Court: Spotty Medical Treatment Does Not Bar Disability Benefits Award - Torres v. Astrue

November 08,2009
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In a perfect world, a person seeking Social Security Disability benefits will support his or her claim with a detailed record of regular medical treatment, explaining the claimant’s impairments and how they affect his or her functioning. For a number of reasons, however, this is not always possible. In Torres v. Astrue, the District Court for the District of South Carolina concluded that a person’s inability to get appropriate medical treatment is not, in itself, sufficient basis to find the person ineligible for disability benefits.

The Social Security Administration (SSA) denied Plaintiff Carlos Torres’ disability benefits claim, in which he asserted that he remained unable to work due to a variety of impairments, including a spine injury. Following an administrative hearing before an SSA Administrative Law Judge (ALJ), the Judge found that Plaintiff was disabled from July 15,2005 through July 23,2007. The ALJ further determined that Plaintiff experienced medical improvement and was no longer disabled as of July 23, 2007.

The ALJ’s decision was based largely on the opinion of Dr. Charles Thomas, who examined Plaintiff on July 23, 2007, the last day in which the ALJ found Plaintiff was disabled, and found “a reduced range of motion in the cervical spine.”
The record revealed that the ALJ found that Plaintiff experienced an improvement in his condition beginning the very day after the examination by Dr. Thomas. The judge supported his conclusion by finding that there was “little evidence” that Plaintiff received treatment for his injury following the examination. Based on this lack of treatment, the ALJ further found that Plaintiff’s testimony regarding the nature and extent of his impairment was “less than credible.”

On appeal, the District Court ruled that the ALJ’s decision was not supported by substantial evidence. “It is notable that Dr. Thomas never again examined Plaintiff, and the record is wholly absent of evidence of any substantial medical change in condition that occurred on July 24, 2007 that would support such a dramatic alteration in the Plaintiff’s disability status.”

Plaintiff Torres explained that he was unable to get regular treatment following the examination because he moved from New Jersey to South Carolina, and did not have health insurance following his move. “It is well settled that a Social Security claimant may not be penalized for failing to seek treatment he cannot afford,” the Court ruled, citing the Fourth Circuit’s 1986 decision in Lovejoy v. Heckler.
In addition, the Court found that the ALJ failed to properly consider the opinions of two other physicians who examined Plaintiff, one of which concluded that Plaintiff had an “orthopedic disability” of 65 percent, and the other who concluded that Plaintiff had a “permanent neurological disability” of 45 percent.

While this ruling shows that a claim is not fatally flawed for lack of ongoing medical care, it is still important to consider that clear and convincing medical evidence can go a long way in proving a Social Security Disability benefits claim by showing not only that the claimant suffers from one or more severe impairments, but also that, as a result, he or she is unable to work. An experienced Social Security disability attorney can provide invaluable assistance to a claimant by gathering the necessary objective medical evidence and physician opinions and presenting it in a compelling manner. Rather than rely on SSA claims examiners or an ALJ to sift through extensive documentary evidence and interpret it potentially unfavorably, a disability lawyer can summarize the evidence and if necessary, point out and explain any inconsistencies in the record,