Navigating Todd Hess's Disabled Adult Child Benefits Appeal

In Hess v. O'Malley, the U.S. Court of Appeals for the Seventh Circuit addressed a dispute involving a claim for disabled adult child benefits under the Social Security Act. Todd Hess, the plaintiff-appellant, sought benefits based on his claim that mental health conditions, including depression, panic disorder, and obsessive-compulsive disorder (OCD), had rendered him disabled before his 22nd birthday and continuously so until his benefits application in 2016.

Disabled adult child benefits allow individuals to receive Social Security benefits based on a parent's account, provided they establish a disability before age 22 and demonstrate its continuation. Mr. Hess was required to prove he was disabled before his 22nd birthday in August 1999 and that his condition persisted without interruption.

Initial Proceedings and Denials

Mr. Hess applied for supplemental security income (SSI), disability insurance benefits (DIB), and disabled adult child benefits in February 2016. While the Social Security Administration (SSA) approved his SSI claim, it denied his applications for DIB and disabled adult child benefits at both the initial and reconsideration stages. Two state-agency physicians reviewed his records and found insufficient evidence to establish a disability before his 22nd birthday.

Mr. Hess's case was subsequently heard by an Administrative Law Judge (ALJ). In December 2018, the ALJ ruled that while Mr. Hess became disabled in June 2009, he had not established disability before August 1999. The decision cited significant gaps in medical treatment, evidence from physicians suggesting Mr. Hess’s conditions were manageable, and his ability to work as an independent contractor.

Appeals Council and District Court Review

After the SSA Appeals Council declined to review the ALJ's decision, Mr. Hess sought judicial review in the Western District of Wisconsin. He argued that the ALJ improperly evaluated medical evidence and failed to account for gaps in his treatment due to lack of insurance. The district court affirmed the ALJ’s decision, concluding that substantial evidence supported the finding that Mr. Hess was not disabled during the relevant period.

Seventh Circuit Review

On appeal to the Seventh Circuit, Mr. Hess raised several arguments. He challenged the ALJ’s reliance on gaps in treatment as evidence against his claim, the weighting of medical opinions, and the evaluation of his residual functional capacity (RFC).

The appellate court upheld the ALJ's decision, emphasizing the following points:

1. Medical Evidence and Testimony: The ALJ reasonably relied on notes from physicians who treated Mr. Hess during the relevant period. For instance, his treating physician in 1998 observed that he was "generally functioning quite well" and that his OCD "did not interfere with his life." While Mr. Hess later reported significant worsening of his condition, those accounts fell outside the required time frame.

2. Gaps in Treatment: The court noted that the ALJ did not use treatment gaps to infer symptom remission but rather to highlight the lack of corroborating evidence. Mr. Hess and his mother testified that financial constraints prevented more frequent treatment, but no additional evidence, such as statements from friends, coworkers, or instructors, supported the severity of his symptoms during the gaps.

3. Residual Functional Capacity: The ALJ’s RFC determination accounted for moderate limitations in concentration, persistence, and pace by restricting Mr. Hess to simple, routine tasks in low-stress work environments. The Seventh Circuit found this consistent with the medical evidence and rejected claims that further inquiry into vague medical statements would have been productive.

4. Weighting of Opinions: The ALJ appropriately weighed opinions from state-agency physicians, considering the entire record. The court found no significant error in the ALJ's attribution of "little" weight to certain assessments after addressing inconsistencies.

Outcome and Implications

The Seventh Circuit affirmed the district court’s decision, concluding that the ALJ's findings were supported by substantial evidence and free from legal error. The court emphasized the burden on claimants to provide consistent, corroborated evidence of disability during the relevant period.

This case underscores the challenges of proving a disability onset date under Social Security law, particularly when gaps in treatment and limited corroborative evidence are involved. For claimants seeking disabled adult child benefits, comprehensive documentation and support from medical professionals and other witnesses are essential to meet the stringent legal standards.

Secure the Social Security Disability Benefits You Deserve

Navigating Social Security Disability claims can be overwhelming, especially when facing denials or complex eligibility requirements. At Whitcomb Selinsky PC, our dedicated attorneys understand the nuances of disability law and work tirelessly to ensure your rights are protected. Whether you're seeking initial benefits or appealing a decision, we provide the expertise and support you need. Contact us to learn how we can assist you in achieving a fair outcome.