The Seventh Circuit Remands Because of “Outdated” State Agency Assessments

Rohan v. Chater, 98 F.3d 966, 970 (7th Cir. 1996) teaches that ALJs “must not succumb to the temptation to play doctor and make their own medical findings,” a teaching that cases such as Blakes ex rel. Wolfe v. Barnhart, 331 F.3d 565, 570 (7th Cir. 2003) reframe as precluding ALJs from substituting their own opinions to fill gaps in the record.

Recently, in Moreno v. Berryhill, 882 F.3d 722 (7th Cir. 2018), the Seventh Circuit noted that many social security appeals raise two principles that can be in tension with one another. First, Social Security Administrative Law Judges (ALJs) are significantly overburdened with massive caseloads and insufficient resources. Second, ALJs are not doctors.

For many years, the Seventh Circuit has held that an ALJ should not rely on an outdated assessment if later evidence containing new, significant medical diagnoses reasonably could have changed the reviewing physician’s opinion. See Stage v. Colvin, 812 F.3d 1121, 1125 (7th Cir. 2016) (remanding where a later diagnostic report “changed the picture so much that the ALJ erred by continuing to rely on an outdated assessment”); Goins v. Colvin, 764 F.3d 677, 680 (7th Cir. 2014) (remanding after ALJ failed to submit new MRI to medical scrutiny).

In Moreno v. Berryhill, the Court noted that We cannot accept the agency’s argument that the newer mental-health records would not have made a difference because they showed improvement. This argument is based on the ALJ’s own assessment of the more recent records. We have made clear, however, that ALJs are not qualified to evaluate medical records themselves, but must rely on expert opinions. Meuser v. Colvin, 838 F.3d 905, 911 (7th Cir. 2016) (remanding because the ALJ improperly “played doctor”); Goins, 764 F.3d at 680 (prohibiting ALJs from “playing doctor” by summarizing the results of a medical exam without input from an expert).

Subsequently, the Agency filed a petition for panel rehearing, requesting that the panel delete one sentence of the opinion. 2018 WL 1787221. The Agency requested that the panel delete the sentence: “We have made clear, however, that ALJs are not qualified to evaluate medical records themselves, but must rely on expert opinions.” Id. The Agency argued that when “severed from the factual context” the holding could be misinterpreted. Id.

On April 13, 2018, the Court granted the Agency’s request, and substituted a more tailored language: “That assessment was not justified under the circumstances of this case.” Id.

If you are appealing a case to the Seventh Circuit or to any of the district courts within, make sure to check the recent Seventh Circuit decisions at http://media.ca7.uscourts.gov/opinion.html

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