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2 min read

Analyzing the ALJ's Decision: Chris A. Martin's SSDI Appeal Outcome

a medical professional places both hands on the back of a patient

Chris A. Martin appealed a decision made by Kilolo Kijakazi, the then acting commissioner of social security, to the United States Court of Appeals for the Seventh Circuit. The case concerns Martin's partial denial of his application for Social Security disability benefits and was argued on February 7, 2023. The final decision was reached on December 19, 2023.

Background

In June 2016, Chris A. Martin sustained a back injury while lifting a heavy bag at work, leading him to stop working. However, he did not seek medical attention until February 2018, finding temporary relief through self-care. Upon medical examination in May 2018, he was diagnosed with a spine disorder. Subsequently, Martin applied for supplemental security income and disability benefits, claiming disability dating back to the initial back injury in June 2016.

Following two initial denials, Martin's case went before an administrative law judge, where Magistrate Judge Garcia affirmed a partial denial of benefits. The court's decision was based on Social Security Ruling 18-01p, stating that the ALJ was not obligated to seek additional medical expert opinions beyond those presented.

During the hearing, Martin testified that he could manage his symptoms through self-care until early 2018 when his condition deteriorated, necessitating the use of a wheelchair and back brace. Despite the setback, he gradually improved through a combination of treatments, resuming normal activities like walking two miles daily. However, Martin disagreed with the ALJ's assessment, arguing that the court overlooked his testimony on the severity of his past symptoms.

In his appeal, Martin maintains that his disability onset predates the medical evidence presented at his first doctor's appointment in February 2018. Martin contends that he was disabled as of June 2016, and challenges the lack of consideration for his potential disability onset before his medical diagnosis in 2018 while still covered for disability insurance benefits.

ALJ's Assessment of Medical Evidence

The ALJ's ruling in Martin's case was a mix of favorable and unfavorable outcomes. The favorable part was that Martin was deemed disabled as of February 5, 2018, which made him eligible for supplemental security income. However, the ALJ denied Martin's application for disability insurance benefits because the objective medical evidence did not support a disability onset date before his date last insured, which was December 31, 2017.

Despite Martin's testimony about his pain before the first doctor's appointment, the ALJ found that the evidence did not substantiate an earlier disability onset date. The ALJ noted the lack of documentation of any medical treatment prior to 2018 and highlighted an improvement in Martin's symptoms in 2016.

Martin argued that the ALJ erred in discounting his symptoms that predate his relationship with his primary care physician. He cited SSR 18-01p, which allows ALJs to consider evidence from non-medical sources. The court, however, found that while the ALJ had discretion in her decision-making process, there was no evidence to suggest that she misunderstood her legal authority.

The ruling under SSR 18-01p, which became effective in October 2018, allows but does not mandate an ALJ to consult a medical expert to determine the claimant's disability onset date. While in the past, ALJs were encouraged to seek medical advice if the disability onset date was unclear, under the current ruling, it is at the ALJ's discretion to do so.

This change from the previous practice, as outlined in SSR 83-20, emphasizes that consulting a medical expert is no longer a requirement but a decision left to the ALJ's discretion. In Martin's case, the ALJ's choice not to seek additional medical expertise aligns with the current ruling's guidelines.

Holding

The Seventh Circuit affirmed. Under Social Security Ruling 18-01p, an ALJ has discretion whether to consult an additional medical expert about onset date. Here, the ALJ did not abuse her discretion by declining to consult another expert, given the lack of objective medical evidence showing Martin was disabled before February 2018. Nor did the ALJ legally err in evaluating Martin's testimony about earlier symptoms.