Social Security Judges and Their Impact on Disability Claims, Part One

Welcome to Season 1, Episode 23 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into the complicated topic of "Social Security Judges and Their Impact on Disability Claims, Part One."

If you’ve ever stared at a denial letter and thought, Did the judge even read my file? - or walked out of a Social Security hearing feeling like the deck was stacked against you - this episode of Winning Isn’t Easy is for you. Host Nancy L. Cavey takes a closer look at the role of Social Security Administrative Law Judges and the enormous influence they have over the outcome of your disability claim. If you’ve worked hard, paid into the system, and now find yourself fighting for benefits, you deserve more than generic rejections. You deserve to be seen, heard, and judged fairly. In this episode, Nancy highlights what happens when judges rise to the occasion. She explores how judges can weigh medical opinions, push past flawed assumptions, and make rulings that truly reflect the evidence. Whether you're gearing up for your first hearing, deep into the appeals process, or simply trying to understand how decisions get made, this episode brings clarity, strategy, and hope. Let’s get into it.

In this episode, we'll cover the following topics:

1 -  Social Security Judge Rejects Opinions of Two State Agency Physicians in Awarding Social Security Disability Benefits to Veteran

2 - Social Security Judges Reject Allegations That Social Security Disability Applicant Is Disabled Because of Substance Abuse and Award Benefits

3 - Second Time Around, the Social Security Judge Finally Awards Benefits to State Farm Insurance Agency Owner

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:15]:
 Welcome back to Winning Isn't Easy. Social Security Disability Benefits. This is a podcast where we break down everything you need to know about navigating the Social Security disability claims process. I'm your host, Nancy Cavey. Now, before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says I have to say this, so I've said it. But nothing will ever prevent me from giving you an easy to understand overview of the Social Security disability claims process, the games that can be played, and what you need to know about getting the Social Security disability benefits you deserve.
 
 Nancy Cavey [00:00:51]:
 So off we go. Now, in the last episode, I covered the Social Security judges and some issues that I see with the Social Security claims process at all levels, including in front of the judges. Now, in today's episode, I am going to talk about that denial letter that you got from the judge. And you are really upset, as potentially you should be. You've waited a long time to get a hearing and, and you presented your case and you got an unfavorable decision. And you think as you read this decision, did the judge even read my file or did they decide to just cherry pick the things they wanted to use to deny the claim and ignore everything else? Now, you may also have felt when you walked out of that hearing that the deck was stacked against you. You might have felt confused, frustrated, or simply defeated. You've worked hard, you've paid into the system, and now you find yourself fighting for the benefits you need.
 
 Nancy Cavey [00:01:57]:
 And I think that you need and deserve more than generic rejections and rubber stamp decisions. You deserve to be seen, heard and judged fairly. Now, this episode is about what happens when a judge does get it right or when it takes a fight to make that happen. And there are lots of great judges. I appear in front of them and they do the right thing. And they do that right thing in the context of the Social Security disability system understanding, I think the real world problems that people have doing their past work and correctly applying and empathetically applying the step five of the five step sequential evaluation, that mythical, not hypothetical, not real world question of whether there's other work that you hypothetically could do in view of your age, education, training and experience. And that comes down in many instances to the way that the judge frames the hypothetical that they give to the ve to answer that question. And what I want to do is to spotlight real cases where Social Security judges made tough calls, they rejected flawed government opinions, and ultimately they did justice to to by the claimant, and in some cases, we'll show you what it took to push back when they didn't.
 
 Nancy Cavey [00:03:21]:
 So whether you're preparing for your first hearing, stuck in the appeals process, or trying to understand how decisions are made, I think this episode offers clarity, strategy, and, most importantly, hope. Why do I say that when I interview a client at the initial stage of a case, I want to understand them and I want to understand my potential theory of the case. Because from the very beginning, I'm thinking about how I'm going to win the case and what I have to do to properly set this case up for an appeal if I lose. I know that may sound strange to you that you prepare by thinking you're going to lose, but I absolutely think that that makes you not only a better lawyer and claims representative, but more importantly lets you think about why a judge may rule against you and help you prepare. So I'm going to cover three things today. 1. Social Security judge rejects opinion of two state agency physicians in awarding Social Security benefits to a veteran. 2.
 
