(Reuters) - An administrative law judge erred in terminating an Arkansas woman’s Social Security Disability Insurance benefits two months after she had back surgery based on the surgeon’s note that her symptoms had “improved significantly” and that she was “very satisfied” with the outcome, a federal appeals court held Wednesday.
The 8th U.S. Circuit Court of Appeals said the ALJ improperly inferred from the surgeon’s “vague, conclusory statements” that Tammy Koch was no longer experiencing disabling pain, then compounded his error by discounting evidence he deemed “inconsistent” with that inference – including Koch’s own testimony, a report by a nurse, and reports by two doctors who examined Koch on behalf of the Social Security Administration.
“Improved symptoms do not necessarily equate to improved pain, especially considering that Koch placed her pain at an eight out of ten” during her visit with the surgeon, Circuit Judge Lavenski Smith emphasized for the court.
“Even if the two did equate, significant improvement in symptoms does not reflect a degree of improvement that would warrant a conclusion that the patient’s pain has subsided sufficiently to enable resumption of work activity,” Smith added. He was joined by Circuit Judges Jane Kelly and Ralph Erickson.
The court remanded the case with instructions to reevaluate Koch’s medical improvement.
Koch’s attorneys at Coleman Law Firm and Thurman & Bishop did not immediately respond to requests for comment on Wednesday. The Social Security Administration does not comment on pending litigation, a spokesman said.
According to the 8th Circuit, Koch has suffered from degenerative disc disease, a bulging disc and other conditions since at least 2009. She has been treated with steroid injections and several pain medications, with no significant change in prescriptions after her surgery.
Koch applied for Social Security disability benefits and supplemental income benefits in 2014. After an initial denial, she requested a hearing, which took place in April 2016.
In the year after the hearing, Koch had her back surgery and followup exam with the surgeon, Dr. Stylianos Rammos; met with the agency’s consulting orthopedist and psychologist; and was examined by a nurse to see if she qualified for disability tags for her car.
The consulting physicians and the nurse reported that Koch suffered from chronic pain and expressed doubt about her ability to complete work-related activities in a timely manner. All the records were supplied to the ALJ.
In September 2017, the ALJ awarded Koch benefits from 2014 until her December 2016 followup visit with Rammos. After December 2016, the ALJ discounted the other medical records and rejected Koch’s testimony outright, finding them inconsistent with Rammos’ notes.
“Here, the evidence as a whole is not inconsistent with Koch’s complaints of pain,” the 8th Circuit held. “Rather the evidence supports Koch’s allegations and does not show that her pain ‘significantly improved’ post surgery.”
Wednesday’s decision marks the second time in as many months that a federal appeals court has vacated a Social Security ALJ’s decision to discount “inconsistent” evidence.
The 11th Circuit in June found no “genuine inconsistency” between a treating physician’s diagnosis of severe mental illness and consulting psychiatrists’ testimony about the claimant’s capabilities, noting that “even a highly unstable patient will have good days.”
Wednesday’s opinion is Tammy Koch v. Kilolo Kijakazi, Acting Commissioner of Social Security Administration, 8th U.S. Circuit Court of Appeals No. 19-3421.
For Koch: Nicholas Coleman of Coleman Law Firm and Gregory Thurman of Thurman & Flanagin
For the SSA: Jennifer Selby, Traci Davis and James Garrett of Social Security Administration Office of General Counsel Region VI
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'Improvement' not inconsistent with continued pain for SSDI claimant – 8th Circ. - Reuters
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