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ALJ erred by 'playing doctor' in head trauma case, 7th Circuit rules

July 10, 2018

Judges must rely on expert opinions instead of determining the significance of particular medical findings themselves, the 7th Circuit Court of Appeals ruled in a case where it found a judge “played doctor” to review limitations caused by a traumatic brain injury.

In 2000, Anthony Kaminski suffered a severe head wound after falling down the stairs, causing a traumatic brain injury and a seizure disorder. Doctors reported that because of the fall, Kaminski had severe cognitive deficits including problems with memory and a change in personality, as well as an inability to understand the severity of his injury.  

Thirteen years after his fall, Kaminski applied under the Social Security Act for disability insurance benefits and supplemental security income, alleging he became disabled on the date of the fall. His neurologist, Dr. Richard Cristea, submitted evidence that Kaminski had “frequent falls” and opined that seizures could be triggered by physical activity, stress, inadequate sleep, and dehydration, so Kaminski was incapable of performing even low‐stress work.

However, the Social Security Administration denied his applications for disability benefits, so Kaminski took his claim to an administrative law judge. He and his sister testified that his injuries had negatively impacted his cognitive and social abilities, while a vocational expert testified that a person with Kaminski’s capabilities could not hold a full-time job if Cristea’s limits were considered.

But the ALJ also denied Kaminski’s request for disability benefits, finding Kaminski’s mental limitations were not as severe as had been reported and that Cristea’s opinions about his functionality were not consistent with the treatment he offered or Kaminski’s testimony. On appeal, Kaminski argued the ALJ misconstrued his own statements as inconsistent with Cristea’s opinions when they were symptomatic of his frontal‐lobe injury, and that the judge did not understand that the physical limits his doctor imposed were meant to prevent seizures. Kaminski also argued the judge was cherry‐picking evidence and “playing doctor” instead of heeding the opinion of an actual physician.

The 7th Circuit agreed with Kaminski, finding the judge improperly discounted Cristea’s opinion on all counts. It found that despite sufficient medical evidence to prove limitations caused by Kaminski’s brain injury, the judge relied on his own interpretation to reach a conclusion.

“Where a judge rejects a treating physician’s opinion because it does not align with the judge’s own ‘incorrect interpretation of the medical evidence,’ that decision is not supported by substantial evidence,” Judge David Hamilton wrote Monday.

The 7th Circuit also found the ALJ had cherry-picked evidence, overlooking a consulting psychologist’s report that Kaminski had diminished cognitive abilities. Instead, the judge relied heavily on the reports of doctors who did not examine Kaminski but who opined that he could work with some restrictions. 

Finally, the 7th Circuit found the judge erred in relying on his own interpretation of Kaminski’s MRI instead of Dr. Cristea’s, citing Moon v. Colvin, 763 F.3d 718, 722 (7th Cir. 2014), in which administrative law judges are required to rely on expert opinion, not their own.

“Once the treating physician’s opinions are given the proper weight, the record compels the conclusion that Kaminski was unable to work and thus was disabled under the relevant statutes and regulations,” Hamilton wrote.

Failure to give controlling weight to the doctor’s opinion was an error requiring remand, Hamilton concluded. The ALJ’s decision was, thus, reversed, and remanded with instructions to calculate and award benefits to Kaminski.

The case is Anthony Kaminski v. Nancy A. Berryhill, 17‐3314.

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