Playing Doctor: How a Social Security Judge Overstepped His Authority

An Administrative Law Judge (ALJ) is an employee of the Social Security Administration (SSA), and he or she will decide at the hearing level whether or not you will be awarded disability benefits. In our experience—earned through representing our clients in thousands of disability hearings—most ALJs are fair and respectful of disability claimants. However, not surprisingly, there are good judges; not so good judges; and in some instances, judges who overstep their authority.

A recent appeal of a denial of disability benefits is illustrative of a case where an ALJ overstepped his bounds and “impermissibly played doctor” (in the words of The United States Court of Appeals for the Seventh Circuit.)

In this disability case, Rebecca A, a 47-year-old woman, was disabled due to fibromyalgia, back and neck pain, and headaches. Ms. A began seeing a doctor in 2011 for her worsening symptoms. The doctor’s medical examination revealed “symptoms of fibromyalgia” with 12 trigger points, and an x-ray of her back “confirmed two fused disks, narrowed spacing and…spurring.” Despite physical therapy and medication, her condition worsened. She made multiple visits to emergency rooms for ongoing, unbearable pain. The Court of Appeals noted that her pain “interfered with her ability to walk, interact with others, perform household chores, and sleep.”

As part of her diagnosis and treatment, Ms. A received an MRI scan. The nurse practitioner who reviewed the results of the scan noted that it showed “[m]oderate to severe stenosis…a disk protrusion…and a [w]orsening disk herniation” which caused pain so severe that it was impossible for Ms. A to maintain gainful employment. Reluctantly, she applied for Social Security disability benefits.

At her disability hearing in June 2014, the judge concluded that Ms. A was not disabled because her “residual functional capacity” allowed her to perform sedentary work. In his ruling denying her disability benefits, the ALJ credited the opinions of two SSA doctors who had not examined Ms. A, but had only reviewed some of her medical records. However, those doctors (who were paid by SSA) did not review some 70 pages of medical records, including the MRI results. The ALJ discounted the opinions of Ms. A’s own doctor and the nurse practitioner who reviewed the MRI scan. In his denial of an award of benefits, the ALJ said that the MRI scan was consistent with her impairments but “the scan did not support her allegations of disabling pain.”This is where the ALJ overstepped his authority by interpreting the MRI results himself. In January of this year the U.S. Court of Appeals determined that “without an expert opinion interpreting the MRI results in the record, the ALJ was not qualified to conclude that the MRI results were ‘consistent’ with his assessment.” The Court set aside the ALJ’s decision and remanded the case—that is sent it back—to the SSA for a new hearing.

This case offers some insight into a couple of issues related to Social Security disability:

• If your disability prevents you from holding a job, don’t give up fighting for the benefits you have rightly earned. As you can see from Ms. A’s case, the road to disability benefits can be long and difficult to navigate.
• A disability lawyer can help you make a stronger case for benefits by helping to obtain the right information and explanation from your treating doctor. In fact, according to the Government Accounting Office, if a claimant has a representative such as an attorney, they are three times more likely to be allowed benefits than someone who had no representation at all. For this reason, it makes sense to hire a local attorney to represent you at your disability hearing. You can call Nash Disability Law at 312.945.7567 or email us through our website to arrange a free evaluation of your case. We have offices in Chicago and Palos Hills.