Social Security disability cases are supposed to center on medical evidence, in particular, the diagnosis and expert views of the applicant's treating physicians. Social Security administrative law judges (ALJs) are normally expected to give “controlling weight” to a treating physician's views. If the ALJ discounts or rejects this testimony, there are a number of regulatory factors that must be considered and explained.

Magistrate: ALJ Failed to Follow Agency Regulations Before Discounting Doctor's Evidence

But as we have often found in practice, ALJs often disregard treating-physician evidence without giving a valid explanation, or even any explanation at all that conforms to the agency's own regulatory factors. A recent decision from a federal magistrate judge here in Illinois, Deborah AM v. Saul, offers a textbook example of this problem.

In this case, the plaintiff applied for disability benefits nearly five years ago. Following a hearing on the plaintiff's application, a Social Security ALJ held she did not legally qualify for disability benefits. The ALJ reached this conclusion after deciding not to give controlling weight to the evidence offered by the plaintiff's treating physician.

It is a well-established rule in Social Security disability cases that the agency's administrative law judges (ALJs) are not allowed to “play doctor.” That is to say, the ALJ is a layperson, not a doctor or a medical expert. Therefore, when assessing an applicant's disability claim, the ALJ must rely on testimony or evidence offered by such experts rather than trying to diagnosis the claimant themselves.

Court Cites ALJ's Failure to Call Medical Expert in Ordering New Disability Hearing

Unfortunately, this rule is not always so easy to implement in practice. As an Illinois federal magistrate judge observed in a recent disability case, Michelle M. v. Saul, it is often difficult to distinguish “playing doctor” from “merely noting or summarizing the evidence.” Indeed, the magistrate observed that “there do not appear to be many clear rules to determine when the doctor-playing line is crossed.”

This particular case illustrated the problem. The plaintiff here applied for disability benefits alleging a number of physical impairments, including chronic pain in her back, hands, and feet. But as the magistrate explained, the plaintiff's treating physicians have been able to make a “single consistent diagnosis” to explain the cause of her problems. Additionally, the plaintiff received significant treatment after her disability hearing before the ALJ, and as a result, there were “200 pages of treatment records” submitted after the hearing.

The Social Security disability application process often puts individuals in a bind. On the one hand, the law requires proof they are unable to hold down even a “sedentary” position. On the other hand, many applicants feel they need to at least apply for work, if for no other reason than to have some source of income while waiting to hear back from Social Security.

But will apply for a job–or even multiple jobs–doom your disability benefits application? The U.S. Seventh Circuit Court of Appeals, which oversees disability cases here in Illinois, has said in the past that a “job search” by itself does not discredit an applicant's disability claim. In many cases, looking for work may simply reflect a strong internal work ethic or an “overly optimistic outlook” about one's job prospects. But in other cases, Social Security or a court may consider job applications as part of the overall evidence supporting or undermining an individual's claims.

Social Security Denies Disability After ALJ Suggests Applicant “Lost His Motivation to Work”

A recent example of the latter is Primm v. Saul, a recent Seventh Circuit decision where the Court affirmed Social Security's decision to reject a disability claim. The plaintiff in this case applied for disability benefits, alleging he was unable to work from 2006 through 2014 due to a variety of impairments. A Social Security administrative law judge (ALJ) determined that despite the plaintiff's ailments, he was still capable of performing “sedentary work” during the relevant period and was therefore not legally disabled.