In addition to an experienced disability attorney, a Social Security disability benefits claimant's most compelling advocate is often his or her doctor. Under the "treating physician" rule, the Social Security Administration (SSA) and courts reviewing a benefits claim are typically required to give great weight to the opinion of a claimant's treating doctor. The Western District of Arkansas' recent ruling in Mathews v. Astrue is the latest example of the rule's significance in the outcome of a claim.
The SSA denied Plaintiff Sheryl Mathews' claim for Social Security Disability Insurance and Supplemental Security Income, in which Plaintiff asserted that she's unable to work due to diabetes mellitus, hypertension, back, knee and neck pain, mood problems, chronic obstructive pulmonary disease and depression. Forty five years old with a tenth grade education at the time she filed the claim, Plaintiff had previously worked on the cleaning staff at a hospital. Following an administrative hearing before an SSA Administrative Law Judge (ALJ), the ALJ found that Plaintiff is not disabled because, although she suffers from severe impairments which prevent her from returning to her previous job, Plaintiff retains the ability to perform other jobs.
The Federal Court overturned the ALJ's decision, finding that it was not supported by substantial evidence. The court took issue in particular with the ALJ's decision to discredit the testimony of Dr. Joe Dunaway, who treated Plaintiff for her various physical impairments. In two Medical Source Statements (MSSs) - reports concerning a claimant's impairments and their impact on his or her ability to perform work-related activities - Dr. Dunaway stated that Plaintiff could occasionally lift or carry ten pounds, frequently lift or carry less than ten pounds and stand or walk for at least two hours in an eight-hour workday. He also indicated that Plaintiff must periodically alternate sitting and standing and could sit and stand for a combined total of less than six hours in an eight-hour workday.
Noting that "[a] treating physician's opinion is given controlling weight if it is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in a claimant's record," the court held that the ALJ improperly discredited the MSSs in reaching the decision. The fact that Dr. Dunaway had treated Plaintiff throughout the relevant time period indicated that he was highly familiar with Plaintiff's symptoms, according to the court. Furthermore, since "Dr. Dunaway was the only treating physician to report on Plaintiff's impairments, disregarding his opinion left no medical evidence in the record on the issue." As a result, the court ruled that the ALJ's decision was not based on substantial evidence and therefore remanded the case for further consideration.
An experienced Social Security disability attorney can provide invaluable assistance to a claimant - especially in a disability case involving medical opinions by treating and other physicians - by presenting the claim in a clear and concise manner and pointing out and explaining any inconsistencies in the record, rather than relying on the SSA or an ALJ to sift through the evidence.
However we see cases like this over and over again where the ALJ rejects the only probative evidence because of what can only be described as a preconceived notion that the claimant is not disabled. Only an experienced, dedicated and principled disability attorney, a would be able to pursue this matter to Federal Court and obtain the "right" decision such as was done here. There is far less chance that an unrepresented claimant would be able to prevail in the face of an ALJ like this!
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