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What Happens When Doctors Cannot Agree on the Cause of My Disability?

b2ap3_thumbnail_diagnosis.jpgIn Social Security disability cases, agency officials are not allowed to “play doctor.” Instead, administrative law judges (ALJs) are expected to look at the medical evidence presented to them. And if two doctors offer different medical assessments of a disability applicant, it is the ALJ's job to resolve that conflict.

ALJ Unable to Resolve Cause of Disability Applicant's “Exploding Head Syndrome”

Here is a recent Illinois disability case, John L. v. Berryhill, where the ALJ did not do that. In this case, the plaintiff applied for Social Security disability benefits seven years ago. At a 2015 hearing, an ALJ considered medical evidence related to the plaintiff's sleep parasomnia, i.e., his sleep disorder.

A sleep specialist diagnosed the plaintiff with “possible exploding head syndrome.” This refers to a rare type of parasomnia “in which affected individuals awaken from sleep with the sensation of a loud bang,” according to a 2013 report from the National Institutes of Health. The plaintiff told the specialist that he “heard sounds when he was sleepy 4 to 5 times a day or when he shifted his attention.”

A second medical expert testified before the ALJ that “exploding headaches” should be considered in the same category as migraine headaches. A third expert, who did not personally examine the plaintiff but reviewed his medical records at the ALJ's request, said the plaintiff “suffered from an anxiety disorder and an organic mental disorder that included sleep apnea, tinnitus, parasomnia, and a mild cognitive impairment.”

The ALJ ultimately denied the plaintiff's application for disability benefits. On appeal, a federal magistrate judge said the plaintiff was entitled to a new hearing for a number of reasons. One of them was the ALJ's failure to address the “conflicting assessments of Claimant's exploding head syndrome.” First, the magistrate noted the second medical expert--an internist--incorrectly identified the plaintiff's condition as “exploding headache syndrome.”

More to the point, the second expert believed the plaintiff's sleep apnea should be evaluated as a seizure disorder, which is considered a “physical impairment” under Social Security regulations. By contrast, the third expert “concluded that exploding head syndrome was a psychological disorder.” This would require evaluation under a different set of regulations.

The ALJ ended up accepting the third expert's opinion but failed to cite any evidence that the plaintiff “suffered from an organic mental disorder,” according to the magistrate judge. And in fact, the ALJ was unable to identify the exact cause of the plaintiff's exploding head syndrome. While that is not necessarily the ALJ's job, the magistrate judge explained, she still needed to “resolve the conflict” between the testimony of the expert witnesses before proceeding to declare the plaintiff did not qualify as disabled.

Speak with an Illinois Social Security Disability Attorney Today

Some of the plaintiff's difficulties in convincing the ALJ may have stemmed from the fact he was not represented by a qualified Chicago disability benefits lawyer at his initial hearing. Do not make the same mistake. If you need advice on how to deal with Social Security, contact Pearson Disability Law, LLC, at 312-999-0999 today to schedule a free consultation.






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