When Is a “Consultant's” View of a Medical Condition More Credible a Doctor in a Disability Case?

 Posted on January 31, 2020 in Social Security Disability Medical Conditions

Social Security often denies applications for disability benefits based on the testimony of “agency consulting physicians.” These are doctors who review an applicant's medical records without personally examining or treating the applicant. In some cases, a Social Security administrative law judge (ALJ) will give greater weight to the opinions of the agency consultants over the treating physicians. This is permitted under Social Security regulations, provided the consultant's opinions are consistent with the available medical evidence.

Appeals Court Questions Social Security's Conclusions Regarding Disability Applicant's Ability to “Reach Overhead”

Here is an example of a case where an ALJ improperly credited an agency consultant. In Gibbons v. Saul, the plaintiff applied for disability benefits approximately seven years ago. The plaintiff suffered from severe chronic pain in his neck, shoulders, and arms. Several doctors provided medical evidence with respect to the plaintiff's condition.

A critical issue was whether or not the plaintiff was capable of reaching overhead. According to Social Security regulations, a person is capable of performing “sedentary work,” and therefore does not qualify for disability benefits, if they can lift up to 10 pounds.

The plaintiff's treating orthopedic surgeon opined the plaintiff should remain “off work” altogether. A second surgeon who examined, but did not treat, the plaintiff similarly opined that he could not work. The second doctor explained the plaintiff “could never lift any weight,” even less than 10 pounds, and could “never reach overhead.”

But the ALJ who heard the plaintiff's case disregarded both of these doctors' opinions in favor of the testimony offered by an agency consultant. The consultant said, based on his review of the medical records, that the plaintiff could in fact “occasionally lift 20 pounds and frequently 10 pounds, occasionally reach overhead with his right arm, and occasionally handle with his left hand.” Based on this, the ALJ denied the plaintiff's application for disability benefits.

A three-judge panel of the U.S. Seventh Circuit Court of Appeals reversed the ALJ's decision and returned the case to Social Security for a new hearing. The appeals court said the ALJ was entitled to give little weight to the views of the plaintiff's treating orthopedic surgeon. But in relying on the agency consultant, the ALJ failed to address “several aspects of [the consultant's] opinion that suggest he did not undertake a careful review of the medical records.” Among other things, the consultant misidentified the plaintiff, who is male, as female. The Seventh Circuit also said the consultant appeared to have formed his conclusion–that the applicant was not legally disabled–before actually reviewing the records.

More to the point, the Seventh Circuit said the consultant appeared to “misunderstand” the treatment notes of the plaintiff's doctors, and this directly impacted the consultant's ultimate opinions regarding the plaintiff's ability to reach overhead.

Speak with an Illinois Social Security Disability Attorney Today

In any disability case, there may be multiple medical opinions for Social Security to sort through. You need to work with an experienced Chicago disability benefits lawyer who will fight to make sure the government considers the most reliable and credible evidence from your own doctors, rather than attempting to “play doctor” themselves. If you need advice or assistance, contact Pearson Disability Law, LLC, at 312-999-0999 today to schedule a free consultation.

Source:

https://scholar.google.com/scholar_case?case=10139196609015443057