As we have mentioned in previous posts, the Social Security Disability benefits claims process often follows a long and winding path. The good news is that a benefits claimant gets several bites at the apple, so to speak, with several layers of appeal available. The bad news is that the Social Security Administration (SSA) initially denies the majority of claims it reviews, including may with merit.
A person whose claim is initially denied may seek review in an administrative hearing conducted by an SSA Administrative Law Judge (ALJ). If the ALJ finds that the claimant is not disabled for benefits purposes, the claimant can typically then file a federal appeal (after seeking review by the SSA’s Appeals Council).
In this blog, we regularly cover claims that were denied at several levels of the claims process, only to have the decision reversed on federal appeal. The reversal typically means that the case simply goes back to the ALJ for further proceedings, but in some instances, a reviewing court finds that the claimant is so clearly disabled and entitled to benefits that the court sends the case back with instructions that the claim be approved. In Gyles v. Astrue, a federal court in Louisiana gives some insight into how a court that disagrees with the SSA’s decision determines whether to send the case back for more proceedings or simply order a benefits award.
Lewis Gyles filed a claim against the SSA in the U.S. District Court for the Western District of Louisiana after the agency denied his benefits claim and an ALJ found that he was not disabled for benefits purposes. A magistrate in the district court reviewed the case and issued a report and recommendation, finding that the claim should be remanded to the ALJ for further proceedings because the ALJ failed to properly determine Gyles’ residual functional capacity (RFC), or ability to work in spite of any physical or mental impairments.
Gyles challenged this decision, arguing that the evidence in the record was sufficient to support the approval of his claim. The District Court sided with the magistrate, however, adopting the recommendation that the case be remanded.
“When the court cannot rule definitively one way or another on the existing record, remand is appropriate,” the court held. Here, according to the court, the ALJ could not properly determine Gyles’ RFC based on the evidence in the record. Indeed, the Judge erred in deciding to give no weight to a physical therapist’s report indicating that Gyles would need to alternate sitting and standing at least twenty minutes every hour in any working environment. Yet the court declined to determine the specific amount of weight that this evidence should have been given, finding that this question was properly left to the ALJ.
Furthermore, the court found that it may be necessary for the ALJ to consult an orthopedist to determine the extent of Gyles’ impairment and its effect on his ability to work while the case was on remand.
As a result, the court reversed and remanded the ALJ’s decision.
The Social Security disability claims process is complex and may, as in the case of Mr. Gyles, require an appeal. An experienced Social Security disability lawyer can help a client prepare a benefits claim and supporting evidence in the most clear and compelling manner and follow up throughout the claims process to ensure that the SSA has all of the necessary information and documentation to make a decision on the claim.
Related blog posts:
Suing to Speed Up A Social Security Disability Decision – McDonald v. Astrue
New York Court on ALJ’s Responsibility to Develop the Record in Social Security Disability Case – Tirado v. Astrue
Severe Impairment in Social Security Disability Cases – Parker-Grose v. Astrue
