A Recent Case Highlights the Critical Differences Between Workers' Compensation and Social Security Disability
In a decision issued January 16, 2026, the U.S. District Court for the District of New Jersey affirmed the denial of Social Security disability benefits to a former auto mechanic—despite the fact that he had been awarded an 80% permanent partial disability rating under workers' compensation. Brian R. v. Commissioner of Social Security serves as a stark reminder that success in one disability system doesn't guarantee success in another.
The Claimant's Story
Brian R., a 45-year-old master-certified automobile technician with 19 years of experience, sustained a work-related back injury in July 2017. What began as pain from reaching under a dashboard evolved into a cascade of medical issues: lumbar degenerative disc disease, spinal stenosis, obstructive sleep apnea, and peripheral neuropathy.
Unable to continue his physically demanding work, Brian transitioned to operating a hot dog cart—a modest business he could run while mostly seated, approximately two days per week for four hours at a time. His workers' compensation evaluations ultimately assigned him an 80% permanent partial disability rating. Based on this and his ongoing medical issues, he applied for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
Yet after a hearing before an Administrative Law Judge (ALJ), his claims were denied. The Appeals Council declined to review the decision, and Brian appealed to federal court. The district court affirmed the denial.
The Court's Rationale: A Multi-Step Analysis
Social Security disability determinations follow a rigorous five-step sequential evaluation process, and Brian's case faltered at multiple points.
Step Two: What Counts as "Severe"?
The court upheld the ALJ's finding that only Brian's lumbar degenerative disc disease qualified as a "severe" impairment. His sleep apnea and neuropathy, while medically diagnosed, were deemed non-severe because they didn't significantly limit his ability to perform basic work activities.
Brian argued that the ALJ had ignored these conditions. The court disagreed, noting that an impairment is only "severe" if it causes more than minimal functional limitations. The ALJ had considered Brian's complaints of fatigue and hand numbness but found them unsupported by objective medical evidence. Multiple examinations showed:
- Normal motor strength (5/5) in upper and lower extremities
- Normal gait without assistive devices
- Intact hand function and grip strength
- No documented muscle weakness
Brian's own medical visits contradicted his testimony—at one pain management appointment, he reported no fatigue, no muscle weakness, and no difficulty walking.
The court emphasized that step two functions as a "de minimis screening device" to weed out groundless claims. Even if the ALJ erred in not labeling these conditions as severe, the error was harmless because the ALJ found at least one severe impairment and continued through the full five-step analysis.
The RFC Determination: What Can You Still Do?
At step four, the ALJ assessed Brian's Residual Functional Capacity (RFC)—essentially, what he could still do despite his limitations. The ALJ concluded Brian could perform the full range of light work.
Brian contested this finding, arguing the ALJ failed to account for limitations from his neuropathy and sleep apnea. The court found this argument unpersuasive for several reasons:
Objective Evidence Contradicted Subjective Complaints: While Brian testified about debilitating symptoms, the medical record told a different story. Treatment notes documented that during the height of his alleged disability, Brian reported walking 5-8 miles per day, swimming, and exercising at the YMCA.
Daily Activities Demonstrated Functional Capacity: Brian's activities were inconsistent with total disability. He operated a small business, drove, shopped, performed household chores, and helped family members. The court noted that while these activities were limited in scope, they demonstrated a capacity for light work.
Conservative Treatment History: Brian's treatment consisted primarily of physical therapy, medication, and one steroid injection—no surgeries or aggressive interventions that would suggest severe, uncontrolled symptoms.
The court reiterated a fundamental principle: "the ALJ need only include in the RFC those limitations which he finds to be credible." Where objective evidence contradicts subjective complaints, the ALJ has discretion to discount the claimant's testimony.
Medical Opinion Evidence: Why Doctors' Letters Aren't Always Persuasive
Perhaps most instructively, the court upheld the ALJ's decision to discount opinions from four different physicians who had suggested greater limitations.
Dr. Blank (Primary Care Physician): While Dr. Blank diagnosed neuropathy and spinal stenosis, his medical source statement lacked a detailed function-by-function assessment. More problematically, Dr. Blank indicated that Brian didn't need to lie down during the day and that medication controlled his symptoms without side effects—statements that undermined claims of disability.
Dr. Lesneski (Pain Management Specialist): Dr. Lesneski's opinion that Brian could walk only one block and had reduced hand function directly contradicted his own treatment notes, which showed Brian reported no difficulty walking and no muscle weakness. The opinion was rendered on a check-box form with minimal narrative explanation—a format courts view as "weak evidence at best."
Dr. Atlas (Orthopedist): Most remarkably, Dr. Atlas's medical source statement contained an internal contradiction that proved fatal to its credibility. When asked to identify clinical findings supporting the assessed impairments, Dr. Atlas wrote "none." He further stated the impairments were expected to last only 1-3 months, not the required 12 months for disability. His own treatment notes showed normal muscle strength and gait, and he recommended only conservative treatment.
Dr. David (Workers' Compensation Evaluator): This opinion illustrates the crucial distinction between workers' compensation and Social Security disability. Dr. David assigned Brian an 80% permanent partial disability rating for workers' compensation purposes. However, the court noted that such determinations are "not inherently valuable or persuasive" for Social Security purposes.
