Split ruling awards Social Security benefits to disabled worker

You can receive disability insurance benefits under the Social Security Act if you suffer a physical or workplace injury and cannot perform any long-lasting substantial gainful activity. The plaintiff in this case suffered a serious workplace injury in her capacity as a school teacher, breaking up a fight among two students, sending her to the ER with a serious head injury, pain in her upper back, nausea, and tingling in her fingers. While this pain was persistent over a number of years, an administrative law judge denied her benefit application. The Court of Appeals reverses and the plaintiff wins.

The case is Colgan v. Kijakazi, issued on January 3. The ALJ ruled against plaintiff because he identified many sedentary jobs in the national economy that plaintiff was able to perform in light of her age, education, and work experience. This is called a RFC assessment, short for residual functional capacity. While plaintiff's expert said she cannot work sedentary jobs because she has suffered debilitating headaches that would last for several hours each day and that her injuries were permanent and her chronic fatigue would interfere with her ability to perform job-related duties, the ALJ rejected that opinion, triggering this appeal.

The Court of Appeals (Calabresi and Walker) says that, while the "substantial evidence" threshold gives ALJ's great deference in resolving these disputes, the medical opinion of the claimant's doctor must be given "controlling weight" if it is "well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence" in the record. The Court finds that plaintiff's doctor's opinion was well-supported and reasonable, and the ALJ improperly rejected that medical opinion. It is not enough to say the doctor's opinion may be rejected because she simply checked off a box on relevant form. Moreover, the doctor's check-box was well supported by voluminous medical records in the course of the doctor's medical treatment of claimant. 

Judge Menashi dissents, finding that the ALJ had a basis to find the doctor's opinion lacked a supportive rationale and was not well-explained. While the doctor did not provide a sufficient rationale for her opinion, the Court "attempts to supply one on appeal," Judge Menashi says, stating further that while the Commissioner of Social Security has final responsibility for determining eligibility for these benefits, "these regulations would mean little if a conclusory check mark, devoid of reasoning, must receive 'controlling deference' that supplants the agency's well-explained judgment" against the receipt of benefits.