New York Court Requires Social Security Judge to Clarify Medical Record in Disability Benefits Case - Stokes v. Commissioner of Social Security

July 07,2009
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In order to prove a claim for Social Security disability benefits, an individual must provide the Social Security Administration (SSA) with clear and convincing medical evidence that details the extent of the claimant’s impairment, its onset date and its effect on the claimant’s ability to perform work. While the Eastern District of New York recently ruled in Stokes v. Commissioner of Social Security that an SSA Administrative Law Judge (ALJ) considering a claim bears some of the responsibility to clarify the record in certain situations, a claimant is well advised to present as much evidence as possible the first time around.

Plaintiff Elizabeth Stokes filed a disability benefits claim, alleging that she’s unable to work due to both a right knee injury and Multiple Sclerosis. The SSA denied the claim. Plaintiff then appeared at an administrative hearing before an SSA ALJ. The ALJ determined that she is not disabled for benefits purposes because, although Plaintiff could not return to her previous job as a police officer, she retained the residual functional capacity (RFC) to perform other jobs available in the national economy.

On appeal, the court found that the ALJ failed to properly clarify the medical evidence presented regarding Plaintiff’s knee injury. Plaintiff’s treating physician – Dr. Varriale – performed arthroscopic surgery on Plaintiff’s right knee in 1991 and in 2003 diagnosed her with arthritis in the same knee. In a 2006 letter explaining the impairment, Dr. Varriale concluded that Plaintiff “is disabled from working.”
The court noted that “[t]he record evidence regarding Plaintiff’s knee injury was, by the ALJ’s own analysis, ‘very limited,'” particularly with respect to the onset date of her arthritis. The court ruled that, considering the limited nature of the evidence, the lack of clarity regarding the arthritis onset date and the fact that Dr. Varriale was the only physician to treat Plaintiff for the impairment, the ALJ had an affirmative “duty to recontact Dr. Varriale for clarification.”

The court also ruled that, on remand, the ALJ should consult a medical expert. Social Security Regulation 83-20 provides that an ALJ “should call on the services of a medical advisor” when the onset date of a claimant’s impairment is unclear. Thus, according to the court, to the extent that the ALJ finds that Plaintiff is disabled as a result of her knee impairment, the judge should consult an expert to determine the onset date. The court ruled that, “Given the ‘limited’ medical evidence regarding Plaintiff’s knee impairment, a medical expert will allow the ALJ to fully develop the record in order to arrive at an accurate determination.”

The court remanded the case to the ALJ for further proceedings.

This case is a perfect example of just how important it is to provide clear and convincing medical evidence to prove a claim. While courts have provided varying interpretations of the degree to which it is an ALJ’s responsibility to develop the record in a Social Security disability case, a disability claimant can avoid the issue altogether by submitting full, accurate and up to date medical records and other evidence. An experienced Social Security disability lawyer can provide vital assistance to a client seeking disability benefits by gathering the necessary medical documentation and following up with the SSA to ensure that it has everything it needs to decide on the claim.