L.S. v. O'Malley

Background

L.S. sought judicial review of the Commissioner of Social Security’s decision denying her applications for disability insurance benefits and supplemental security income. She alleged disability based on vasovagal syncope, anxiety, dermatitis, nerve damage in her right foot, and depression. The administrative law judge found anxiety disorder and vasovagal syncope to be severe impairments, but determined that L.S. was not disabled. The judge found that L.S. could perform work at all exertional levels, subject to limits on interaction with the public, coworkers, and supervisors, and could perform her past work as a gluer or other jobs identified by a vocational expert.

L.S. challenged three aspects of the decision: the evaluation of consulting psychologist Dr. M. Jakubowski’s medical opinion, the failure to include all of the limitations from that opinion in the residual functional capacity assessment, and the rejection of L.S.’s subjective testimony about her symptoms.

Medical-opinion analysis

Dr. Jakubowski reported that L.S. could follow simple instructions but appeared to struggle with complex tasks. The psychologist also stated that L.S. would likely have difficulty tolerating stressful work environments and social engagement, might have difficulty functioning independently, and would need repeated instructions and periodic prompts from a supervisor. Dr. Jakubowski described some limitations involving attention, concentration, memory, interaction with others, completing a workday without interruptions, and dealing with workplace stress.

The administrative law judge found the opinion only partially persuasive. The judge adopted the portions addressing L.S.’s ability to interact with coworkers, supervisors, and the public, but rejected the remaining opinions. The court found no error in the resulting social-interaction limits because the residual functional capacity reasonably reflected the portions of Dr. Jakubowski’s opinion that the judge accepted. The court also concluded that L.S.’s argument about repeated instructions and supervisory prompts rested on an unsupported premise: the judge had not adopted that portion of the opinion.

The court nevertheless found error in the reasons given for rejecting the remaining limitations. The judge relied on L.S.’s treatment history and daily activities, but the court concluded that the judge’s assessment of those matters was not supported by substantial evidence. Because the same assessment was used to reject parts of Dr. Jakubowski’s opinion and to discount L.S.’s testimony, remand was required.

Subjective-testimony analysis

L.S. testified that anxiety and panic attacks could be triggered by leaving home, being around people, hearing people outside, or dealing with ordinary situations at home. She also described fainting-related symptoms, including nausea, dizziness, and breathing difficulties. She testified that she managed symptoms by avoiding triggers and using measures such as breathing exercises, elevating her legs, therapeutic sounds, and sleep. She reported doing some household chores and activities such as going to the beach and fishing, generally while avoiding people.

Because the administrative law judge found no evidence that L.S. was pretending to have symptoms, the judge was required to provide specific, clear, and convincing reasons supported by substantial evidence for discounting her testimony. The court rejected the judge’s reliance on generally normal or mildly abnormal mental-status examinations. Those examinations did not show that L.S. experienced a debilitating episode while being examined, and the judge did not explain how findings from examinations—many conducted remotely and after L.S. stopped working—contradicted her testimony about episodic attacks triggered by stress and leaving home.

The court also found unsupported the judge’s conclusion that medication had been relatively effective. The record showed that L.S. rarely used anti-anxiety medication and had stopped or declined several medications because of side effects or concerns that they worsened her symptoms. Although the record showed conservative treatment and some decisions by L.S. not to pursue recommended treatment, the judge did not rely on those facts as the reasons for discounting her testimony. Instead, the judge stated that medication effectively controlled her symptoms, and the court found that conclusion unsupported.

Finally, the court found that the judge did not adequately explain why L.S.’s daily activities were inconsistent with her reported limitations. Activities such as puzzling, journaling, and preparing meals generally did not require leaving home, while going to the beach and fishing were consistent with L.S.’s testimony that being around people was a primary limitation. The court also found no explanation that these activities were comparable to full-time workplace activities.

Disposition

The court held that the administrative law judge’s reasons for discounting L.S.’s testimony and rejecting portions of Dr. Jakubowski’s opinion were not supported by substantial evidence. It reversed the Commissioner’s decision and remanded the matter for further administrative proceedings. On remand, the administrative law judge must reconsider L.S.’s testimony and Dr. Jakubowski’s opinions, reassess L.S.’s residual functional capacity, and reconsider her ability to perform past relevant work or other work in the national economy, if applicable.

The court declined to order immediate payment of benefits. It concluded that the record required further assessment of L.S.’s impairments and did not establish that she would necessarily be found disabled if the improperly rejected evidence were credited. The clerk was directed to enter judgment and close the file.