows your medical condition best. In the context of a Social Security disability benefits hearing, an administrative law judge (ALJ) is therefore required to give your doctor's views “controlling weight,” so long as the doctor's opinions are supported by the available medical evidence. If the ALJ chooses to discount or disregard your doctor's diagnosis, the ALJ must provide “good reasons” for that decision, which also must be supported by evidence.

Christopher C. v. Saul

What the ALJ may not do is misrepresent the evidence in order to discredit your doctor's testimony. Unfortunately, this happens more than Social Security would like to admit. Just recently, an Illinois federal magistrate judge ordered Social Security to conduct a new disability hearing precisely because an ALJ failed to follow the rules in assessing a treating physician's views.

The plaintiff in this case, Christopher C. v. Saul, suffers from physical impairments related to his left ankle and obstructive pulmonary disease. The plaintiff's treating podiatrist said that as a result of the plaintiff's impairments, he would “need to elevate his leg just above hip level about 20 to 50 percent of an eight-hour workday due to edema, pain, and inflammation.” The plaintiff would also require a cane to stand and walk and could not lift more than 10 pounds. He was also incapable of stooping, bending, crouching, squatting, or climbing stairs or ladders.

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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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