Those who suffer from physical or mental conditions that make it difficult or impossible to work will often be concerned about their ability to support themselves financially. Fortunately, Social Security disability benefits are available in many cases. However, the process of applying for Social Security disability can be complicated, and disability claims are often denied for a variety of reasons. While it is possible to appeal the decision to deny disability benefits, it is important to understand the procedures followed when doing so and the types of evidence that may be considered in an appeal.

Appeals Court Upholds Decision to Deny Benefits and Refuses to Reweigh Evidence

If a disability claim is denied, an applicant will usually need to file a request for reconsideration, and if benefits are once again denied, they may request a hearing before an Administrative Law Judge (ALJ). Both sides will present evidence at this hearing, and the ALJ will follow specific procedures to determine whether the applicant is disabled and whether they should be able to find work that fits within their physical or mental limitations. If an ALJ rules that a person is not disabled, the applicant can appeal this decision. However, an appeal must be based on the claim that the ALJ committed errors, and an applicant cannot introduce new evidence or ask the appeals court to reconsider or reinterpret previous evidence.

When seeking Social Security disability benefits, the opinions of your treating physicians will often provide crucial evidence in support of your case. But not all treating-physician opinions are treated equally. For instance, if your doctor simply confirms your own subjective reports regarding certain symptoms–such as chronic pain–without providing any further analysis, that may be of limited value to a Social Security administrative law judge (ALJ) reviewing your application.

Seventh Circuit Dismisses Appeal Brought by Illinois Woman with Fibromyalgia

A recent decision from the Chicago-based U.S. Seventh Circuit Court of Appeals, Apke v. Saul, helps to illustrate this point. In this case, a 37-year-old woman applied for disability benefits, citing a number of impairments, including fibromyalgia. Fibromyalgia is a pain disorder that is notoriously difficult to diagnose using objective tests. As a result, Social Security often views disability claims based on fibromyalgia with increased skepticism.

This case proved to be no different. Although the plaintiff submitted expert reports from three of her treating physicians, the ALJ overseeing the case decided after holding a hearing to solicit the views of a third-party rheumatologist. Based on the rheumatologist's findings, the ALJ ultimately denied the plaintiff's application for disability benefits.

In Social Security disability cases filed before March 27, 2017, agency officials are normally required to give “controlling weight” to the medical opinions of your treating physicians when assessing your claim for benefits. A Social Security administrative law judge (ALJ) may only depart from this controlling-weight rule by giving specific reasons, based on the available medical evidence, why the treating physician's views are contradicted by other evidence or are someone internally inconsistent.

Judge Rules ALJ Failed to Properly Follow Pre-2017 Regulations

Even though the pre-2017 rule is well understood, it is not always correctly applied. Take this recent decision from an Illinois federal judge, Rosalinda G. v. Saul. In this case, the judge ordered Social Security to conduct a new disability hearing after finding the ALJ failed to properly follow the treating-source rule.

The plaintiff here applied for disability in 2013 based primarily on her fibromyalgia. Three of the plaintiff's treating physicians presented medical evidence for her disability hearing. The ALJ assigned to the case ultimately gave “little weight” to the views of two of these doctors, and only assigned “great weight” to “aspects” of the third doctor's opinions. As you might expect, the ALJ found the plaintiff did not qualify as disabled and denied her application for benefits.