New York Social Security Disability Lawyer Blog

In a perfect world, a person seeking Social Security Disability benefits will support his or her claim with a detailed record of regular medical treatment, explaining the claimant's impairments and how they affect his or her functioning. For a number of reasons, however, this is not always possible. In Torres v. Astrue, the District Court for the District of South Carolina concluded that a person's inability to get appropriate medical treatment is not, in itself, sufficient basis to find the person ineligible for disability benefits.

The Social Security Administration (SSA) denied Plaintiff Carlos Torres' disability benefits claim, in which he asserted that he remained unable to work due to a variety of impairments, including a spine injury. Following an administrative hearing before an SSA Administrative Law Judge (ALJ), the Judge found that Plaintiff was disabled from July 15,2005 through July 23,2007. The ALJ further determined that Plaintiff experienced medical improvement and was no longer disabled as of July 23, 2007.

The ALJ's decision was based largely on the opinion of Dr. Charles Thomas, who examined Plaintiff on July 23, 2007, the last day in which the ALJ found Plaintiff was disabled, and found "a reduced range of motion in the cervical spine."

The record revealed that the ALJ found that Plaintiff experienced an improvement in his condition beginning the very day after the examination by Dr. Thomas. The judge supported his conclusion by finding that there was "little evidence" that Plaintiff received treatment for his injury following the examination. Based on this lack of treatment, the ALJ further found that Plaintiff's testimony regarding the nature and extent of his impairment was "less than credible."

On appeal, the District Court ruled that the ALJ's decision was not supported by substantial evidence. "It is notable that Dr. Thomas never again examined Plaintiff, and the record is wholly absent of evidence of any substantial medical change in condition that occurred on July 24, 2007 that would support such a dramatic alteration in the Plaintiff's disability status."

Continue reading "Court: Spotty Medical Treatment Does Not Bar Disability Benefits Award - Torres v. Astrue" »

The central question in a Social Security Disability case is whether the person seeking benefits can still work, despite any physical or mental impairments. That includes both a consideration of any limits on the claimant's ability to work imposed by the impairments, and the types of jobs the claimant can perform, given those limits and his or her education, background and experience. This decision often involves input from a vocational expert (VE), a vocational professional engaged by the SSA to provide an opinion as to whether a person with the same background and impairments as the claimant's can still work.

In Quiros v. Astrue, the U.S. District Court for the Middle District of Florida explains that in certain circumstances, it's not just a good idea for the Social Security Administration (SSA) and its judges to consult a VE, it's a requirement.

The SSA denied Plaintiff Odemaris Quiros' disability benefits claim, in which Quiros claimed she was unable to work due to anxiety and panic attacks, osteoarthritis and hypertension. Plaintiff then appeared before an SSA Administrative Law Judge (ALJ) at an administrative hearing. The ALJ found that Plaintiff was not disabled for benefits purposes because she retained the residual functional capacity (RFC) to do medium work in a supervised, low stress environment and with certain physical limitations, including a number of jobs available in the national economy.

On appeal, the Court found that the ALJ should have consulted a vocational expert in reaching the decision on Plaintiff's ability to work.

"There are two avenues by which the ALJ may determine whether the Plaintiff has the ability to adjust to work in the national economy: either by using the Medical Vocational Guidelines ("grids") or by testimony from a vocational expert," the Court explained. The grids draw on a claimant's physical limitations, age, education and experience to determine the types of jobs the person can perform. The ALJ may not rely solely on the grids, however, where the claimant is either not able to perform a full range of work at a certain level or where the person is affected by "non-exertional" impairments that significantly limit his or her work skills, such as a mental impairment. Under such circumstances, the judge may consult the grids, but must also consider independent evidence, such as VE testimony.

Continue reading "Court Requires Social Security Judge to Consult Vocational Expert in Disability Benefits Case - Quiros v. Astrue" »

While medical evidence is often hard to obtain from doctors and hospitals, the sooner it is submitted in a Social Security Disability case, the better. In Brewes v. Commissioner of Social Security, the Ninth Circuit Court of Appeals considered whether evidence submitted late in the claim process should be included in the record on an appeal.

