Social Security Ruling 96-6p provides that findings of fact by a State agency psychological consultant must be treated as expert opinion evidence. The Eleventh Circuit Court of Appeals makes clear in a recent decision that while an Administrative Law Judge (ALJ) reviewing a denied claim for Social Security disability benefits cannot ignore this evidence and must explain the weight given to it, the judge must also consider the evidence as part of the larger question of whether the individual is unable to work for a year or more due to a physical or mental condition.
Maffia v. Astrue concerns claims filed by Plaintiff Nancy Maffia with the SSA seeking Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits based on a mental ailment. The SSA denied the claim and an ALJ upheld this decision on appeal, finding that although Maffia could not return to her previous career, she could still perform certain unskilled jobs in the national and local economies. On further appeal, Maffia argued that the ALJ did not comply with Regulation 96-6p because he failed to consider a Mental Residual Functional Capacity (RFC) Assessment prepared by Michael Zelenka, Ph.D., a state psychological consultant, which indicated that Maffia was moderately limited in her concentration, persistence and pace.
According to the court, the assessment at issue indicates that Maffia has moderate limitations in her ability to maintain attention and concentration as well as in her ability to complete a normal workday or workweek without interruptions from psychologically-based symptoms or to perform at a consistent pace without an unreasonable number and length of rest periods. However, Dr. Zelenka ultimately concluded that these limitations did not prevent Maffia from carrying out instructions, relating to others or accomplishing daily tasks.
In affirming the denial of Maffia's benefits, the Eleventh Circuit found that the ALJ properly considered the Mental RFC Assessment, noting "[a]lthough the ALJ did not refer to Dr. Zelenka by name, the ALJ specifically referred to and gave 'great weight' to Exhibit 40F. Dr. Zelenka's Mental RFC Assessment is stamped as Exhibit 40F, and it is identified as such in the administrative record's table of contents."
The court further found that the ALJ properly posed hypothetical questions to a Vocational Expert (VE), a vocation rehabilitation professional that provides advice to an ALJ regarding a claimant's ability to perform any type of work activity, based on the information in Dr. Zelenka's assessment. Specifically, the ALJ asked the VE if an individual who could only understand, remember and carry out simple instructions could still perform certain jobs available in the national and local economies. The VE responded affirmatively. As a result, the court held that the ALJ's decision to deny benefits is based upon the proper legal principles and is supported by substantial evidence.
Despite the ruling in this case, the ALJ hearing is a claimant's best opportunity to win his or her Social Security disability case. An experienced Social Security attorney will have an opportunity to expedite a fully favorable decision by submitting written arguments and medical evidence prior to the scheduling of the hearing. In a case where there is supportive evidence from a treating physician, a attorney familiar with the evidence will know to emphasize how the opinion of a treating source should carry more weight than the opinion of an examining source, regardless of the degree of "expertise" attributed to that non-treating source. In addition, a disability lawyer who is familiar with the unique personality of the ALJ before whom they may appear can present a case in the most effective manner by understanding the ALJ's approach to hearings and how he or she tends to interpret different types of evidence.
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