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IL disabilty lawyerThere is often a significant delay in hearing Social Security disability cases. One result of this delay is that new information regarding an applicant's medical condition may come to light after a doctor has already reviewed the record. When this happens, a Social Security administrative law judge (ALJ) should take the time to obtain a proper expert assessment of this new information before making a decision.

Illinois Magistrate Orders New Hearing to Consider Applicant's MRIs and X-rays

Unfortunately, that is not always how things work in practice. Consider this recent decision from a federal magistrate judge here in Illinois, Renee L. M. v. Commissioner of Social Security. The plaintiff, in this case, is a woman in her 50s who applies for disability insurance benefits four years ago. Although an ALJ determined the plaintiff did suffer from a number of severe impairments, including “fibromyalgia, back arthritis, anxiety disorder, and personality disorder,” she nevertheless had the “residual functional capacity” to perform “light work” with limitations. On that basis, the ALJ denied the claim for disability benefits.

Before the magistrate, the plaintiff argued the ALJ relied on the “outdated opinion” of a state agency medical consultant. These consultants do not personally treat the disability applicant; rather they review their medical records and offer opinions to the ALJ. The ALJ is never supposed to “play doctor” themselves, but instead assess the credibility of the consultants as well as any treating physicians.

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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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IL disability attorneyWhen reviewing Social Security disability applications, an administrative law judge (ALJ) needs to weigh the evidence offered by various medical experts. As a general rule, the ALJ should give more weight to the testimony offered by a doctor with respect to their own specialty as opposed to someone who is not. For example, if a disability applicant is unable to walk, you would credit the testimony of an orthopedic surgeon over, say, a dermatologist.

This might sound like just basic common sense. Yet there are many cases where ALJs will disregard the specialist's view in favor of a non-specialist's view–especially when the latter is willing to say the applicant's condition does not really qualify them for disability benefits. Such decision-making not only defies common sense, but it is also often in direct contravention of Social Security regulations.

Let's take this recent disability case from here in Illinois, Kathy P. v. Saul. The plaintiff in this case applied for Social Security disability benefits about five years ago. Although she suffers from a number of physical and mental impairments, the critical issue here involves her mental disorders and frequent migraines. In support of her claims, the plaintiff presented expert testimony from her treating psychiatrist. Based on her extensive treatment history, the psychiatrist told Social Security that the plaintiff “was unable to meet competitive standards for several abilities such as completing a normal workday and workweek without interruptions, accepting instructions and responding appropriately to criticism from supervisors, and dealing with normal work stress.”

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