In Chase v. Astrue, the Seventh Circuit Court of Appeal recently pointed out something that may seem obvious, but is nevertheless important to keep in mind in the Social Security disability claims process: judges are not doctors.
David Chase, a 48-year-old with a seventh grade education who previously worked as a day laborer, filed a claim for Social Security Disability Insurance and Supplemental Security Income benefits, asserting that he's unable to work due to an ulcer on his right big toe. His right foot was crushed in a forklift accident in 1995 and five years later he reinjured that foot by stepping on a sharp object. The Social Security Administration (SSA) initially denied the claim and again on appeal. Following an administrative hearing, an SSA Administrative Law Judge (ALJ) found that Plaintiff is not disabled because he retained the residual functional capacity (RFC) to perform sedentary work.
On appeal, Plaintiff argued that the ALJ improperly determined the level of foot elevation that Plaintiff requires while seated as a result of his impairment. Specifically, the ALJ reached his decision after asking a vocational expert (VE) how many sedentary jobs might be available for someone, like Plaintiff, who needs to keep his foot elevated while seated in order to avoid swelling in his toe. According to the court, the VE stated "10 to 15 to maybe 20 degrees would be still acceptable but that any higher elevation would make it extremely difficult to be able to continue to work."
After the hearing, Plaintiff's lawyer contacted his treating physician to determine just how high Plaintiff needed to keep his foot elevated while seated. In a written statement, the doctor indicated that Plaintiff should elevate his foot "higher than the heart" and "at least 90 degrees." The ALJ, however, rejected this information, noting that it was provided after the hearing and that none of the evidence in the record discussed foot elevation. Instead, the ALJ determined that Plaintiff did not need to elevate his foot higher than 15 to 20 degrees and, based on the VE's testimony, could therefore perform sedentary work.
The Seventh Circuit agreed with Plaintiff, ruling that "the ALJ overstepped his role by determining that the degree of foot elevation required by Chase was 15 to 20 degrees." Citing its prior decision in Myles v. Astrue, the court noted that an ALJ "may not 'play doctor' by using his own lay opinions to fill evidentiary gaps in the record." In this case, neither Plaintiff's physician nor two state agency physicians who examined him indicated that Plaintiff could perform sedentary work by keeping his foot elevated 15 to 20 degrees.
Noting that the VE testified that Plaintiff could do sedentary work only in response to the ALJ's hypothetical questioning, the Court also reminded that "an ALJ may not rely on a VE's testimony to resolve medical questions, which are outside a VE's area of expertise." As a result, according to the Court, the ALJ should have sought further medical evidence to determine how high Plaintiff needed to elevate his foot in order to work while seated.
While this case makes clear that an ALJ considering a Social Security disability claimant's medical condition can't simply make it up as he or she goes along, it also shows just how important clear and convincing medical evidence is in proving a claim. An experienced Social Security disability lawyer can provide vital assistance to a client seeking disability benefits by gathering the necessary medical documentation and following up with the SSA to ensure that it has everything it needs to decide on the claim.
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