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Objective Medical Findings Needed to Obtain Pennsylvania SSI Benefits

Social security insurance (SSI) benefits are paid to Pennsylvania individuals when they are disabled and insured. To be “insured,” an individual must have worked for a certain period of time and paid social security taxes. The last date that an insurance claimant meets the second requirement is called the “date last insured.” The Social Security Commissioner expects to see objective medical findings before finding disability. In a recent SSI benefits case a plaintiff asked a Pennsylvania district court to review the Commissioner of Social Security’s denial of his claim for social security insurance benefits.

The plaintiff was in his early 50s and held a GED. He had been an apprentice with a pipefitters and plumbers’ union. He had been promoted multiple times and eventually was a supervisor. He believed his seizures, stress, and depression limited him. He also claimed other symptoms associated with these conditions, like memory and balance problems.

He met the insured status requirements through June 2015, but had filed his application in August 2010, claiming he became disabled the month before. He had been diagnosed with a seizure disorder, anxiety disorders and gout. His application was initially denied. He requested a hearing before the administrative law judge (ALJ). The judge denied his application.

After going through the appropriate channels, the plaintiff appealed the ALJ’s determination, arguing (1) he had failed to evaluate his gout, (2) he had failed to give the right amount of weight to the treating physicians opinion, and (3) the ALJ had erred in failing to find him credible.

At his intake and a second appointment with a doctor (Dr. Phelan), the plaintiff complained of gout. However, there were no objective medical findings for a gout diagnosis. He did suffer from seizures from 2009 onward. There was no record of a hospital visit after the first seizure, but there was one after the second. The physical exam was normal. He was referred to another doctor who did not rule out seizures, but did not find abnormalities on the MRI.

Although the MRI did not contain evidence of a seizure, the doctor did diagnose him with a seizure disorder during a follow-up. Another treating doctor found he had no limitations with regard to lifting, carrying and other manual work, but did state he shouldn’t be working at heights or extreme temperatures.

A state agency medical consultant found he could lift 100 pounds or more and could sit for 6 out of 10 hours a day. He found few limitations other than difficulties with heights.

The plaintiff was also diagnosed with mental impairments, mood disorder and anxiety. He was found to have extreme limitations in his ability to understand, remember and carry out instructions and to make judgments. However, the doctor did not include medical or clinical findings to support that opinion.

At the administrative hearing on his claim, testimony was put forward regarding gout and related symptoms. The ALJ asked questions of a qualified vocational expert. When posed a hypothetical question in which the subject of the question had the same problems as the plaintiff, the expert testified the individual in question could not return to the plaintiff’s old job. However, he believed the individual would be able to perform three other jobs existing in significant numbers in the national economy.

The district court explained that a five-step process is used to evaluate disability insurance benefits claims. The process requires the Commissioner to consider whether a claimant is (1) engaging in substantial gainful activity, (2) is severely enough impaired, (3) has a combination of impairments that meet or qualify for the requirements of a listed impairment, (4) has residual functional capacity to return to his past work and (5) if not, whether he can perform in another job the national economy.

In this case, the ALJ had failed to consider gout, but it was not error. Gout was not established through medical signs or laboratory findings.

When a treating physician’s opinion is in conflict with a physician not treating the plaintiff, a judge can choose whom to credit so long as he doesn’t reject evidence for no reason or the wrong reason. In this case, the plaintiff’s allegations of pain were not supported by objective medical evidence. The court affirmed the ALJ’s decision.­

An experienced Pennsylvania workers’ compensation attorney can evaluate the facts of your particular case if you are hurt because of an entity’s negligence and bring a lawsuit on your behalf if appropriate. Contact the attorneys at Needle Law Firm at 570-344-1266 or via our online form for a free consultation.

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