Can Social Security Officials Interpret an MRI Without a Doctor?

 Posted on December 31, 2018 in Social Security Disability

One of the cardinal rules of Social Security disability cases is that agency officials are not allowed to “play doctor.” In other words, when a Social Security administrative law judge (ALJ) holds a hearing to decide whether or not an applicant is legally disabled, the ALJ must rely on medical testimony presented by qualified experts. The ALJ is not supposed to rely solely on their own interpretation of medical evidence, since, after all, they are not doctors themselves.

Federal Court Orders New Disability Hearing After ALJ Ignores Medical Evidence

Here is a recent disability case in which Social Security forgot this basic rule. This is taken from a decision by the U.S. Seventh Circuit Court of Appeals, which has jurisdiction over Illinois, although this particular case originated in Indiana. The plaintiff was a 49-year-old woman who formerly worked as a hairstylist. She stopped working in 2009 due to a variety of ailments, notably degenerative disc disease, fibromyalgia, and depression.

The degenerative disc disease–the plaintiff's chronic back pain–was the main focus of a hearing before a Social Security ALJ. At the hearing, the plaintiff's treating physician testified that her degenerative disc disease had progressed to the point where she qualifies as disabled under Social Security regulations. Although the doctor based his findings on examinations conducted during 2014, he nevertheless concluded that the plaintiff had been disabled since at least June 2011.

The timeframe is crucial because of the nature of disability insurance. The plaintiff was last considered “insured” on December 31, 2013. In order to qualify for continuing disability benefits, she needed to prove that she was medically unable to work before the date that she was last insured.

The ALJ ultimately decided to disregard the doctor's opinions, finding they were “not consistent with the medical records.” The ALJ also ignored an MRI taken by the doctor in April 2014 that clearly showed the plaintiff suffered from “severe nerve root compression” in her back. Again, the ALJ decided this was not consistent with the medical records during the “relevant period,” i.e. prior to the December 2013 last insured date.

The Seventh Circuit, however, determined it was the ALJ's actions that were inconsistent with the law and returned the case to Social Security for a new hearing. In particular, the Court agreed with the plaintiff that the ALJ “impermissibly assessed the MRI report on his own without the assistance of a medical expert.” The ALJ basically compared the April 2014 MRI results with the plaintiff's “earlier treatment records.” This was tantamount to playing doctor, the Seventh Circuit said. The ALJ was required to engage a qualified medical expert's opinions before reaching such conclusions.

The ALJ further compounded his mistake by disregarding the treating physician's “retrospective diagnosis,” i.e. the opinion that the plaintiff's crippling back pain started before the end of her insured period. The doctor's own treatment notes from November 2013–a month before the end of the relevant period–indicated the plaintiff exhibited “some measure of debilitating back pain.” Additionally, the Seventh Circuit noted that if an April 2014 MRI showed the plaintiff's nerve-root and spinal-cord compression had progressed to the point she was disabled, it was likely this problem did not develop “in the three months after the relevant time period ended.” 

Contact an Illinois Disability Benefits Lawyer Today

Despite repeated admonitions from the courts, Social Security officials continue to “play doctor” when they should not do so. The best way to combat this problem is by working with a qualified Chicago Social Security disability attorney who will hold agency officials accountable for their actions. Contact Pearson Disability Law, LLC, at 312-999-0999 to schedule a free consultation today.

Source:

http://media.ca7.uscourts.gov/cgi-bin/rssExec.pl?Submit=Display&Path=Y2018/D12-26/C:18-1691:J:PerCuriam:aut:T:fnOp:N:2270103:S:0