 Nancy Cavey [00:04:22]:
 A Social Security judge rejects allegations that the applicant is disabled because of substance abuse and awards benefits. And second time around, the judge finally awards benefits to a State Farm Insurance Agency owner. This is going to be kind of detailed. And so when you come back after we take our break, please bring a piece of paper and a pencil or pen because I want you to understand this thought process. If you think you're going to walk into a hearing and win simply because your doctor says you're disabled, you are sadly mistaken. And many times people do that. But even those who have attorneys need to understand the judge's thought process as they prepare an initial application, as they prepare a request for reconsideration, and certainly as they prepare for hearing. Got it.
 
 Nancy Cavey [00:05:13]:
 Let's take a break.
 
 Speaker B [00:05:15]:
 Are you considering filing for Social Security Disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security disability benefits, which will cover everything you need to know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:05:37]:
 Welcome back to Winning Isn't Easy. Social Security Judge rejects Opinion of two State Agency Physicians in Awarding Social Security disability Benefits to a veteran. Now did you know that when you apply for Social Security disability benefits, your medical records are sent ultimately to your A state agency called Disability Determination Services and DDS is where the claims examiners are housed and where there are state Disability Determination Services doctors. Often these physicians who are going to be reviewing the medical records are going to be helping the claims examiner understand in quotes the nature of the medical condition, but more importantly will address your functional restrictions and limitations based on a paper review. These physicians are often older retired doctors who haven't been in practice in years, and they supplement their retirement income by reviewing records. Unfortunately, I find very often that their opinions are the basis of a claims denial at the initial application or request reconsideration stage. And that's important because one of the things I try to use to get around this is to have my clients treating physicians complete some forms called radio Residual functional capacity forms. These forms will address your functional restrictions and limitations.
 
 Nancy Cavey [00:06:54]:
 How long you can sit, stand, walk, stoop, bend, can you lift? How much you can lift? How often can you lift? Do you have to change positions? Would you be off task at least 10% of the time? Do you have problems with bilateral manual dexterity? Would you be absent? Those things are relevant to understanding your functional capacity because at step four, Social Security has to determine if you can go back to the lightest job you held in the five years before your claim was adjudicated. And at step five, where most of these cases are resolved or decided is whether there's other work in the hypothetical mythical, not real world national economy that you wouldn't want to do that doesn't pay a living wage. In view of your age, your education, the skills that you've learned in your past work and those restrictions and limitations, that's where your case is really going to be decided. Now we try to address that obviously by having those RFC forms because we want it to be absolutely clear what the functional restrictions and limitations are because often you won't find that in medical records. When a judge hears a case, the administrative Social Security law judge, here's the case the going to start their analysis by looking at what the state agency DDS doctors had to say about your restrictions and limitations. And the judge has to decide whether they're going to accept or reject those opinions and they're going to consider when those opinions were rendered, how old are they? What treatment have you received since those opinions were rendered? What were the physical exam findings subsequent to the DDS evaluation? What do your treating physicians have to say about your restrictions and limitations? Now I recently tried a case in front of a judge who was hearing the case of a veteran and I'm going to use a made up name if you will. So we don't disclose this privacy of this individual, but I'm going to call him Hugh. Hugh was a veteran who suffered from bipolar disorder, severe depression and anxiety as well as low back and neck problems.
 
 Nancy Cavey [00:09:04]:
 He had difficulty, as you can imagine, with concentration, pace, and getting along with others. His back and neck pain caused limitations in his ability to sit, stand, walk, and lift in his job as a laboratory technician. Now, you know, the lab tech is going to be standing most of the day, maybe doing some bending and doing some lifting. What the judge did was he rejected the opinions of the state agency physicians and found that the opinions of the treating physician were more persuasive. His doctors had filled out residual functional capacity forms that documented his complaints, the consistency of his symptoms, and his inability to function in the workplace. And so what was important here was that the judge looked at the age of the DDS opinions, looked at the subsequent treatment that had been received, looked at the residual functional capacity forms, and said, I'm going to reject the DDS doctors and. And ultimately awarded benefits. So what are the takeaways that you should be taking away from this case? Well, I think this case highlights how crucial it is to have detailed, consistent documentation from the treating physician.
 
