When applying for Social Security disability benefits, it is important to remember that the officials who will rule on your claim are not themselves doctors or medical experts. Social Security regulations require officials to carefully consider the medical evidence, as well as your own testimony regarding your symptoms, in making a decision. It is improper for Social Security to “play doctor” on its own accord or rule in a way that is not supported by the actual medical evidence presented.

Illinois Magistrate Orders New Hearing for Disability Applicant, Citing Multiple Legal Errors

Let's take this recent decision from a federal magistrate judge here in Illinois, Matthew DS v. Saul. In this case, Social Security denied the disability application of a man (the plaintiff) who suffers from “inflammatory arthritis, rheumatoid arthritis, and obesity.” Following a hearing, a Social Security administrative law judge (ALJ) determined these impairments did not qualify the plaintiff for the disability benefits.

The magistrate judge, however, found that several aspects of the ALJ's decision were not supported by the medical evidence. Among the problems cited by the magistrate:

Social Security often denies applications for disability benefits based on the testimony of “agency consulting physicians.” These are doctors who review an applicant's medical records without personally examining or treating the applicant. In some cases, a Social Security administrative law judge (ALJ) will give greater weight to the opinions of the agency consultants over the treating physicians. This is permitted under Social Security regulations, provided the consultant's opinions are consistent with the available medical evidence.

Appeals Court Questions Social Security's Conclusions Regarding Disability Applicant's Ability to “Reach Overhead”

Here is an example of a case where an ALJ improperly credited an agency consultant. In Gibbons v. Saul, the plaintiff applied for disability benefits approximately seven years ago. The plaintiff suffered from severe chronic pain in his neck, shoulders, and arms. Several doctors provided medical evidence with respect to the plaintiff's condition.

A critical issue was whether or not the plaintiff was capable of reaching overhead. According to Social Security regulations, a person is capable of performing “sedentary work,” and therefore does not qualify for disability benefits, if they can lift up to 10 pounds.

Fibromyalgia is one of the more difficult medical conditions to address in the context of applying for Social Security disability insurance. The medical definition of fibromyalgia, according to the U.S. Centers for Disease Control and Prevention, is a “condition that causes pain all over the body (also referred to as widespread pain), sleep problems, fatigue, and often emotional and mental distress.” While fibromyalgia can manifest itself through these symptoms, there is no simple medical “test” that can diagnose a patient with the condition.

As a result, Social Security administrative law judges (ALJs) tend to discount subjective complaints of pain by disability applicants as insufficient to prove their fibromyalgia prevents them from working. Illinois courts have repeatedly told Social Security, however, that ALJs cannot require such “objective” tests to confirm a fibromyalgia diagnosis.

Appeals Court Rejects Widower's Appeal of Social Security Decision

At the same time, an ALJ may consider additional objective evidence when evaluating the “severity” of fibromyalgia under the Social Security Administration's disability listings. A recent decision from the U.S. Seventh Circuit Court of Appeals here in Chicago, Gebauer v. Saul, illustrates this principle in greater detail. This sad case actually involved the widower of a woman (the decedent) who died suddenly while her application for disability benefits was still pending.