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An administrative law judge was correct in denying disability insurance benefits to a man who waited more than 18 months to see a doctor after hurting his back at work, the 7th Circuit Court of Appeals affirmed Tuesday.
Chris Martin injured his back while lifting a heavy bag in June 2016. But he didn’t see a doctor for the injury until Feb. 5, 2018.
In May 2018, Martin was diagnosed with a spine disorder.
Later that year, he applied for supplemental security income benefits and disability insurance benefits, asserting that he had become disabled back in June 2016.
After two initial denials, Martin’s case was heard before an ALJ.
At the hearing, Martin testified that after his 2016 injury but before early 2018, he was able to “baby” his back. But in early 2018, he said, his back pain suddenly became worse. He visited a doctor while using a wheelchair and wearing a back brace.
However, Martin provided the ALJ no medical evidence indicating he was disabled earlier than his first doctor’s appointment in February 2018.
The ALJ did not consult an additional medical expert to determine whether Martin might have become disabled at an earlier time, particularly while he was still insured for purposes of disability insurance benefits.
The ALJ ruled that Martin was disabled as of Feb. 5, 2018, the date he first saw a doctor about his back, albeit three months before he was officially diagnosed. That finding made Martin eligible for supplemental security income.
But the ALJ denied his application for disability insurance benefits, in part because objective medical evidence did not support a disability onset date before his date last insured, which was Dec. 31, 2017. The ALJ wrote that Martin’s symptoms had improved in 2016 and that the record was “void of documentation of any medical treatment” prior to 2018.
On appeal by Martin, the Social Security Appeals Council affirmed the ALJ’s decision.
Martin then sought judicial review in the United States District Court for the Southern District of Indiana, arguing the ALJ erred by failing to consult an additional medical expert to interpret medical evidence, and by ignoring Martin’s testimony about his symptoms.
The district court affirmed the partial denial of benefits. It ruled that Social Security Ruling 18–01p did not require the ALJ to call an additional medical expert, and noted that the ALJ had specifically addressed Martin’s testimony about his symptoms but had ultimately found he had not proven an earlier disability onset date.
Martin appealed to the 7th Circuit, which affirmed, agreeing that the ALJ did not abuse her discretion in deciding not to consult another medical expert.
Senior Judge David Hamilton wrote the opinion for the appellate court.
According to Hamilton, the issue in Martin’s case is governed by SSR 18–01p, which took effect on Oct. 2, 2018. Under that ruling, an ALJ may, but is not required to, consult a medical expert to determine whether the claimant became disabled before the dates of his earliest relevant medical records.
Hamilton stressed that an ALJ is not required to do so, and the decision to consult a medical expert is “always at the ALJ’s discretion.”
“Because SSR 18–01p applies to Martin’s case, the ALJ did not err by not consulting an additional medical expert,” he wrote.
The appellate court agreed with Martin that the ALJ had the discretion to assign greater weight to Martin’s symptoms, but the court saw no evidence that the ALJ misunderstood her legal power or discretion.
“The ALJ considered Martin’s allegations of pain supporting an earlier onset date but found that an earlier date was not supported by the medical evidence,” Hamilton wrote.
Finally, Martin argued that the ALJ abused her discretion by misunderstanding and misapplying SSR 18–01p. But the 7th Circuit ruled that the onset date found by the ALJ had substantial evidence supporting it.
Under SSR 18–01p, the ALJ was not required to keep digging for further evidence to support an earlier onset date, particularly in light of the evidence that Martin’s condition had improved or was managed by self-help during 2017, Hamilton wrote.
“Accordingly, the ALJ did not act contrary to law or abuse her discretion by declining to have a medical expert explore further the onset date of Martin’s disability,” the senior judge concluded.
Judges Michael Brennan and Candace Jackson-Akiwumi concurred.
The case is Chris A. Martin v. Kilolo Kijakazi, Acting Commissioner of Social Security, 22-1972.
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