SSA Uses Gynecologist To Deny Man’s SSD Claim

Denial rates for Social Security Disability (“SSD”) benefits has increased about 20% the last several years, while the demographics and medical conditions of the claimants have basically remained the same. So what has changed? Besides increasing the quality and quantity of the evidence required, the Social Security Administration (“SSA”) is employing tactics in violation of their rules. 

When reviewing a claimant’s application, the SSA is obligated to use doctors who are experienced and qualified to evaluate the medical evidence. However, the SSA frequently uses doctors who lack the appropriate medical backgrounds when reviewing files and examining claimants. Now, it seems, the SSA has totally abandoned its obligation to an absurd extent. 

I represent a 57 year old man who had to stop working as a sewer worker because of musculoskeletal problems. The SSA denied his SSD application based upon a review of the claimant’s medical records by “Myron Watkins, M.D. (015).” According to both the New York State Department of Health and the American Medical Association, there is nobody by the name of Myron Watkins who is licensed to practice medicine in New York. 

According to the American Board of Medical Specialties, there is only one person in the entire United States named Myron Watkins who is board certified, and he is licensed in Texas, not New York, and certified in Obstetrics & Gynecology. 

To make sure that I had not discovered some sort of mistake, I decided to check the medical code that the SSA provided for Myron Watkins. The SSA Medical Consultant Code for 15 is gynecology. Unbelievably, it was no mistake. The SSA had denied my client’s application, a man who has cervical and lumbar radiculopathies, based upon a review of medical records by a gynecologist.

Undisclosed ALJ Rule

For many years, I have contended that a person who had a high income when working deserved to be believed when they said they could not work, especially when working at the same job or for the same employer. After all, the higher one’s income, the greater the discrepancy between pre-disability income and the amount provided by disability benefits. Moreover, logic dictates that such a person has a strong work ethic. I regularly advise my clients that regardless of what an administrative law judge (“ALJ”) says in their decision about a claimant’s credibility, they mostly base the credibility determination upon the claimant’s work history. 

Recently, a federal district court judge finally stated in explicit terms that the aforementioned assumptions are valid. In a decision that reversed an administrative law judge’s (“ALJ”) denial of social security disability (“SSD”) benefits, the federal district court judge specified that if a claimant worked for the same employer over a period of many years, or consistently had high earnings, then those factors would be particularly relevant to the credibility assessment. 

I represent a 57 year old claimant, whose application was approved today by an ALJ without a hearing. Like many other claimants whose cases proceed to a hearing, he had an assortment of musculoskeletal problems. Like many other claimants whose cases proceed to a hearing, this client had reports from his doctors showing that he lacked the ability to perform even full time sedentary work, which were supported by diagnostic testing. Unlike most other claimants with musculoskeletal problems and supporting medical evidence whose cases proceed to a hearing, this client worked for the same employer for 34 years, and was earning close to a $100,000. 

I have no doubt that the reason why the ALJ approved the SSD application without a hearing is because it was obvious that the claimant would have continued to work had he been able to do so. This undisclosed rule should be kept in mind when developing the record, and should be emphasized when submitting an OTR. Similarly, if a hearing ensues, ensure that the record reflects the claimant’s work history beyond the last 15 years.