According to the Social Security Administration’s own statistics through 2009, nearly 53 percent of all Social Security Disability claims are denied. While the reason for a large number of denials of Social Security disability claims is administrative, sometimes the reason is the apparent stubbornness of the administrative law judge to see the larger picture, that is, the progression of the disability itself.
Gentry v. Commissioner of Social Security
The claimant suffered a long history of psoriasis, an autoimmune disease which, in one of its severe forms, results in the formation of plaques-the buildups of dead skin cells that crack and bleed. Approximately 80 percent of those with psoriasis develop plaques. The claimant also developed psoriatic arthritis similar to 30 percent of all those with psoriasis. Eighty percent of those with psoriatic arthritis develop psoriasis first with symptoms of psoriatic arthritis appearing after about 10 years.
The claimant also had injuries to her right arm and wrist, right hip, and left ankle due to a 1994 automobile accident. In addition, she had several skeletal injuries and deformities which caused pain and changes in posture and gait.
In 2004, at the age of 29, the claimant filed for Social Security Disability benefits. She had a high school education, some college, and had worked as a pizza maker/delivery person. Recently, she had been fired as a receptionist after bleeding on paperwork due to her plaques.
After bouncing around the system several times with her claim denied, a third hearing was held at which time the claim was denied yet again. The finding was that the disability was not sufficiently severe under the regulatory requirements and the claimant could perform work as a receptionist. Ultimately, the Sixth Circuit was asked to review the decision.
Severity of the medical condition
The Sixth Circuit began its review by recounting the claimant’s various medical conditions and treatments since 1994. It was clear to the court that, as the psoriasis worsened and her psoriatic arthritis appeared, the claimant tried numerous medications to little avail. By 2011, a consultative exam reported that the claimant had significant psoriatic plaques on her torso, legs and extremities, and bleeding plaques on her hands. She also had spinal stiffness and pain due to psoriatic arthritis. The claimant’s daily activities became largely limited to housework with some walking and standing.
The Sixth Circuit emphasized that the regulations require that an administrative law judge inquire into the severity of the impairment and not focus upon periodic instances of improvement as the ALJ did here. Instead, the focus of the ALJ should have been upon the arc of the entire illness and the claimant’s response to the medications and treatments thereto. The ALJ was found to have ignored: (1) evidence of the claimant’s pain; (2) the bleeding of her lesions; and (3) the conclusions of her treating physician.
Ability to work
The Sixth Circuit reviewed the evidence presented to the ALJ and found that it showed that the claimant was unable to perform even sedentary work due to limitations to the use of her hands and her inability to sit.
Given the record, the court reversed the ALJ and found that substantial evidence supported a finding of total disability.
Seek legal help
If you suffer from a serious injury or disease which substantially limits your ability to work, you should call a Tennessee attorney experienced in handling social security disability cases. An attorney can assist you in filing a disability application and, if necessary, pursuing an appeal from an adverse decision.