Denied Before? Key Takeaways From Past Decisions and How to Move Forward

As an attorney, I have far too many opportunities to review prior unfavorable decisions.  Many claims are denied, in part, because doctors' statements are inconsistent with their medical records, and because claimants' statements are inconsistent with their own statements or with statements made to their doctors.  

A Real Life Example:  Claimant has normal exams at their doctor’s office.  There is no complaint about pain medication not working or an increase in their pain.   There is no complaint about not being able to pick things up or walk very far, or request assistive devices (cane, walker, etc).  The claimant is giving a picture to the doctor of someone who is stable, not in need of additional treatment and whose medical condition is well managed.  The SSA requests that the doctor complete a medical source statement, which describes the claimant’s limitations.  The doctor, wanting to help the claimant, says the claimant cannot lift even a few pounds and cannot walk or stand for more than a few minutes.  The claimant would be off task more than 25% of the workday and/or absent several times a month.  Then the claimant appears before the Judge and testifies that they are in immense pain all of the time, they cannot walk or stand at all, their hands and feet tingle all the time, and are very painful.  They cannot meet their basic needs.   

The Judge is tasked with assessing credibility; no higher authority will reassess the credibility of the witnesses, absent extreme circumstances.  The Judge looks at the medical records, then at the medical source statement, and then at the claimant’s testimony and decides that the only real credibility here is the medical records, which, in this example, show a fairly stable individual with stable medical issues that are kept under control by medication, therapy, etc.  There have been no complaints made to their doctors about the claimant's medical situation.  The Judge decides to discount or throw out the medical source statement and the claimant's testimony, indicating they are exaggerated.   Even if the doctor and the claimant are telling the truth about the actual impairments, because the medical records do not reflect those limitations, those statements are not used in determining whether the person is disabled.  Nearly every time this situation occurs, the claimant is found not disabled.  And the Appeals Council and the District Court will not address credibility in their review of the claims.  

This type of denial is difficult to overturn at the Appeals Council level or the District Court, as it is the Judge who determines credibility, and that is not disturbed by other people reviewing the Judge’s decision.   Further, because the medical records can support the Judge’s decision to deny, the decision will not be overturned on that basis either.  Thus, the only thing potentially left is whether the Judge did not follow the rules and regulations; if so, did the failure to follow the rules result in an unfavorable decision? And if they followed the rules, would that be enough to change the decision to a favorable one.  Therefore, misstating a date or failing to address every piece of evidence in the file is insufficient grounds to send the case back.  

Now, what to do to reduce this?

For one thing, you must be honest with both your doctor and your lawyer.  If you are putting on a brave face at the doctor’s office, DON’T.   First, you will not receive the proper treatment for your conditions.  If the doctor thinks you are doing well, that’s what goes in their report.  Second, if you are not telling your doctor exactly what is happening in your day-to-day life, as it relates to your medical condition, then they don’t know how to help you.  Third, if the doctor is asked to fill out a medical source statement and they fill it out with you, they may take answers from you that are inconsistent with their own medical records.  They may say you cannot stand for more than a few minutes at a time, but they have documented in their records that you have no lower-extremity problems.  Therefore, how can you not stand for more than a few minutes, especially since you are not using any assistive devices, which would likely be needed if you were unable to stand for more than a few minutes?  

You need to be completely honest with your attorney as well. If you are not telling the attorney the absolute truth, we, as the attorney, cannot navigate around what may appear to be grounds to deny the claim, nor can we properly prepare for a hearing.    If I, as the attorney, have discussed the claim with you, the claimant, and you have told me that you can only stand for 5 minutes, I am going to believe that that is all the time you can stand.  I am going to incorporate this information into my argument.  If, however, you testify that you can stand for an hour, then, we have an issue that I, as the lawyer, wasn’t prepared for, and since my argument was based, in part, on your statements about standing for 5 minutes, my argument is now flawed and based on wrong information.  This makes it look like I am attempting to exaggerate your medical issues, and therefore, what I, as the attorney, am arguing is suspicious.  

In order to be in the best possible position regarding your disability claim, you need to make sure that your doctor is recording what you are telling them, you need to be honest about what you are really experiencing medically.  There is no reason to put on a brave face to your doctor.  They want to help you and they can’t if they don’t know there is a problem or you are hiding it because you don’t want them to think you are as bad off as you are.  

SSA cases are heavily dependent on the medical records and the statements in those records.  SSA is looking for anything that will allow them to deny claims, thus medical records that don’t match RFC statements, or testimony or other forms filled out during the process only gives SSA additional information to deny claims.

This information is not intended to create an attorney-client relationship and should not be considered advice for your specific situation. It is provided as a general discussion of issues that may arise and possible approaches that may be considered in similar cases. Because every case is different, it is always recommended that you contact an attorney to discuss the facts of your individual situation and obtain legal advice tailored to your circumstances. If you have questions or would like to speak with our office, you can contact us at (833) 438-7734.