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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 you make a Social Security disability claim, multiple different types of medical evidence will be considered to determine whether you qualify to receive benefits. An administrative law judge (ALJ) will consider a number of factors, including whether you have an impairment that is equal or similar to specific impairments described in Social Security regulations and whether you are able to work in your current occupation or perform other types of work. When looking at whether the medical tests you have received support your claim, an ALJ is required to rely on the opinions of medical experts rather than forming their own opinions.

Illinois Court Reverses ALJ’s Decision to Deny Benefits

In some cases, an ALJ may base the decision to deny a disability claim on an improper interpretation of medical tests. This was demonstrated in a recent Illinois case, Paul R. C. v Commissioner of Social Security. The plaintiff, a man in his 50s who had worked as a painter and drywaller, applied for Supplemental Security Income (SSI) based on a number of medical conditions, including arthritis in the knees, torn shoulder muscles, diabetes, carpal tunnel syndrome, and injuries to the lower back. A previous disability claim had been denied because the ALJ concluded that he was capable of a “limited range of light work.”

In the claim in question in this case, the ALJ denied benefits and ruled that the plaintiff was capable of “medium work” that did not involve climbing on ladders or scaffolds, and only occasionally included kneeling, crouching, or crawling. Even though the plaintiff was unable to do the work he had done in the past, the ALJ stated that he would be able to find a job where he could work at the “medium exertional level.”

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IL disabilty lawyerThere is often a significant delay in hearing Social Security disability cases. One result of this delay is that new information regarding an applicant's medical condition may come to light after a doctor has already reviewed the record. When this happens, a Social Security administrative law judge (ALJ) should take the time to obtain a proper expert assessment of this new information before making a decision.

Illinois Magistrate Orders New Hearing to Consider Applicant's MRIs and X-rays

Unfortunately, that is not always how things work in practice. Consider this recent decision from a federal magistrate judge here in Illinois, Renee L. M. v. Commissioner of Social Security. The plaintiff, in this case, is a woman in her 50s who applies for disability insurance benefits four years ago. Although an ALJ determined the plaintiff did suffer from a number of severe impairments, including “fibromyalgia, back arthritis, anxiety disorder, and personality disorder,” she nevertheless had the “residual functional capacity” to perform “light work” with limitations. On that basis, the ALJ denied the claim for disability benefits.

Before the magistrate, the plaintiff argued the ALJ relied on the “outdated opinion” of a state agency medical consultant. These consultants do not personally treat the disability applicant; rather they review their medical records and offer opinions to the ALJ. The ALJ is never supposed to “play doctor” themselves, but instead assess the credibility of the consultants as well as any treating physicians.

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