In Stage v. Colvin, a case from the United States Court of Appeals for the Seventh Circuit, claimant was working at a factory in 1985 when she suffered two slipped discs in her spine. She simply kept working through the pain, but her condition got much worse as the years went by. Two decades later, she was diagnosed with severe arthritis in hips, left leg, both shoulders and her back. She also suffered from a degenerative disease in her spine. She was 5’6” in height and her weight about 200 pounds at the time she first appealed a denial of her Social Security Disability Insurance (SSDI) benefits.
She also had X-rays taken by her family doctor, and these x-rays revealed blood flow problems in her hands and feet caused by calcification. The x-rays also showed a compression and narrowing of her spinals discs. Her doctor also diagnosed her with with lumbar disc bulge after an MRI was ordered. He then referred her to a specialist who said he would give her an epidural injection to block the pain, but she declined to have the procedure. Her reasoning was that she had this type of epidural in the past but it did not help in any way to reduce the pain.
The following year, a doctor who worked for the United States Social Security Administration (SSA) examined her. This doctor noted that she had trouble walking and bending, had hunch when she walked, and was already wearing a prescription back brace. She also was required to use a shower chair, because she could not stand long enough to bathe herself. At this point, another doctor hired by SSA reviewed her medical records but did not personally examine claimant.
This doctor was tasked with determining claimant’s residual functioning capacity (RFC). An RFC is a number determined by SSA that describes the ability a worker has to go back to work and engage in gainful activity, as they call it, despite his or her claimed disability. He decided she could lift 20 pounds occasionally, frequently lift 10 pounds, and sit, stand or walk for six hours a day. He also said her claims of being in pain were only partially credible.
Despite the fact that her condition got far worse over the next year, the administrative law judge (ALJ) denied her claim for Social Security disability benefits. His reasoning was that the other doctor hired to determine her RFC was more credible than her treating physician, even though that doctor never actually examined the patient. She ultimately appealed the denial of benefits, and the court determined that while an ALJ can use one doctor’s opinion over another, there is a presumption in favor of using treating physicians’ opinion, and if an ALJ is to disregard that opinion, his or her basis for doing must so must be carefully explained in the order. This was not the case here, and he reversed and remanded the case for further proceedings.
If you are seeking Social Security Disability Insurance benefits in Boston, call for a free and confidential appointment at (617) 777-7777.
Additional Resources:
Stage v. Colvin, February 9, 2016, United States Court of Appeals for the Seventh Circuit
More Blog Entries:
Hanson v. Colvin: A Critical Look by a Court of Appeals on a Denial of Benefits, August 14, 2014, Boston Disability Lawyers Blog.