Plaintiff Mindy Brewes filed a Social Security Disability Insurance benefits claim, maintaining that she was unable to work due to depression, bipolar disorder, anxiety and agoraphobia. After the Social Security Administration (SSA) initially denied the claim, Plaintiff appeared at an administrative hearing before an SSA Administrative Law Judge (ALJ) in February 2007. The evidentiary record before the judge at the time of the hearing covered Plaintiff's medical history from 2002 to 2007. Although the ALJ found that Plaintiff suffered from a number of severe mental impairments, he nevertheless concluded that she retained the residual functional capacity (RFC) to perform "simple one-, two-, three-step work with limited interaction with co-workers and no public interaction." As a result, the ALJ determined that Plaintiff was not disabled for benefits purposes.

Plaintiff then requested the SSA's Appeals Council to review the ALJ's decision and provided additional medical evidence to the Council which was not before the ALJ. The Council denied the request for review, finding that the additional evidence did not provide a basis for further review.

On appeal, a federal district court refused to consider the additional evidence because it was not before the ALJ when he rendered the decision. On further appeal, the Ninth Circuit ruled that not only was the district court's ruling erroneous, but all of the evidence combined to show that Plaintiff was disabled and entitled to benefits.

"[W]hen the Appeals Council considers new evidence in deciding whether to review a decision of the ALJ, that evidence becomes part of the administrative record, which the district court must consider when reviewing the Commissioner's final decision for substantial evidence" the Court ruled.

Continue reading "Late Evidence in Social Security Disability Cases - Brewes v. Commissioner of Social Security" »

Here at Insler & Hermann, we have found that winning a Social Security Disability claim is the result of dozens, if not hundreds, of separate action steps taken by our dedicated attorneys and staff. No one particular step is any more important than another, and there is usually no single thing that can be singled out as the reason a case is won. It's the combination of everything we do that leads to favorable decisions.

Our work is not over when a favorable decision comes in, however. In fact, it is at that point that we do for our clients what I consider to be the single most important thing: review their award certificate, the document that explains their retroactive and ongoing payments and the attorney's fee. Mistakes in that document are common, and a claimant who has never seen one before doesn't know what to look for.

In our office, we take this review very seriously, and our entire staff is vigilant to catch mistakes made by the Social Security Administration. Recently Stephanie Burkland, our longest serving paralegal and a former Social Security employee, took that to heart and wound up causing Social Security to change what they do on a regional, if not a national basis!

If a claimant's disability is found to have ended due to improvement in his or her medical condition, either based on the hearing decision or after the person has been approved and is receiving benefits, he or she is entitled to an additional two months of benefits after the month in which the improvement occurred.

Recently, in a short period of time we heard from three different clients who were in that situation. When the notices about the suspension of benefits came to our office, Stephanie found the same mistake in all three of our clients' award certificates. In each case they had been paid through the month before the SSA determined they were able to go back to work, but no payment had been made for the extra three months!!

Using her contacts at Social Security, Stephanie alerted the management of the Payment Center that is responsible for most of our clients as to these mistakes, and called their attention to what appeared to be a systemic flaw in the way that benefits were being awarded. They were very appreciative and after checking into the problem, they let Stephanie know that they had instituted changes to make sure that all benefit analysts, many of whom are new to the job, knew of the provision ensuring that the additional three months would be paid in all closed period cases!!

Kudos to Stephanie for helping not only our clients but countless others to receive all the benefits to which they are entitled! As our Insler & Hermann Mission Statement says: we pursue claims vigorously, maximizing benefits to which our clients are entitled!

Lewis B. Insler, Esq.

After a one year cost savings experiment during which the Social Security Administration did not send out Statements of Estimated Benefits to all wage-earners, the Administration has rolled out a terrific new on-line tool that can be used to access your benefits statement. Just go to SSA.gov and, along the left side of the website, you will see a link to "Get your Social Security Statement online". After providing necessary personal information, you will be asked several challenge questions that only you should know. You will then be invited to set up a user name, password and recovery questions. After that point, you will be able to access your earnings record and benefits estimate.

Please note that while anyone can set up an account, not everyone will be able to access the familiar earnings statement form, which is only available to people who have not initiated claims for benefits from the Social Security Administration (including Disability and Retirement claims).

It is my understanding that SSA has also started sending benefits estimates to wage-earners by mail (though that usually comes a few months before every birthday, so it's great to have the online option available for most of the year).

