Plaintiff Evangeline Smith filed a claim for Social Security Disability (SSDI) and Supplemental Security Income (SSI) benefits, due to a painful joint condition. The claim was denied initially and following a hearing where the SSA Administrative Law Judgefound that although Plaintiff suffered from a joint problem, it did not prevent her from working.
On appeal, the Fourth Circuit noted the standard of proof- that it will overturn an ALJ's decision on a Social Security disability claim only where the decision is not supported by "substantial evidence." According to the court, "[s]ubstantial evidence is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." In this case, the court ruled, Plaintiff failed to show that the ALJ's decision was not supported by substantial evidence. It also appears that Plaintiff missed an opportunity to present substantial evidence that she is disabled and unable to work.
As the court explains,
The determination of whether a person is disabled by pain or other symptoms is a two-step process. First, the claimant must produce objective medical evidence showing the existence of a medical impairment which could reasonably be expected to produce the pain alleged....Second, the intensity and persistence of the claimant's pain, and the extent to which it affects her ability to work, must be evaluated.
With respect to the second factor, Smith based her appeal largely on her own personal statements regarding the pain and its effect on her ability to work. The court noted, however, that in considering this factor an ALJ should take into account all of the available evidence, including doctor's records, lab results and overall medical history.
Smith argued that the ALJ improperly failed to obtain her treating physician's opinion as to whether she met the requirements of an SSA listing. A Listing is a regulation that describes a medical condition that is so severe that the SSA presumes that any person who satisfies the criteria of a particular listing is unable to perform any gainful activity and therefore eligible for benefits.
Smith could have avoided this problem altogether by simply getting the doctor's opinion into the record. Although some doctors are not willing to complete the forms that satisfy the Regulations to show that a LIsting is met; we spend a great deal of effort trying to get these opinions in our cases.The ALJ's are required to give well supported treating source opinion significant weight and, very often, "controlling" weight in reaching their decision.
As this case makes clear, the assistance of an experienced Social Security attorney can be invaluable in successfully obtaining Social Security disability benefits. The attorney can help an applicant prepare a claim and supporting information to ensure that it is reviewed by the SSA in the most efficient and effective possible manner. The disability lawyer will not only file a claim on behalf of a disabled client, but also follow up throughout the claims process to ensure that the SSA has all of the necessary information and documentation. If a hearing is necessary, disability attorneys who have received advocacy training are much more likely to persuade judges who might be on the fence over how to interpret certain evidence in the claims record.
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