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b2ap3_thumbnail_medical-impairment.jpgIn a typical Social Security disability case, an administrative law judge (ALJ) will hear medical opinions from a number of different experts. In addition to the disability applicant's own treating physicians, the ALJ will also review the views of non-treating “consultants” who have examined the applicant's medical records. For disability cases filed before March 2017, the ALJ is normally required to give the treating physician's views “controlling” weight in the event of a conflict. That said, it is permissible to discount those opinions in favor of the non-treating consultants.

Magistrate: ALJ Cannot Rely Solely on Her “Lay Expertise” in Assessing Applicant's Mental Impairments

What the ALJ may not do, however, is ignore all of the medical evidence and “play doctor” themselves. The ALJ is a legal officer, not a medical professional. That means their job is to apply the law fairly and impartially.

But we often see ALJs step outside this legal role to make improper medical diagnoses. A recent disability case from here in Illinois, Christopher P. v. Saul, provides a useful illustration. The plaintiff here applied for disability benefits over five years ago. As part of the application process, the plaintiff's treating psychiatrist opined that he suffered from a number of mental impairments that included “marked limitations in concentration, persistence, or pace, and three episodes of decompensation, along with other disabling symptoms.”

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Chicago disability claim denial lawyerSocial Security disability applicants who suffer from chronic pain often face a difficult choice. If they stop treatment that is no longer effective, Social Security may cite that as proof the pain is not that bad. But if the treatment continues, the agency may say that shows the applicant can effectively “manage” their pain. Either way, Social Security may decide that the applicant is not disabled.

Fortunately, the federal courts often see through this “heads I win, tails you lose” logic. The reality is that a disability applicant may need to stop treatment for a number of valid reasons. This does not, in and of itself, mean they are able to work full-time in spite of their chronic pain and other ailments.

Social Security Criticized for Inaccurate Description of Disability Applicant's Pain, Treatment Options

Here is a recent example from here in Illinois: the plaintiff in this case–a woman now in her mid-60s–lost her job in 2009 because she required “too much time off” to deal with her existing medical problems. Later that same year, she was diagnosed with lupus, which only further aggravated her existing back pain problems.

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Chicago disability benefits denial attorneyInconsistency is often a major factor in Social Security denying disability claims. If the agency feels your doctor's opinions are inconsistent with the other medical evidence available, your claim can be denied. Similarly, if an administrative law judge (ALJ) feels your own testimony with respect to your symptoms–especially with respect to subjective matters like pain–is inconsistent, that may also form the basis for denying a claim.

Appeals Court Sides With Social Security Despite Problems With ALJ's Reasoning

Consider a recent decision by the U.S. Seventh Circuit Court of Appeals here in Chicago. The plaintiff in this case unsuccessfully applied for disability benefits. He previously worked for a chemical company, and while loading chemicals onto a truck at work one day, he “felt pain in his low back.” The pain persisted, so he eventually saw a specialist, who determined the plaintiff had a large disc herniation “that was pinching a spinal nerve root.”

Although doctors initially advised a conservative course of treatment–i.e., physical therapy–the plaintiff ultimately needed back surgery. This led him to stop working in 2007. In 2008, a physical therapist suggested the plaintiff could resume performing “light” work. However, the plaintiff did not return to work and instead applied for disability benefits in 2012.

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