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Social Security ALJ must explain the why in rejecting treating doctor's opinion

Although Social Security Disability determinations are non-adversarial, each administrative law judge wears numerous hats.
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    January 10, 2014 /24-7PressRelease/ -- Social Security ALJ must explain the why in rejecting treating doctor's opinion

Article provided by Tucker & Boklage, Attorneys at Law
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Although Social Security Disability determinations are non-adversarial, each administrative law judge wears numerous hats. He or she must not only develop evidence, but must weigh that evidence and then must decide the result. Thus, the ALJ must resolve any significant conflict and must do so properly, based on substantial evidence in the record.

The ALJ is constrained by the rules of law; he or she cannot choose the medical opinion that is most appealing. The ALJ must provide "clear and convincing" reasons for rejecting an uncontradicted opinion of either a treating or examining physician or psychologist. Even if a treating or examining physician's opinion is contradicted, that opinion can be rejected only for specific and legitimate reasons that are supported by substantial evidence in the record. The ALJ can accomplish this by "setting out a detailed and thorough summary of the facts and conflicting clinical evidence, stating his interpretation thereof, and making findings."

A recent federal District Court opinion from the Western District of Washington provides an example. The claimant was 41 years old at the date of disability onset. She worked as a security consultant for a telecommunications corporation when she went on medical leave and was terminated when she was unable to return to work. The claimant has at least the severe impairments of fibromyalgia, obesity, left shoulder supraspinatus teninopathy and bursitis, and post-traumatic stress disorder. Her claim for disability insurance benefits was denied, leading to this appeal.

The rejection of evidence of the treating psychiatrist not supported

The treating psychiatrist had been seeing the claimant for four months, followed by a one-month break, and then by two more months before providing his report, when he diagnosed the claimant with PTSD; Major Depression, and Anxiety Disorder, , among other things. To condense the psychiatrist's opinion, he opined that while the claimant could manage her own benefits and had no limitations in her activities in daily living, she had frequent deficiencies in her concentration, persistence and pace and continual episodes of decompensation.

The ALJ chose to give little weight to this opinion, but the ALJ failed to explain why his interpretation of the psychiatrist's findings were more correct than the psychiatrist's own words. The reviewing court held that the ALJ's finding that there were multiple inconsistencies in the psychiatrist's reports were based in part on an erroneous reading of the record, and the failure to give greater weight to the treating psychiatrist's opinion was not supported by substantial evidence.

Similarly, substantial evidence did not support the determination that there was an inconsistency between the treating psychiatrist's opinion that the claimant suffered from marked limitations in social functioning, and his indications that she could interact appropriately with the public, get along with others and maintain socially appropriate behavior. Again, the court found that the ALJ's finding was based on an incomplete review of the record.

Social Security Disability determinations may often present multiple questions of law and fact, requiring both legal assistance and medical experts. If you find yourself with a question regarding Social Security Disability, contact someone knowledgeable in that field.

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