In Jefferson v. Astrue, the District Court for the Northern District of Florida provides some insight into how a court reviews a Social Security disability judge's decision to discredit a doctor's opinion in considering a disability benefits claim.
Plaintiff Alleachi Mae Jefferson asserted in her benefits claim that she has been unable to work since January 2007 due to back pain and depression. The Social Security Administration (SSA) initially denied the claim and, following an administrative hearing, an SSA Administrative Law Judge (ALJ) found that Plaintiff is not disabled for benefits purposes. Specifically, the ALJ determined that although Plaintiff suffers from severe physical and mental impairments which prevent her from performing her previous job as a school bus driver, she nevertheless retains the residual functional capacity to do a limited range of light work and can therefore perform other jobs available in the national economy, such as "ticket taker, gate guard, parking lot cashier, shipping and receiving clerk and companion." Plaintiff then appealed this decision to the SSA's Appeals Council, which agreed with the ALJ's decision.
On further appeal, Plaintiff argued that the Appeals Council improperly discounted a mental health assessment prepared her treating psychiatrist - which was presented to the SSA after the hearing - in reviewing the ALJ's decision. In 2009, psychiatrist Dr. Judy Ognibene prepared a physician's report based on two examinations of Plaintiff in 2008 for the Florida Retirement System. In order to be eligible for disability benefits under the state system, a person must meet the statutory definition for "total and permanent disability," which requires the state to find that "he or she is prevented, by reason of a medically determinable physical or mental impairment, from rendering useful and efficient service as an officer or employee." In completing the report, Dr. Ognibene checked a box indicating that Plaintiff has "severe limitation of functional capacity" and is "permanently incapable of any kind of work; totally and permanently incapable of any kind of work; totally and permanently disabled from gainful employment."
The District Court, however, found that the Appeals Council properly declined to rely on Dr. Ognibene's report because she had only seen Plaintiff twice before preparing the report and, according to the court, "seemed to base her assessment upon Plaintiff's subjective statements without any explanation or clinical findings to substantiate her opinion." As a result, the court affirmed the SSA's decision denying Plaintiff's benefits claim.
The opinion of a "treating physician" is entitled to additional weight in comparison to doctors who have seen a claimant on very few occasions It would appear that while the District Court was correct in finding that the doctor does not qualify for "treating physician" status and upholding the Appeals Council; the problem was real ly the failure to get this report before the ALJ. At the hearing a claimant has his or her best opportunity at winning the claim. It is the only time that a claimant and the decision maker are ever face to face. While a report like this cannot be given "controlling weight", it is far more likely that an ALJ would give it"substantial" weight when taken together with the claimant's testimony and the rest of the medical evidence than would the Appeals Council, as we see.
There are of course many reasons why such a report might not have been available prior to the hearing and I am not criticizing the plaintiff's representative. However there are two points to take from this case- as we have said frequently in these postings, obtain and submit evidence early; and as we noted above, not all medical reports are entitled to the same weight.
An experienced Social Security disability attorney can assist a client in the claim process by helping to gather the necessary evidence, filing the claim on the client's behalf and following up with local SSA staff to ensure that it has the information it needs to decide on the claim. A disability lawyer can also represent the client at an administrative hearing or on federal appeal, if necessary.
Related blog posts:
Quantifying Pain in Social Security Disability Cases - Felton-Miller v. Astrue
