7th Circuit To Social Security: Back Off Denials!

Federal appeals courts have repeatedly reminded Social Security administrative law judges that they cannot ignore a claimant’s actual medical treatment history in favor of agency doctors whose opinions do not match the treating physicians’ records. In 2014, the 7th Circuit Court of Appeals, the federal appeals court for Illinois, Indiana, and Wisconsin, issued several decisions making that point.

In one case, Goins v. Colvin, 2014 WL 4073108 (7th Cir. Aug. 19, 2014), an MRI revealed the claimant had a Chiari malformation, a condition in which brain tissue extends into the spinal canal, causing severe headaches and pain. The administrative law judge relied on an agency doctor’s review that did not discuss the Chiari malformation and concluded the claimant could lift 50 pounds. The judge also found the claimant was not credible because the medical evidence did not support the claimant’s complaints. Writing for the appeals court, Judge Posner rejected that reasoning: “Having a part of one’s brain lodged in one’s spine is not the equivalent of having a runny nose or an ingrown toenail. . . The presence of a Chiari I malformation . . . supports the plaintiff’s claim.” The court also emphasized that judges must consider an applicant’s medical problems in combination and criticized the judge for “playing doctor.”

The decision is a reminder that the treating physicians’ records are often the most important evidence in any case that turns on the extent of a person’s injuries, including personal injury claims, where a complete and consistent medical history can make the difference.