S.M. v. O'Malley

Background

S.M. challenged the final decision denying her application for Supplemental Security Income benefits. The administrative law judge found that S.M. had severe schizoaffective disorder, major depressive disorder, generalized anxiety disorder, borderline intellectual functioning, and methamphetamine abuse. The judge determined that S.M. could perform simple, routine work with limited workplace changes and limited contact with others. Based on vocational-expert testimony, the judge found that S.M. could work as a sorter, laundry worker, or rack room worker and therefore was not disabled.

The record described numerous psychiatric hospitalizations and emergency-department visits involving suicidal ideation, suicide attempts, hallucinations, psychosis, involuntary holds, and other serious symptoms. The administrative law judge relied in part on evidence that S.M. did not consistently follow prescribed treatment, improved when taking medication, used methamphetamine, and had sometimes been described as malingering. The judge rejected treating physician Dr. Mortimer's opinion that S.M. could not perform even low-stress work.

Arguments

S.M. argued that the administrative law judge failed to account for the effect of frequent hospitalizations and related absences on her ability to maintain employment. She also argued that the judge did not give adequate reasons for discounting her symptom statements and improperly relied on medication noncompliance, alleged malingering, and drug use.

The Commissioner argued that the judge properly evaluated S.M.'s reported symptoms and relied on evidence of improvement with treatment. The Commissioner also argued that a heightened standard for rejecting symptom statements did not apply because the judge found evidence of malingering.

Court's Analysis

The court held that the administrative law judge erred by using S.M.'s medication noncompliance to discount opinion evidence and the practical effect of her hospitalizations without first considering why she failed to follow treatment. The judge had recognized in some parts of the decision that difficulty following treatment could itself reflect S.M.'s impairments, but treated the same conduct elsewhere as evidence against the severity of those impairments.

The court also found that the judge did not adequately explain why S.M.'s residual functional capacity did not include some limitation for absenteeism caused by frequent psychiatric hospitalizations. The record contained evidence of hospitalizations involving severe symptoms and no indication of malingering. The court stated that the judge needed to consider whether S.M.'s noncompliance was an excusable effect of her impairments and whether she required a structured setting to take medication and function adequately.

The court further stated that the judge may have mishandled the role of methamphetamine use. Social Security rules require the Commissioner to consider the effects of co-occurring mental illness and substance use before deciding whether the effects of substance use can be separated from the mental impairments. Because remand was required for the medication-noncompliance error, the court did not decide whether the substance-use issue alone required reversal.

Disposition

The case was REMANDED for further proceedings consistent with the order. The Clerk was directed to enter judgment in favor of S.M. The court did not decide that S.M. is disabled and did not reach the parties' remaining arguments.