When Can Social Security Reject the Views of My Treating Physicians in a Disability Case?

 Posted on July 24, 2020 in Social Security Disability Medical Conditions

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.

But as the judge explained in her order returning the case to Social Security for a new hearing, the ALJ never bothered to explain any of his conclusions regarding the decision not to follow the treating-source rule. Among the problems identified by the Court:

• Social Security regulations require an ALJ to account for a treating physician's specialty and treatment history with an applicant. The ALJ here did neither.
• The three treating physicians presented “consistent” testimony regarding the plaintiff's condition, which the ALJ did not address.
• The ALJ insisted the treating physician's conclusions conflicted with “objective medical evidence,” but failed to “discuss how evidence favorable to Plaintiff factored into his assessment of the treating physician opinions.”

As noted above, the ALJ did give “great weight” to “aspects” of one of the treating physician's views–but there was no explanation as to which “aspects” the ALJ actually credited.

All in all, the judge said the ALJ “did not build an accurate and logical bridge from the evidence to his conclusion about Plaintiff's treating physician's opinions.” This alone justified a new hearing. The judge did not address the merits of the plaintiff's disability claim or direct Social Security to make an award of benefits.

Speak with an Illinois Disability Benefits Lawyer Today

Although the regulations regarding the assessment of treating-source opinions changed in 2017, there are still many outstanding disability claims that still fall under the old rules. Indeed, disability cases often take years to go through the hearing-and-appeals process, and it is not uncommon for applicants to undergo multiple hearings before obtaining a favorable ruling.

If you need advice or representation from an experienced Chicago Social Security attorney, contact Pearson Disability Law, LLC, at 312-999-0999 to schedule a free consultation with a member of our team.

Source:

https://scholar.google.com/scholar_case?case=10677068555767482428