When Can a Treating Provider’s Assessment Be Rejected in California?

When can a district court in Fresno, California reject the assessment of a treating provider? A recent district court decision considered this question. While the court’s decision provides guidance, a dedicated California Social Security Disability attorney can help answer any additional questions you may have that are specific to your situation.

The plaintiff in this case asked for judicial review of an administrative law judge’s decision denying his application for benefits under Title II of the Social Security Act. The plaintiff had filed a claim for social security disability benefits on June 4, 2013 claiming a disability date of April 11, 2013.

Anyone filing a claim for social security disability benefits needs to show they’re unable to perform any substantial gainful activity due to a medically determinable mental or physical impairment that has lasted or is anticipated to last for 12 or more months.

Disability is determined by using a 5-step sequential process. The first step is to look at whether the claimant’s been engaged in substantial gainful activity since the disability date. The second step is to show a medically severe impairment or combination of them. An impairment isn’t severe where it’s just a slight abnormality with no more than a minimal impact on the ability to do basic work.

The plaintiff suffered from serious impairments like PTSD, major depressive disorder, atrial fibrillation, and others. However he didn’t find that these impairments met or medically equaled a listed impairment. The administrative law judge also found that the claimant had the residual functional capacity to do medium work with some limitations, but unable to perform past relevant work. The administrative law judge needs to decide whether a claimant is able to do other work, and in this case the administrative law judge determined there were jobs existing in significant numbers in the national economy the plaintiff could’ve performed.

The plaintiff claims the administrative law judge made a mistake in rejecting his treating medical providers’ assessments. He argued that the limitations they found made it impossible for him to do any sustained job. The court explained that it distinguishes among the opinions of three types of doctors: (1) doctors that treat the claimant, (2) doctors that examine but don’t treat, and (3) doctors that don’t examine and also don’t treat. The court is supposed to give more weight to a treating doctor than one that doesn’t treat, and where a treating or examining doctor’s opinion is countered by another doctor’s, the treating or examining doctor’s is only supposed to be rejected where an administrative law judge gives valid, specific reasons supported by substantial evidence.

The plaintiff argues that the administrative law judge had made a mistake in rejecting a treating doctor’s assessment of the plaintiff on the ground that he had recently been fired and was under abnormal stress. The judge hadn’t explained how his stress level would invalidate the doctor’s opinions on his physical abilities. The plaintiff also challenged the administrative law judge’s finding that the earliest date of his restrictions was 2006 since he’d been a patient at the doctor’s clinic for 15 years. He argued that the judge had made a misstatement in claiming that medications helped.

The administrative law judge found there was no basis for the limits determined by the doctor. He found specifically that the treatment notes for the day the disability paperwork was submitted gave no support for the major restrictions on activities.

The court found that the plaintiff hadn’t shown legal errors or that the judge’s decision lacked support. The plaintiff also argued that the administrative law judge had perpetrated harmful legal errors by rejecting the symptom testimony.

The administrative law judge found the complaints of pain weren’t well documented or corroborated. The court reasoned that although a Commissioner can’t discredit a claimant’s testimony about subjective symptoms just because they’re not supported by objective proof, that hadn’t happened here. The administrative law judge had considered various other factors such as the plaintiff not receiving treatment for physical problems beyond medication.

The plaintiff’s motion for summary judgment was denied and the defendant’s summary judgment motion was granted.

It is common for even valid Social Security Disability benefits claims to be rejected, but it can make a difference to work with an experienced attorney. If you believe you may need to apply for Social Security Disability benefits in Fresno, contact Peña & Bromberg, PLC at 559-439-9700 or via our online form.

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