 Nancy Cavey [00:10:10]:
 I always tell my clients, I want you to really give a good interval history of what your symptoms were between your visit and how those symptoms impacted your ability to function. So, for example, if you've got back pain, you might have to change positions every 45 minutes. So I want my client to go in and say, doctor, I have back pain. The pain is here, goes down my right leg to my toes. I have tingling and numbness. Those are the symptoms. And I can only sit for 45 minutes, and I have to get up and move around because the pain and the numbness become unbearable. That's the functional limitation.
 
 Nancy Cavey [00:10:49]:
 So I want you to give a really good interval history, and of course, that history should be consistent from visit to visit. And of course, ultimately, we want the consistency to convince the judge that this ongoing medical treatment is more current and is based on actual physical exams where the DDS doctors didn't do a physical exam. So you have this opportunity by the treating physician to understand, observe, and document a person's functional limitations and complaints. Why? Well, we want the judge to weigh the treating physician's opinions more heavily in favor of the client. There is no treating physician rule in Social Security. But what we want to argue is, look, you can't rely on these DDS opinions. There was no physical exam. The opinions are outdated.
 
 Nancy Cavey [00:11:46]:
 They're remote, didn't consider current evidence. There's a consistency in the claimant's medical, treating physician's medical records. And by the way, here's a residual Functional capacity form reforms. Now, the other thing that was important in the success in this case was the strong residual functional capacity forms that aligned with with the medical history and the functional limitations. This reinforces the importance in my view of a well supported medical narrative in disability cases. So you can see history of symptoms and functionality, good interval history documented at each visit. The support of a doctor in terms of strong functional limitations and consistency throughout can be used to successfully overcome an unfavorable and outdated state. DDS Doctor's opinion.
 
 Nancy Cavey [00:12:41]:
 Got it. Let's take a break. Welcome back to Winning Isn't Easy. Social Security judge rejects allegations that a Social Security disability applicant is disabled because of substance abuse and awards benefits. Now, it doesn't matter how disabled you might be. You could have degenerative joint disease of the shoulders, knees and neck. You could have undergone multiple surgeries. You could have Parkinson's, you could have Ms.
 
 Nancy Cavey [00:13:39]:
 It doesn't really matter because if your disability is found to be caused by substance abuse, the Social Security judge must by law deny your claim. In other words, the judge must find that you are physically or psychiatrically disabled even in the absence of substance use or abuse disorder. So it's really crucial that your treating physician is supporting your claim and completes a residual functional capacity form outlining your restrictions and limitations both from a physical and psychiatric standpoint. Now, when an administrative law judge hears your case, they start out by looking at what the state agency DDS Dr. Said and what your own doctor said about your functional limitations. And the ALJ is going to closely examine your medical records for any evidence of drug or alcohol use, which includes when you might have last used those substances, whether you're attending a treatment program, your compliance with that program, and you're treating physicians perspective on your condition and substance abuse. I will tell you in my practice, we use AI to do medical records review. We used to do them manually, but one of the things that that we did manually and now we do electronically through AI is to specifically look for evidence of drug or alcohol abuse or use.
 
 Nancy Cavey [00:15:01]:
 Because I know that that is going to be a red flag for a judge and a red flag that I want to address with my client in preparation for the hearing in my brief to the judge and as we testify in front of the judge. So let me tell you about a case that I tried in front of an ALJ where the claimant, I'm going to call her Julie, was a home health aide, housekeeper and kitchen manager. She had significant orthopedic problems with her neck, her back, her shoulder. She had undergone multiple shoulder surgeries. Her back and her neck pain, along with limited shoulder motion, caused significant limitations in her ability to sit, stand, walk, and lift. Now, the judge started out with the DDS opinions who opined that she could do light duty work. And the judge rejected those DDS opinions and instead found that she could only lift five pounds because of the multiple problems that she had with her shoulder, as documented by her physician. Now, as a result, the judge ultimately awarded benefits, but the judge had to address in this decision the DDS doctor's comments that there was substance abuse and that potentially could cause disability as defined by Social Security.
 
