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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 lawyerIn determining eligibility for disability insurance benefits, Social Security must first determine your “residual functional capacity” or RFC. This is an assessment of your ability to work, taking into account any documented physical or mental impairments that you have. By law, Social Security must take all of your limitations into account when formulating an RFC.

Magistrate: Social Security Acknowledged Disability Applicant's Severe Headaches, Yet Did Not Account for Them in RFC

That does not, however, mean that Social Security officials always follow the law. A recent decision from a federal magistrate judge here in Illinois, Charlene J. v. Saul, provides a case in point. This case actually involves a plaintiff who filed for Supplemental Security Income (SSI) benefits. SSI is a type of benefit available to low-income individuals who do not enough of a work history to qualify for disability insurance (SSDI). That said, Social Security uses the same RFC standards when assessing SSI and SSDI claims, so the issues discussed here also apply to disability cases.

Here, a Social Security administrative law judge (ALJ) determined the plaintiff suffered from a number of impairments, including the loss of vision in one eye, type-2 diabetes, and chronic headaches. The ALJ then found that despite these conditions, the plaintiff had the RFC to perform a “full range of medium work” with certain limits. Based on this RFC, the ALJ said the plaintiff could still perform her prior job as a cashier and denied her application for benefits.

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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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