Does Social Security Have to Listen to My Treating Physician?

 Posted on January 05, 2017 in Social Security Disability

If you are applying for Social Security Disability Insurance benefits, it is critical to present medical evidence demonstrating the extent of your impairments. The testimony and opinions of your regular physician is especially important. Social Security officials in Illinois are supposed to follow the Treating Physician Rule. This Rule states a treating physician's opinion regarding a disability applicant's medical condition must be given “controlling weight” if it is “supported by medical findings and not inconsistent with other substantial evidence in the record.”

The Treating Physician Rule means that Social Security can only discount or ignore your doctor's opinions if there are “good reasons” to do so. According to the U.S. Seventh Circuit Court of Appeals, which has jurisdiction over all disability-related appeals from Illinois, there are five factors Social Security must consider in determining if good reasons exist:

• Did the physician personally examine the applicant?
• How long did the physician treat the applicant, and how often and thorough were the examinations?
• Is there other medical evidence supporting the physician's diagnosis?
• Is the physician's medical opinion consistent with other medical evidence?
• Does the physician's medical opinion relate to his or her specialty or field?

Court Chides Social Security for Ignoring Medical Evidence

Despite the clear mandate of the Treating Physician Rule, Social Security administrative law judges often “play doctor” and try to make their own medical judgments without respect to the record. The Seventh Circuit recently addressed such a case involving a disability applicant from Wisconsin. The applicant here applied for disability based on her long history of crippling back pain—the byproduct of two car accidents—and obesity.

A Social Security ALJ rejected the applicant's claim on three separate occasions. In the most recent rejection, the ALJ decided not to give the medical opinions of the applicant's physician controlling weight. The physician testified that, based on his treatment of the applicant over a period of many years, she was not physically capable of performing a full day's worth of “sedentary work.” The applicant cannot sit for more than 30 minutes at a time or more than two hours per day. Similarly, she could not stand for more than 15 minutes at a time or more than two hours in a day.

The ALJ claimed the physician's opinions were “not supported by his treatment notes” and contradicted by evidence of the applicant's “daily living activities.” But the Seventh Circuit said the ALJ's assertions were “erroneous.” In fact, the physician's “treatment records support his opinions,” and it was unclear “what additional observations or tests” the doctor could have performed to satisfy Social Security.

The Seventh Circuit quipped Social Security might only be satisfied if the doctor “had somehow replicated a full work day to test the limits of [the applicant's] sitting and standing endurance.” Obviously that would be “cruel,” the court said, but it nonetheless ordered Social Security to reconsider the applicant's case–preferably before a different ALJ.

Get Help With Your Illinois Social Security Disability Case

Disability cases are rarely simple. They involve a complex web of law and medical evidence. An experienced Chicago disability benefits lawyer is therefore indispensable. Contact the offices of Pearson Disability Law, LLC, if you need to discuss your Social Security case with a qualified attorney today.

Source:

https://scholar.google.com/scholar_case?case=16252714668338445412&hl=en&as_sdt=6,47