Gabriel Hermann, Esq.

As experienced Social Security Disability attorneys who have represented thousands of clients in New York, New Jersey and Connecticut in claims for disability benefits, we understand that many people are not able to work as a result of a combination of physical and mental impairments. In Jusino v. Commissioner of Social Security, the District Court for the District of Puerto Rico vacates a Social Security judge's decision on a disability benefits claim, finding that the judge failed to properly take into account the full extent of the claimant's mental impairments on his ability to work.

Plaintiff Rafael Cabanillas died as a result of arterial hypertension and diabetes mellitus while his claim for Social Security Disability benefits was pending before the Social Security Administration (SSA). He had also been diagnosed with major depression and severe panic disorder with agoraphobia prior to his death.

The SSA initially denied Cabanillas' claim. Following an administrative hearing before an SSA Administrative Law Judge (ALJ), the ALJ determined that Cabanillas was not disabled for benefits purposes during the period for which he was covered under the SSA's Social Security Disability Insurance (SSDI) program, August 2003 to December 2008. Specifically, the ALJ found that, while Cabanillas had moderate limitations in his daily living activities and could not return to work as a shipping clerk or salesperson, he retained the residual functional capacity (RFC) to perform a full range of light work, including jobs as table worker and small product assembler.

Cabanillas' mother, Flor Jusino, was substituted as the Plaintiff in this case following Cabanillas's death.

On appeal, the District Court reversed the ALJ's decision, finding that it was not supported by substantial evidence. Specifically, the Court found that the ALJ failed to properly consider the non-exertional limitations imposed by Cabanillas' mental impairments.

Continue reading "Court Reverses Social Security Disability Decision for Failure to Properly Consider Mental Impairments - Jusino v. Commissioner of Social Security" »

We often see clients in Social Security Disability cases who are unable to work due not only because of one physical or mental impairment, but due to a combination of impairments which, together, can wreak havoc on a person's everyday life. In Bryant v. Astrue, the District Court for the District of New Jersey explained that, when considering a claim by a person who suffers from severe obesity, the government must not only determine the effect of the obesity alone, but also its effect on any other impairments.

The Social Security Administration (SSA) rejected Plaintiff Lorraine Bryant's disability benefits claim where she asserted that she was unable to work due to asthma, glaucoma, hypertension, obesity, depression and a history of substance abuse. Plaintiff then appeared before an SSA Administrative Law Judge (ALJ) in an administrative hearing in New Jersey. Following the hearing, the ALJ determined that Bryant was not disabled for benefits purposes because, although she could not return to her previous job as a sales representative, she could nevertheless transition to other available jobs in the New York-New Jersey-Connecticut area.

On appeal, the District Court remanded the case to the ALJ, finding that the judge failed to assess the impact of Plaintiff's obesity on her other impairments. Citing the Third Circuit's 2009 decision in Diaz v. Commissioner of Social Security, the Court ruled that an ALJ considering a disability benefits claim by a person who suffers from obesity must perform an "individualized inquiry" that "focus[es] on the combined effect of obesity and other severe impairments." Specifically, "an ALJ must meaningfully consider the effect of a claimant's obesity, individually and in combination with her impairments," the Court held. That includes discussing the relevant evidence and explaining the weight afforded it in a manner that allows a reviewing court to perform its duty.

In this case, the ALJ determined that Plaintiff suffered from severe obesity and indicated that he considered its impact on her ability to work. The judge did not, however, explain what analysis was performed, nor set forth the reasons for concluding that Plaintiff could continue to work despite her obesity and other impairments. Thus, the Court remanded the case "for further analysis as to the impact of Plaintiff's obesity on her other impairments."

Until 1999 a person who suffered from obesity could have been found eligible for Social Security Disability benefits if he or she was unable to work for a year. At that point obesity was removed as a a disabling impairment in and of itself, but in a Ruling that is binding on the ALJ's, Social Security pointed out that the impact of obesity on all other impairments that a claimant has must be considered.

As the Court made clear in its ruling, obesity is a serious condition that can have a debilitating effect on those who suffer from it. It can result in a number of other impairments and exacerbate existing impairments. The ALJ cannot simply give this direction lip service. He must truly analyze the impact that obesity has on a claimant's other conditions.