 Nancy Cavey [00:16:25]:
 Now, when a DDS doctor reviews the file and they see this kind of information, they're going to be addressing the question of whether the disability is caused or contributed to by alcohol or substance abuse. And if they say no, I still try to address it in front of the judge by having my client talk about the fact that they aren't using or abusing the last time they did their efforts to attend AA or other forms of support groups. And obviously, I'm arguing to the judge that there's a lack of evidence of substance use or abuse. But if the DDS doctor suggests that the disability is caused by the use of. Of alcohol or other substances, we have to address that. And we have to address that because ultimately we have to show that the person would be disabled based on their physical or psychiatric problems, notwithstanding the substance abuse. That can be pretty easy or that can be pretty hard. So what do I mean? I had a case that I absolutely refused to try because the individual had a seizure disorder.
 
 Nancy Cavey [00:17:39]:
 That seizure disorder was caused by their alcohol abuse. And the ER records on the date of the claimed onset clearly said that that individual had come to the ER under the influence of alcohol, was legally intoxicated, and that the stroke that the person had and the seizure that they had at the time they were admitted was caused by the alcohol use. I wasn't going to win that case. The doctor, the ER doctor, clearly indicated that the seizure and the stroke were caused by alcohol. I can't overcome that. So I didn't take that case. And if that case had got tried, it would have been a loser, because in that instance, it was the substance abuse that caused the physical condition. So that has to be addressed and potentially addressed by your physicians and your attorney in a case.
 
 Nancy Cavey [00:18:35]:
 And ultimately, of course, the judge awarded benefits in our case, the Julie case. And what that case does illustrate is that past substance abuse doesn't automatically disqualify an applicant from receiving benefits. What matters is whether the disabling condition exists independently of the substance use disorder. And of course, in this case, her case, her claim was strengthened by consistent medical records, participation in appropriate care, and a treating physician who provided a compelling RFC form. And the judge focused on her physical limitations rather than seizing on the previous substance use because the clear medical evidence and documentation established that the substance use and abuse was in the past, that it was not contributing in any way to her disability. Got it. Let's take a break.
 
 Speaker B [00:19:26]:
 Struggling with your Social Security disability case? The right attorney can make all the difference. Get our booklet the Key to hiring a Great Attorney for your Social Security Disability case. Discover how to find an experienced attorney who will fight for your rights and navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Nancy Cavey [00:20:16]:
 Welcome back to Winning Isn't Easy Second time Around the Social Security judge finally awards benefits to a State Farm Insurance Agency owner Now at my law firm, I will tell you we're not afraid to take a case to the Appeals Council, which is the appellate level above an administrative law judge, or even to Federal court, which is the appellate level above the Appeals Council. If I think that the Social Security judge is decision is legally wrong, we are not afraid to take an appeal and potentially get that judge reversed. And we have to get the judge reversed before we can win the claim. And that's what happened in Laura Lee's case. Of course this is a pseudonym, but Laura Lee owned a State Farm Insurance Agency and due to neuropathy and a hearing impairment, she rarely went to the office despite taking a full salary draw. She had visited a gun range and the noise of the shooting had caused bilateral hearing loss resulting in ear pain and sensitivity to sounds such as simple things like telephone conversations and more complex things like listening to lawnmowers or leaf blowers or even going to a restaurant. She had undergone ear surgery and multiple post operative diagnostic tests that continued to document not only the hearing loss but dizziness and and because of those issues she sold her insurance agency and then applied for her Social Security Disability benefits. Her claim was denied by the administrative law judge at Step five and the judge said that you could do other work in the national economy.
 
 Nancy Cavey [00:21:50]:
 Because she was a younger individual under 50. The judge did not accept her testimony about the severity of her symptoms. Despite the supporting medical testimony and testing and RFC forms. We took an appeal to the Appeals Council and and Fairfax, Virginia and we argued, among other things, that the judge had improperly rejected her testimony and didn't give proper weight to the medical evidence. The appeals council agreed and remanded it back to the same judge who had originally denied the claim. Now, the judge got it right the second time when we retried the case. And the judge got it right in part because of the instructions given by the appeals council and how she was to evaluate the credibility of my client and to evaluate the medical evidence. Just because a judge rules against you doesn't necessarily mean you should give up.
 
