As you can see it has been some time since my last blog post. For lack of better reasons, I have spent all of my spare time thinking of things other than Social Security Disability law. After a scathing review from a fellow attorney and self-proclaimed fan of the blawg, I have repented of my ways...
In preparing for a recent appeal to the Appeals Council, I came across a case that caught my attention and when this case was highlighted in the last NOSSCR publication "Social Security Forum" by interest peaked. The question that the case presents and I feel summarily answer is what do we do as attorneys when we read the medical records from a doctor that states something of the following: "patient is responding well to medications", "patient is stable", and/or "patient is doing fairly well in medication and treatment". As many practitioners know, ALJs, although not intentionally, will look at the statements from the doctor and will conclude that the claimant is functioning well and if the patient is functioning well then the cliamant can either resume past work or has the capacity to perform other types of work.
I see this most often when the claimant will have a doctor that is supportive of their claim for disability and provides a report that would preclude work ability. If the ALJ believes that the report is not consistent with the medical treatment notes, then the ALJ will not give the appropriate weight of the assessment and will dismiss the said assessment as not being consistent with the medical record as a whole. The ALJ will then go on in the decision to point out from the treatment notes that the assessment cannot be afforded weight because the notes will reflect the statements as outlined above.
In Wild v. Astrue, 581 F.Supp.2d 1155 (N.D. Ala. 2008), the Federal District Court reversed the ALJ decision and awarded benefits on the basis that the ALJ rejected the opinion from several medical sources. Although I think that the real rationale for reversal and payment of benefits was that the ALJ had a long history of rejecting the statements from every possible treating, examining, and reviewing source, I think the fundamentals are informative. The Federal District Court stated that the ALJ misinterpreted the treating psychiatrist's statement that the plaintiff "has done fairly well on her medications" as meaning that she "functions appropriately." As the NOSSCR summary of the case states, doing fairly well on medications is not the same as functioning appropriately. The Court goes on to say that the ALJ should have recontacted the psyciatris for elaboration or clarification of the opinion under the ALJs dute to develop the record.
I think this case bolsters an argument that the ALJ must give good reasons in rejecting the opinion of a treating source under 20 C.F.R. 404.1527(d)(2) and 416. 927(d)(2) and Wilson v. Commissioner of Social Security, 378 F.3d 541 (CA6, 2004). I do not believe that statements of "doing well" is enough reason to undermine a doctors opinion.
Friday, March 20, 2009
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1 comments:
I see this type of "patient is doing well" language frequently in records and in decisions that are unfavorable. In my experience, physicians treating medical problems tend to put a mostly positive spin on the claimant's condition in their reports. By contrast, psychologists and psychiatrists tend to be less likely to find significant improvement. This makes sense as doctors treating physical problems are usually focused on a cure, whereas mental health professionals focus on long term management. In addition, physical medicine doctors might see a less than positive observation as a potential malpractice claim risk which also leads to these "patient doing well" type of statements.
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