Continue reading "Court Reverses New Jersey Social Security Disability Decision Involving Obesity Claim - Bryant v. Astrue" »

In Bunger v. Astrue, the Eastern District of New York recently took on a case appealing the Social Security Administration's (SSA's) denial of a disability benefits claim: in which both the claimant and the SSA agree that the agency's decision was flawed.

Plaintiff Richard Bunger filed a claim for Social Security Disability benefits in 2008, asserting that he was no longer able to work as a New York City firefighter due to lumbar degenerative disc disease. The SSA denied the claim and Bunger later appeared before an SSA Administrative Law Judge (ALJ) at an administrative hearing . The ALJ found that although Bunger could not return to his previous job, he retained the residual functional capacity (RFC) to perform light work, including various jobs that exist in significant numbers in the national economy.

On appeal, both Bunger and the SSA acknowledged that the ALJ failed to properly weigh the medical evidence in determining Bunger's RFC. Specifically, the ALJ gave only "some weight" to the opinion of Bunger's treating physician, simply stating that the opinion was "conclusory and not supported by the treatment record or the evidence as a whole," without providing sufficient analysis or explanation. Furthermore, according to the court, the ALJ failed to consider Bunger's nonexertational limitiations, "despite overwhelming evidence" of them.

The parties disagreed, however, as to how the court should address the ALJ's failings. Bunger argued that the court should award him benefits and remand the case to the ALJ simply to determine the amount of those benefits, while the SSA asserted that the case should be remanded for further proceedings to determine whether Bunger is even eligible for benefits.

Citing the Second Circuit's 1980 decision in Pratts v. Harris, the court noted that "[r]emand solely for calculation of benefits is appropriate where 'the record provides persuasive proof of disability and a remand for further evidentiary proceedings would serve no purpose.'" Remand for further proceedings, however, is appropriate where there are gaps in the administrative record or the ALJ applied the wrong legal standard.

Continue reading "The Clock is Ticking: New York Court Reverses Disability Benefits Decision, Sets Time Limit for SSA to Hold Further Proceedings - Bunger v. Astrue" »

We know that the Social Security Disability claims process can be a long, complicated and even intimidating experience for a person who is injured, unable to work and seeking benefits. As the Sixth Circuit Court of Appeals' decision in Rife v. Commissioner shows, a claimant should not give up until the process is complete. We advise our clients that the initial and reconsideration denials are designed to discourage claimants from going further with their claims.

Plaintiff Donald Rife filed a claim for Social Security Disability benefits, asserting that he was unable to work due to a back injury that he sustained working on a construction job. After the Social Security Administration (SSA) denied the claim, Rife appealed and requested a hearing before an SSA Administrative Law Judge (ALJ).

The ALJ determined that Rife could not return to construction work, but was not disabled for benefits purposes because, because he retained the residual functional capacity (RFC) to perform other jobs available in the national economy.

The Appeals Council upheld the ALJ's decision and he then filed this lawsuit in federal district court. The court again affirmed the ALJ's decision, denying Rife's claim.

On further appeal, the Sixth Circuit vacated the District Court's decision and remanded the case back to the ALJ for further proceedings. The Court found that the ALJ did not provide sufficient reasoning for rejecting the opinion of plaintiff's treating physician, Dr. Hall.

As readers of this blog may know, it is well established that "the ALJ must give controlling weight to a treating source's opinion if that opinion is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in your case record." If an ALJ declines to give the opinion such weight, he must provide clear reasons for discounting or rejecting the opinion, based on evidence in the record.

Continue reading "In Social Security Disability Cases, Don't Give Up - Rife v. Commissioner of Social Security" »

Sometimes a decision in a Social Security Disability case makes you scratch your head. In Small v. Commissioner of Social Security, the U.S. District Court for the Middle District of Florida took on a case where a Social Security judge found that a disability benefits claimant was disabled before he later found that she was not disabled.

In 2003, Plaintiff Angela Small filed a claim for Social Security disability benefits, asserting that she was unable to work due to back pain, migraines, anxiety and depression. The Social Security Administration (SSA) initially denied the claim. In a hearing before an SSA Administrative Law Judge (ALJ), the Plaintiff's lawyer informed the ALJ that she wanted to amend her claim to assert that her disability only lasted from April 1, 2003, to July 22, 2005. The judge awarded benefits for this "closed period" of disability.

