Kudos To ALJ Wexler

I represented a former valet with cardiovascular problems whose claim for Social Security Disability (“SSD”) benefits was approved today by Administrative Law Judge (“ALJ”) April Wexler. Unfortunately, the claimant died on February 27, 2016, from those health problems. 

The Social Security Administration (“SSA”) had insisted that the claimant attend a consultative examination (CE”) by Jerome Caiati, a doctor who claims to be an internist working for IMA Disability. According to the American Medical Association, American Board of Medical Specialties and New York State Department of Health, Caiati did not attend medical school in the United States, and is not board certified in any medical field. That fact alone should suffice to accord little weight to Caiati’s opinion. 

As discussed in my prior postings, the IMA CEs are frequently baseless. Some of my colleagues believe that the Caiati CE reports are the worst of all. ALJ Wexler’s decision is consistent with that opinion. 

Caiati diagnosed the claimant with history of "asymptomatic" hypertension/high blood pressure, while cautioning the claimant to follow up with his own physician after the CE revealed elevated blood pressure. As he virtually always does, Caiati opined that the claimant had no limitations in sitting, standing, walking, reaching, pushing, pulling, lifting, climbing, and bending. 

ALJ Wexler gave Caiati's opinion little weight because it was not only inconsistent with the record as a whole, but with is own CE findings as well. For example, the ALJ pointed out that the claimant could not only have a "history" of high blood pressure, implying that it was a thing of the past, while Caiati admitted that the claimant currently had high blood pressure, and even warned that the claimant had to follow up with his own physician. ALJ Wexler added that high blood pressure is etiologically related to the claimant's fatal cardiac failure. 

In rejecting Caiati's opinion, ALJ Wexler concluded that, “It strains credulity that, given the claimant's significant medical history and the positive examination findings for high blood pressure, the claimant would have had absolutely no physical limitations as opined by Dr. Caiati.” 

I am surprised that the ALJ gave any weight to Caiati's opinion at all. Anyone whose SSD application was denied based upon a CE by Caiati should file an appeal.

Vocational Report Pays Off

Disability claims involve both medical and vocational issues. However, while disability claimants frequently pay for medical reports, they rarely consider investing in a vocational report. I represent a former construction manger with neck and back problems who was approved for Social Security Disability (“SSD”) benefits today because after an Administrative Law Judge (“ALJ”) reviewed the claimant’s vocational report. 

The ALJ had scheduled a hearing with a Vocational Expert (“VE”) from the Social Security Administration (“SSA”). I submitted a letter to the ALJ objecting to the SSA VE because the claimant had submitted a report from his own VE, who also happens to serve as a VE for the SSA. My letter explained why none of the reasons set forth in the HALLEX for scheduling a VE to testify applied. The Hearings, Appeals and Litigation Law Manual (“HALLEX”) is a compilation of rules from the Social Security Administration's Office of Disability Adjudication and Review (“ODAR”). Moreover, the claimant’s VE was available to answer any questions that the ALJ might have. 

When the ALJ originally scheduled the hearing, he did not read the VE report. That is because, as frequently happens, that evidence had been excluded from the file. After I resubmitted the VE report, together with the receipt showing that the SSA had received it, the ALJ approved the SSD application without a hearing. As a result, the claimant will be awarded in excess of $100,000. Money well spent for the VE report.

Holding IMA Accountable

We represent a claimant for Social Security Disability ("SSD") benefits. His claim was approved today without a hearing, even though Social Security rarely does this anymore. 

We had filed a request with the Freedom of Information Act (“FOIA”) when the claimant attended a Consultative Exam (CE) at IMA in January, only to be told when he got there that the doctor wasn't in. We filed the FOIA request because we wanted to show that fraud was being committing, as they denied our client his SSD benefits initially for not attending the CE. Our FOIA request was denied. The evidence in other cases was just as strong, so we can only assume that Social Security did not want to have to explain why IMA lied regarding the CE. The bottom line, do not let IMA lie.