The regulations explicitly state that disability decisions under other programs don't control Social Security determinations. Workers' compensation evaluates your ability to perform your specific job. Social Security disability requires that you cannot perform any substantial gainful activity in the national economy. These are fundamentally different standards.
The Workers' Compensation Wild Card
Brian's case vividly illustrates why workers' compensation awards don't translate to Social Security disability benefits.
Different Legal Standards: Workers' compensation in New Jersey—like most states—compensates workers for injuries arising out of and in the course of employment. It focuses on your capacity to perform your pre-injury job and provides partial wage replacement even if you can still work in a limited capacity. An 80% permanent partial disability rating means you've suffered significant impairment related to your work injury, but it doesn't mean you cannot work at all.
Social Security disability, by contrast, requires that you be unable to engage in any substantial gainful activity due to a medically determinable impairment expected to last at least 12 months or result in death. The bar is total disability, not partial.
Different Evidentiary Focus: Workers' compensation evaluators often rely heavily on the mechanism of injury and the relationship between the workplace accident and the resulting condition. Social Security ALJs must assess objective medical evidence, functional limitations, and whether those limitations preclude all work in the economy—including sedentary jobs that bear no resemblance to your former occupation.
Different Treating Relationships: Dr. David's workers' compensation evaluation was a one-time assessment for litigation purposes. The ALJ gave greater weight to Brian's ongoing treatment records, which showed relatively normal examinations and conservative management—evidence more probative of his day-to-day functional capacity.
Key Takeaways for Claimants and Practitioners
This case offers several important lessons:
1. Objective Evidence Matters More Than Subjective Complaints: No matter how genuine your pain or limitations, if the medical evidence doesn't corroborate your testimony, your claim will likely fail. Ensure your treating physicians thoroughly document objective findings, not just your subjective reports.
2. Daily Activities Can Make or Break Your Case: Be honest about what you can do, but understand that ALJs will scrutinize your activities for consistency with your claimed limitations. Operating even a part-time business, no matter how modest, can undermine a total disability claim.
3. Medical Opinions Must Be Supported and Consistent: A letter from your doctor saying you're disabled isn't enough. The opinion must be supported by clinical findings, consistent with the treatment record, and provide specific functional assessments. Check-box forms with minimal explanation carry little weight.
4. Workers' Compensation Success Doesn't Predict Social Security Success: If you've been awarded workers' compensation benefits, don't assume your Social Security claim will be approved. The standards are different, and you must prove you cannot perform any work in the national economy.
5. Conservative Treatment May Suggest Less Severe Impairment: If your doctors are managing your conditions with medication and physical therapy rather than surgery or aggressive interventions, ALJs may infer that your impairments aren't as limiting as you claim.
6. Gaps and Inconsistencies in the Record Are Fatal: Brian's case featured periods where he reported walking 5-8 miles daily and exercising regularly—statements difficult to reconcile with total disability. Any such inconsistencies will be used against you.
The Broader Implications
Brian R. reflects the increasingly rigorous scrutiny Social Security disability claims face. With trust funds under pressure and approval rates varying widely by ALJ and region, claimants face an uphill battle even with legitimate impairments.
The case underscores that Social Security disability is reserved for those who truly cannot work in any capacity. It's not a remedy for being unable to perform your chosen occupation or for receiving a workers' compensation award. The system requires objective medical evidence of functional limitations so severe that no jobs in the national economy—including sedentary, sit-down work—remain available to you.
For Brian, despite his genuine back injury, documented degenerative disc disease, an 80% workers' compensation disability rating, and the difficult transition from a skilled trade to operating a modest hot dog cart, the evidence simply didn't support total disability under Social Security's stringent standards.
Conclusion
The District of New Jersey's decision in Brian R. v. Commissioner of Social Security serves as a cautionary tale. Success in workers' compensation doesn't guarantee success in Social Security disability. The standards differ, the evidence required differs, and the outcomes can differ dramatically.
If you're considering applying for Social Security disability—particularly if you've already received workers' compensation—work closely with experienced counsel. Ensure your medical records thoroughly document objective findings and functional limitations. Be prepared to explain any inconsistencies between your claimed limitations and your daily activities. Understand that your doctors' opinions, while important, aren't controlling if they're unsupported by the medical evidence.
Most importantly, recognize that Social Security disability is a safety net for total disability, not partial disability. The system demands proof that you cannot engage in any substantial gainful activity, regardless of your training, skills, or prior occupation. That's a high bar—one that Brian, despite his legitimate medical issues and workers' compensation award, ultimately could not clear.
Brian R. v. Commissioner of Social Security, No. 25-cv-00049, 2026 WL 125564 (D.N.J. Jan. 16, 2026).
*Jon L. Gelman of Wayne, NJ, is the author of NJ Workers' Compensation Law (West-Thomson-Reuters) and co-author of the national treatise Modern Workers' Compensation Law (West-Thomson-Reuters).
Blog: Workers' Compensation
LinkedIn: JonGelman
LinkedIn Group: Injured Workers Law & Advocacy Group
Author: "Workers' Compensation Law" West-Thomson-Reuters
Mastodon:@gelman@mstdn.social
Blue Sky: jongelman@bsky.social
Substack: https://jongelman.substack.com/
© 2026 Jon L Gelman. All rights reserved.
Attorney Advertising
Prior results do not guarantee a similar outcome.
No comments:
Post a Comment