Plaintiff later appealed, claiming that she remains disabled and should be awarded benefits beyond July 2005. The SSA Appeals Council affirmed the ALJ's award. Following another hearing before the ALJ, the judge issued another decision, finding that Plaintiff had not been disabled since April 2003 and denying her benefits claim despite the earlier favorable determination covering the same period.

On appeal, the Middle District reversed the ALJ's decision, ruling that it was not supported by substantial evidence. "Weighing the opinions and findings of treating, examining, and non-examining physicians is an integral part of...the ALJ's sequential evaluation process for determining disability," the court noted. Citing the Eleventh Circuit's decision in Winschel v. Commissioner of Social Security, the Court further explained that an ALJ considering a medical opinion must "state with particularity the weight given to it and the reasons therefore."

In this case, the ALJ stated that he gave "some weight" to the opinion of Dr. George Solomon, who determined that Plaintiff was permanently unable to work due to her impairments. The judge did not, however, indicate whether the opinion was consistent with other medical evidence in the record. In fact, according to the court, it was unclear whether the ALJ actually considered Dr. Solomon's opinion at all. "The Court cannot tell if the ALJ considered Dr. Solomon's opinion in his most recent decision, the weight given to Dr. Solomon's opinion or the reasons such weight was given."

Continue reading "Disabled or Not Disabled: In Social Security Cases, That is The Question - Small v. Commissioner of Social Security" »

As experienced Social Security Disability attorneys who have represented clients in New York, New Jersey and Connecticut over a combined 50 years, we know that doctor opinions can go a long way in proving a disability benefits claim. In Gay v. Commissioner of Social Security, the District Court for the Eastern District of Michigan explains that - as important as doctor opinions are - the conclusions in any opinion must be supported by either the findings of a medical examination or the claimant's medical record.

The Social Security Administration (SSA) denied Plaintiff Jerry Gay's claim for Social Security Disability benefits, in which he asserted that he's unable to work due to low back pain. Plaintiff then appeared before an SSA Administrative Law Judge (ALJ) at an administrative hearing. In a written opinion, the ALJ found that Plaintiff was not disabled for benefits purposes because he retained the ability to perform light work (lifting no more than 20 pounds at a time).

Plaintiff filed an appeal in federal court. The case was assigned to a magistrate judge and Plaintiff filed a motion for summary judgment in his favor. The judge recommended that Plaintiff's motion be denied and instead that summary judgment be entered in favor of the SSA. Plaintiff then filed an objection to the recommendation, arguing that the ALJ's decision should be reversed because the ALJ failed to give appropriate weight to the opinions of two of his treating physicians, Doctors Cheryl Lerchin and Todd Best.

The District Court adopted the magistrate's recommendation, finding that the magistrate properly determined that the ALJ's ruling was consistent with Dr. Lerchin's opinion and properly discredited Dr. Best's opinion. After examining Plaintiff in August 2005, Dr. Lerchin had concluded that Plaintiff was limited in his bending and twisting, should lift no more than 20 pounds and should limit the amount of time he spends in any one position. This opinion, according to the court, is in line with the ALJ's decision, finding that Plaintiff retained the ability to perform light work.

Dr. Best examined Plaintiff in July 2007. the Court found that "[d]espite finding that Plaintiff was capable of engaging in most daily activities (except shopping) and ambulating without a cane, Dr. Best indicated that he could walk and stand for only one hour at a time and no more than two hours in an eight hour work day." He also concluded that Plaintiff could only sit for 15 minutes at a time. Yet the Court ruled that "there is nothing in Dr. Best's notes and no other medical evidence in the record to support his restrictions on Plaintiff's activities." Dr. Best did not explain the basis for recommending these restrictions, which the court ruled were inconsistent with his finding that Plaintiff was able to engage in normal daily activities. Furthermore, an orthopedic specialist who examined Plaintiff just one month later recommended no such limitations, concluding only that Plaintiff should undergo physical therapy.

Continue reading "Michigan Court Affirms Social Security Disability Judge's Decision to Discredit Doctor's Opinion - Gay v. Commissioner of Social Security " »

In Bathrick v. Astrue, the District Court for the District of Connecticut reminds the ALJ's once again that they cannot make a decision on a disability benefits claim without referring to evidence in the record that is sufficient to support it.

