Social Security Officials Making “Medical” Judgments

 Posted on March 09, 2016 in Denied Social Security Benefits

In assessing a claim for Social Security Disability Insurance benefits, agency officials are required to seek out expert medical advice. Social Security administrative law judges (ALJs) are not supposed to substitute their own non-expert judgment when it comes to medical matters. Yet, too often, ALJs still try to “play doctor,” which forces applicants to spend time and money pursuing appeals through the court system.

Chicago Court Orders New Disability Hearing for Grandmother Who Needs Hip Replacement

In one recent case, the U.S. Seventh Circuit Court of Appeals in Chicago ordered Social Security to reconsider an applicant's claim for disability benefits after the ALJ brazenly refused to consider certain medical evidence. The applicant was a 56-year-old woman who suffered from “chronic back and hip problems.” In March 2011, the applicant's treating physician examined her and found she “walked with a hunch, had a restricted range of motion in her lumbar region, could not stoop or squat, had difficulty walking heel-to-toe, and had difficulty both rising from a sitting position and getting off the examination table.”

Seven months later, an orthopedic surgeon examined the applicant and determined she required a “total left hip replacement.” The surgeon noted that due to the applicant's severe pain, “she was not capable of working even low-stress jobs.” The applicant herself later told a Social Security ALJ that she could not carry her purse or walk more than “30 or 40 feet” without taking a break.

Despite all this medical evidence, the ALJ still denied the applicant's claim for disability benefits. The ALJ largely relied on the report of a physician who never even examined the applicant. This “non-examining physician” prepared a report based on the applicant's March 2011 records, which did not take into account the orthopedic surgeon's diagnosis and recommendation for a hip replacement. Instead, the ALJ simply declared the applicant's testimony lacked credibility, in part because she had yet to actual undergo the hip replacement.

The Seventh Circuit found the ALJ's analysis sorely lacking. In particular, the ALJ had a legal obligation to consider the “significant, new, and potentially decisive findings” of the surgeon. The ALJ should have at least submitted the surgeon's findings to a medical expert, the Seventh Circuit said. But the ALJ, who is not a medical professional, simply decided to evaluate (and disregard) this new information himself. The appeals court said that was not acceptable.

The appeals court also said the ALJ could not use the applicant's delay in seeking a hip replacement to “discount her credibility.” The applicant testified she “needed to delay surgery until she could arrange for her grandchildren's care.” Her family situation had no bearing on “the legitimacy of her claim of pain that was disabling and called for a hip replacement.”

Need Help from a Chicago Disability Attorney?

Social Security officials may use every excuse in the book to deny a legitimate claim for disability benefits. That is why if you are unable to work due to serious medical impairment, you need assistance from an experienced Chicago Social Security Disability attorney who understands the system. Contact Pearson Disability Law, LLC, today if you need to speak with someone about your case right away.

Source:

https://scholar.google.com/scholar_case?case=8714993906634097352&hl=en&as_sdt=6,47