In a Social Security Disability hearing, an Administrative Law Judge (“ALJ”) cannot replace a treating physician’s opinion with his or her own lay opinion. In other words, it is inappropriate for an ALJ to ignore or reject a medical opinion based only on his or her own medical understanding. That is, an ALJ cannot substitute his or her judgment for that of the medical and vocational experts.
Several Courts of Appeal have warned against allowing the ALJ to “play doctor.” In Schmidt v. Sullivan, 914 F.2d 117, 118 (7th Cir.1990), (as cited favorably in Frank v. Barnhart, 326 F.3d 618 (5th Cir. 2003)), Judge Posner warned:
But judges, including administrative law judges of the Social Security Administration, must be careful not to succumb to the temptation to play doctor…The medical expertise of the Social Security Administration is reflected in regulations; it is not the birthright of the lawyers who apply them. Common sense can mislead; lay intuitions about medical phenomena are often wrong.
See also Freeman v. Schweiker, 681 F.2d 727, 731 (11th Cir. 1982); Graham v. Bowen, 786 F.2d 1113, 1115 (11th Cir. 1986) (“A hearing officer may not arbitrarily substitute his own hunch or intuition for the diagnoses of a medical professional”); and Marbury v. Sullivan, 957 F.2d 837, 840-41 (11th Cir. 1992) (Johnson, J., concurring) (ALJ erred in according little or no weight to the opinions of two different treating physicians that the claimant suffered from a psychogenically caused seizure disorder). Additionally, at least two District Courts from within the Sixth Circuit have addressed the issue. “…[I]t was error for the ALJ to substitute his judgment regarding Plaintiff’s condition for that of the physicians’ opinions. A medical opinion is not within the province of the ALJ.” Copeland v. Harris, 1982 U.S. Dist. LEXIS 18073 (S.D. Ohio 1982). “…[T]he ALJ made conclusions about the extent of plaintiff’s mental impairments and the effect of those impairments on his ability to work that did not fairly take into account all of the evidence. Therefore, it is the recommendation of the undersigned that this matter be remanded to the ALJ for a determination based on all of the psychological evidence.” Lenon v. Apfel, 191 F.Supp.2d 968, 978 (W.D.Tenn. 2001) (finding that the ALJ erred by “playing doctor” in finding that an individual could not suffer from mild to moderate depression and yet have a “poor” ability to deal with the stresses of the workplace).
The admonition for ALJs not to “play doctor” is a corollary of the “treating physician rule,” discussed in a previous blog. To reiterate, the medical opinion of the treating physician is to be given substantial deference – and, if that opinion is not contradicted, complete deference must be given. King v. Heckler, 742 F.2d 968, 973 (6th Cir. 1984). This “treating physician rule” affords a claimant’s treating physician a great deal of respect, including acknowledging their ability to reasonably render medical opinions based on “treatment of the claimant’s symptoms over a lengthy period of time and by exclusion of other possible diseases.” Preston v. Secretary of H.H.S., 854 F.2d 815, 820 (6th Cir. 1998); see also, Swain v. Commissioner, 297 F.Supp.2d 986, 990-993 (N.D. Ohio 2003). Indeed, a treating physician can reasonably render an opinion concerning her patient’s condition even without “objective manifestations.” Id. Again, this is why it is so important that any prospective Social Security disability Claimant speak with his or her treating physician to make sure that physician will support them in their pursuit of disability benefits.