The Reasons Why a Social Security Judge Is Not Allowed to “Play Doctor”

 Posted on December 16,2019 in Social Security Disability Medical Conditions

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 ALJ determined that the plaintiff did not meet the legal standard for disability. Essentially, the ALJ found the “objective medical evidence” presented at the hearing only proved the plaintiff had “mild problems” rather than impairments that prevented her from working. Similarly, the ALJ said the record of the plaintiff's medical treatment up to that point was “consistent with only mild problems.”

On appeal to the magistrate, the plaintiff argued the ALJ improperly played doctor. The magistrate found the plaintiff “raised enough–just enough–concerns and questions to justify” a new hearing. The magistrate agreed with the plaintiff that the “ALJ played doctor in too many instances, and should have sought the assistance of an expert.” The ALJ also improperly “ignored critical part of [the] plaintiff's testimony.

With respect to the first point, the magistrate noted the ALJ "did not call a medical expert at the hearing.” Instead, the ALJ relied heavily on the analysis of opinions submitted by two state agency doctors nearly a year earlier. As noted above, there were 200 pages of medical evidence made available after the hearing but never considered by the ALJ.

On the second point, the ALJ found the plaintiff's claims regarding her pain “only partially consistent with the medical evidence.” Again, the magistrate said the ALJ should have called an actual expert to testify with respect to the medical evidence. Instead, the ALJ “basically lumped all of the plaintiff's alleged impairments into one large category without distinguishing the symptoms for each.”

Speak with a Cook County Disability Attorney Today

Disability claims succeed or fail based on the available medical evidence. An experienced Chicago Social Security benefits lawyer can help you in preparing and presenting such evidence. Contact Pearson Disability Law, LLC, at 312-999-0999 today to schedule a free consultation with an attorney who can review your Social Security case.

Source:

https://scholar.google.com/scholar_case?case=2840229607599797918