Sarah Bathrick filed a Social Security Disability benefits claim, asserting that she's unable to work as a result of a number of mental impairments as well as nerve damage in her right leg that resulted from a spider bite. The Social Security Administration (SSA) denied the claim and Ms. Bathrick then appeared before an SSA Administrative Law Judge (ALJ) in an administrative hearing. The ALJ determined that Plaintiff was not disabled because she retained the residual functional capacity (RFC) to perform "medium work, limited to jobs involving simple, routine, repetitive tasks with short simple instructions and few workplace changes."

On appeal, the District Court remanded the case to the ALJ for further proceedings because the ALJ failed to properly develop the record. SSA regulations define "medium work" as lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. The evidence in the record, according to the court, was insufficient to determine Plaintiff's ability to lift 50 pounds.

"The ALJ rendered the RFC finding without reference to a medical opinion that specifically described Bathrick's physical limitations," the court ruled. Nor did the evidence of Plaintiff's daily activities - including grocery shopping and housework - indicate that she could lift up to 50 pounds at a time.

An ALJ's decision on a disability claim must be based on substantial evidence. In this case, the evidence regarding Plaintiff's physical ability to perform medium work was not only not supported by substantial evidence, it was not supported by any evidence at all. "Without further evidence specifically relating to Bathrick's physical limitations, it is impossible to make an accurate RFC determination," the court concluded.

As a result, the court determined that it was appropriate to remand the case for further proceedings. Specifically, the ALJ should have re-contacted Plaintiff's treating physicians, obtained a consultative examination or requested the opinion of a medical expert on the issue of lifting and carrying. On remand, the court instructed the ALJ "to obtain the necessary medical opinions regarding Bathrick's physical limitations, including her abilities to perform the tasks required by medium level jobs."

Continue reading "Connecticut Court Reverses Social Security Disability Case For Failure to Develop the Record - Bathrick v. Astrue" »

In order to prove a claim for Social Security disability benefits, an individual must provide the Social Security Administration (SSA) with clear and convincing medical evidence that details the extent of the claimant's impairment, its onset date and its effect on the claimant's ability to perform work. While the Eastern District of New York recently ruled in Stokes v. Commissioner of Social Security that an SSA Administrative Law Judge (ALJ) considering a claim bears some of the responsibility to clarify the record in certain situations, a claimant is well advised to present as much evidence as possible the first time around.

Plaintiff Elizabeth Stokes filed a disability benefits claim, alleging that she's unable to work due to both a right knee injury and Multiple Sclerosis. The SSA denied the claim. Plaintiff then appeared at an administrative hearing before an SSA ALJ. The ALJ determined that she is not disabled for benefits purposes because, although Plaintiff could not return to her previous job as a police officer, she retained the residual functional capacity (RFC) to perform other jobs available in the national economy.

On appeal, the court found that the ALJ failed to properly clarify the medical evidence presented regarding Plaintiff's knee injury. Plaintiff's treating physician - Dr. Varriale - performed arthroscopic surgery on Plaintiff's right knee in 1991 and in 2003 diagnosed her with arthritis in the same knee. In a 2006 letter explaining the impairment, Dr. Varriale concluded that Plaintiff "is disabled from working."

The court noted that "[t]he record evidence regarding Plaintiff's knee injury was, by the ALJ's own analysis, 'very limited,'" particularly with respect to the onset date of her arthritis. The court ruled that, considering the limited nature of the evidence, the lack of clarity regarding the arthritis onset date and the fact that Dr. Varriale was the only physician to treat Plaintiff for the impairment, the ALJ had an affirmative "duty to recontact Dr. Varriale for clarification."

The court also ruled that, on remand, the ALJ should consult a medical expert. Social Security Regulation 83-20 provides that an ALJ "should call on the services of a medical advisor" when the onset date of a claimant's impairment is unclear. Thus, according to the court, to the extent that the ALJ finds that Plaintiff is disabled as a result of her knee impairment, the judge should consult an expert to determine the onset date. The court ruled that, "Given the 'limited' medical evidence regarding Plaintiff's knee impairment, a medical expert will allow the ALJ to fully develop the record in order to arrive at an accurate determination."

