Is Social Security Allowed to Ignore the Medical Advice of Its Own Doctors?
We often talk about cases where a Social Security administrative law judge (ALJ) rejects the expert medical opinions of a disability applicant’s treating physicians. In many cases, the ALJ will instead rely on the views of state agency physicians, who review the applicant’s medical records but do not necessarily examine them personally.
Federal Court Chastises ALJ For “Unilaterally” Making Medical Judgments
But what if the state agency physicians actually agree that the applicant’s medical condition meets the requirements for disability benefits? Can the ALJ ignore the agency’s own doctors and still deny benefits?
A recent decision from a federal appeals court in Chicago helps answer these questions. In this case, Jones v. Saul, a 60-year-old Indiana woman (the plaintiff) applied for disability due to chronic pain in her right knee and shoulder. Three different doctors–the plaintiff’s treating physician and two state agency physicians–all agreed that the plaintiff’s medical condition made it impossible for her to perform her past work.
The ALJ who reviewed the plaintiff’s case, however, disagreed. The ALJ believed all of the doctors were “overly restrictive” in their medical recommendations. Notably, the ALJ pointed to the fact that the plaintiff worked a three-month stint as a short-order cook just before applying for disability benefits. Since this particular job “required greater exertion than every physician opined she could perform,” according to the appellate court, the ALJ inferred the plaintiff could “perform at that level” on a consistent basis. The ALJ therefore denied the plaintiff’s application for disability benefits.
But as the U.S. Seventh Circuit Court of Appeals explained, the plaintiff’s “greater exertion” in her final job led to a second rotator-cuff injury. More to the point, Social Security’s own doctors agreed the plaintiff could not continue to work at the level of a short-order cook or any similar job. The Seventh Circuit said the ALJ “unilaterally” made her own medical judgment, which was not legally permitted.
Indeed, the Seventh Circuit noted that “rejecting the opinion of an agency’s doctor” in support of a disability finding is itself an “unusual” event. So when the ALJ ends up rejecting such opinions outright, the Seventh Circuit said it raises suspicion. At the very least, the Court said the ALJ needed to provide a stronger justification for her actions than she did.
To be clear, the Court said that when there is conflicting medical evidence, the ALJ is expected to resolve such differences. But in this case, “all the medical reports contradict the ALJ’s findings.” That was not acceptable. The plaintiff was therefore entitled to a new hearing on her disability application.
Speak with National Disability Lawyer Stephen Barszcz Today
Social Security is required to make disability decisions based on medical evidence, not on the whims of ALJs who lack the necessary training and experience to make such judgments. National SSD eligibility lawyer Stephen Barszcz can help you in navigating the disability process, and if necessary contest an adverse decision by an ALJ fails to follow the law. Contact his office today at 877-655-2667 to schedule a consultation.