Why the Medical Record Can Make or Break a Disability Appeal

Every disability appeal has two moving parts:

1. The law (statutes, regulations, case precedent)

2. The record (medical evidence, testimony, daily-activity logs)

   
   

A recent Ninth Circuit case, Thomas v. Bisignano (Aug. 26, 2025), underscores just how closely the courts—and ALJs—scrutinize the record.

The Core Conflict: Discounting Opinions vs. Deference to ALJ

What the Claimant Argued

Thomas contended that the ALJ improperly discounted:

• Multiple treating or examining physician opinions

• His own subjective symptom testimony

  
  

What the Court Held

The Ninth Circuit affirmed the denial, explaining that the ALJ’s analysis was supported by substantial evidence (i.e., more than a mere scintilla).

The ALJ’s decision turned largely on two regulatory factors:

• Supportability: whether the medical opinion is backed by objective clinical findings or is based mainly on the claimant’s subjective complaints.

• Consistency: whether the opinion aligns with the rest of the longitudinal record.

  
  

In Thomas’s case, the ALJ found:

• Dr. Morgan’s opinion was overly reliant on Thomas’s subjective complaints

• Dr. Petaja’s opinion essentially echoed Dr. Morgan’s

• The record—over time—showed mostly normal attention/concentration, no hospitalizations since 2018, reports of improvement, and relatively robust daily activity (running a sober home, ushering, volunteering, preparing multi-course meals)

  
  

Because the ALJ’s interpretation was rational and supported by evidence, the court declined to overturn it simply because a different interpretation might also have been reasonable.

Lessons for Building a Strong Record in Disability Cases

Here are tactical takeaways (which align well with your original tips)—polished for readability and client/colleague education:

• Tie opinions to objective findings.Encourage treating and examining doctors to reference lab tests, imaging, neuropsychological testing, or observable physical/mental signs—not just claimant self-reports.

• Ensure longitudinal consistency.One-off notations won’t carry much weight. The record should tell a continuous, coherent story of impairment over time (e.g. monthly/quarterly updates).

• Contextualize daily activities.When claimants engage in tasks (e.g. cooking, volunteering, managing a home), document:

  • Frequency

  • Duration

  • Need for rest or recovery

  • Supervision or assistance

  • Variability (i.e. whether they do less when symptomatic)

    
    

• Capture flare-ups and triggering stressors. If impairments worsen under certain conditions (e.g. high stress, fluctuating symptoms), make sure the medical record captures that nuance (e.g. “on bad days,” “in high-stress settings,” or “following exertion”)

  
  

• Anticipate challenges to symptom testimony. If the claimant’s subjective complaints are critical, corroborate them with objective findings, contemporaneous symptom logs, and third-party observations.

  
  

• Use consistent, cumulative evidence rather than “one-off bombs.”Multiple aligned pieces of evidence are harder to disregard.

  
  

  Got any questions? Schedule a consultation with us. I’m here to help. It’s a lot to take in, but we’ll get through it together. After all, navigating these waters is always easier when you’ve got someone to chat with.