 Nancy Cavey [00:22:44]:
 You should be consulting with your lawyer to determine if there are appealable issues. Now, if I didn't like this decision in Laura Lee's case, but there wasn't any appealable issues, I would not have taken the appeal. And most lawyers won't take such an appeal. So there's got to be legal error that would justify the appeal. Unfortunately, the judge on remand followed the instructions of the appeals counsel. That is not always the case. There are some judges who are going to use this remand as a second opportunity to deny the claim and ignore the appeals counsel's decision or the federal court's decision. If that happens, we've got another appeal, much to my unhappiness.
 
 Nancy Cavey [00:23:30]:
 But we'll appeal and appeal and retry the case until we feel as if we have gotten a legally correct decision. So you need to understand that most of the judges are great. They're looking for a reason to pay a well developed and well prepared claim. But there are other judges who do seem to have a proclivity to deny claims. And I'm not going to say anything more than that. But you can certainly look up the approval rating of any administrative law judge and get a sense of what they're about. There are also comments sections about these particular judges. Most of us who handle Social Security disability cases appear in front of the same judges over and over.
 
 Nancy Cavey [00:24:12]:
 So we know what judges will give us a fair chance and we know what judges who make it more difficult to get a case approved. We try to address those proclivities in our hearing and our hearing preparation. In other words, we know that with this particular judge, we most likely are going to have to take an appeal. So we want to set the case up for an appeal and see if the judge has committed legal error so that we can have a successful appeal. Again, most judges get it right, some don't. And that means that potentially you've got to do an appeal. But I'm going to talk more about this in another episode. But again, I want you to understand that in Laura Lee's case, this case demonstrated the importance of persistence in the power of the appeals process.
 
 Nancy Cavey [00:25:05]:
 Even when a judge gets it wrong, a well argued appeal can correct that error. And the case also shows that subjective complaints like dizziness, when supported by objective testing, can form the basis of a successful claim. So don't underestimate, please, how the importance of continuing to fight for your claim if you're initially denied at the application stage, at the request for reconsideration stage, and even continuing to fight for your claim if it's been improperly denied by an administrative law judge. Well, that's it for today's episode of Winning Isn't Easy. I hope that these real world cases give you a clearer picture of what actually happens behind the scenes in a Social Security disability hearings and the thought process that goes behind preparing for a hearing and developing the right evidence. Persistence and advocacy can make all the difference. And if there's one thing to take away, it's that while most judges get it right, not always. Not all judges get it right the first time.
 
 Nancy Cavey [00:26:06]:
 And you've got options. So whether it's really finding the right lawyer to represent you from the very beginning, whether it's developing the right medical evidence to win your claim at the initial application or recon stage, or whether it's getting prepared properly for the hearing and making sure that the right evidence has been developed and the right questions are asked of you and the vocational evaluator. It really is something that is a team approach. You don't have to navigate this alone, and particularly if you get a denial, you need to have an experienced Social Security disability appellate lawyer look at the case and determine whether an appeal is appropriate or not. You shouldn't be navigating the Social Security disability claims process through at any stage. Quite frankly, without representation. At my law firm, we've seen how powerful it is when claimants are informed and empowered. Because when you understand what it is, you have to prove the rules, the evidence, you're in a better position to fight for what's rightfully yours.
 
 Nancy Cavey [00:27:14]:
 If you found this episode helpful, please take a moment to like our page, leave a review, share it with your family and friends, and subscribe to this podcast. And by the way, in next week's episode, I'm going to discuss more about Social Security judges and more examples of claims outcomes. I think it's really crucial for for you to understand this because having your doctor say you're disabled isn't going to cut it. You need to understand the claims process. What we need to prove and how to go about presenting that evidence to the Social Security Administration and, if necessary, an administrative law judge. Got it. Thanks for listening.