Continue reading "New York Court Requires Social Security Judge to Clarify Medical Record in Disability Benefits Case - Stokes v. Commissioner of Social Security " »

In Social Security disability cases, medical evidence - doctor's opinions, treatment records, objective clinical studies etc. - is the key to winning a claim. That is, a clear and accurate record showing that the claimant suffers from an impairment or combination of impairments affecting his or her ability to work makes it more likely that a claim will ultimately be approved. In Troy v. Commissioner of Social Security, however, the District Court for the District of New Jersey explains that medical evidence is not the only thing that a Social Security judge must consider in reaching a decision on a disability benefits claim.

Plaintiff Candace Troy received Social Security disability benefits from 1976 to 1981. In 2007, she filed a claim for retroactive benefits related to a disability period that began in 1991. Plaintiff asserted that she's been unable to work since that time as a result of depression and personality disorder.

The Social Security Administration (SSA) denied the claim and Plaintiff later appeared before an SSA Administrative Law Judge (ALJ) at an administrative hearing. The ALJ found that Plaintiff was not disabled for benefits purposes because the claim was based on "spotty and general notes" from Plaintiff's doctors that were not sufficient to show that she suffered from a severe impairment.

On appeal, the District Court reversed the ALJ's decision, finding that he failed to consider all of the evidence Plaintiff provided, including Plaintiff's own testimony. In concluding whether a benefits claimant suffers from a severe impairment, the court explained

the ALJ must take into account all of the evidence, including Plaintiff's symptoms, to determine whether the functionally limiting effects of [claimant's] impairments have an effect on their ability to perform basic work activities.

According to the court, the ALJ must specifically consider Plaintiff's testimony regarding her symptoms and compare it to objective medical evidence. In so doing, the ALJ must make findings that are sufficiently clear to allow a subsequent reviewer to determine the weight afforded to the Plaintiff's testimony.

Continue reading "New Jersey Court Reverses Disability Benefits Denial for Failure to Consider Claimant Testimony - Troy v. Commissioner of Social Security" »

The "treating physician" rule - providing that the opinion of a Social Security disability claimant's treating physician is entitled to substantial weight, unless contradicted by other substantial evidence - is an important tool in many disability benefits cases and one that is often the subject of posts on this blog. In Ash v. Commissioner of Social Security, a Magistrate in the District Court for the Southern District of Ohio explains how to determine whether a particular doctor qualifies as a "treating physician."

In 2006, Plaintiff Christopher Ash filed a claim for Social Security disability benefits, asserting that he's been unable to work since May 2003 due to obesity, arthritis of the feet, knees and spine, depression and a variety of personality disorders. The Social Security Administration (SSA) denied the claim.

Following an administrative hearing before an SSA Administrative Law Judge (ALJ), the ALJ determined in a June 2009 decision that Plaintiff was not disabled for the time period between May 2003 and November 2008, during which Plaintiff's age category was a "younger person." The SSA sorts disability benefits claimants into specific age categories which it then uses to determine the claimant's ability to work in spite of any impairments. During this time, the ALJ determined that Plaintiff retained the residual functional capacity (RFC) to perform sedentary work. However, the ALJ granted benefits from November 2008 forward, when Plaintiff turned 50 and his age category became "closely approaching advanced age."

On appeal, the Magistrate found that the ALJ failed to take into account the opinion of Dr. Borders, a psychiatrist who diagnosed Plaintiff with major depression and intermittent explosive disorder and determined that he was disabled as a result. While a treating physician's conclusion that a claimant is disabled "is not determinative of the ultimate issue," according to the court, it must be taken into consideration. The Magistrate noted that "The weight given such a statement depends on whether it is supported by sufficient medical data and is consistent with other evidence in the record,"

The judge rejected the SSA's argument that Dr. Borders should not be considered Plaintiff's treating physician. The Social Security regulation codified at 20 C.F.R. § 404.1502 explains to claimants that a "treating" source is "your own physician, psychologist, or other acceptable medical source who provides you, or has provided you, with medical treatment or evaluation and who has, or has had, an ongoing treatment relationship with you."

Continue reading "Doctor Opinions in Social Security Disability Cases: Which Ones are Treating Physicians? Ash v. Commissioner of Social Security " »