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IL disability lawyerIn 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.

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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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