T.G. v. O'Malley

Background

T.G. sought judicial review under 42 U.S.C. § 405(g) of the Social Security Administration Commissioner’s denial of her applications for disability benefits. The opinion describes physical conditions including osteoarthritis, sciatica, back pain, knee pain, hip pain, ulcers, abdominal pain, and anemia, as well as a history of severe trauma and psychiatric hospitalizations.

An administrative law judge (ALJ) previously issued an unfavorable decision. After an earlier federal-court complaint, the Appeals Council vacated that decision and sent the case back to the ALJ for further proceedings. Following additional hearings, the ALJ again denied benefits, finding that T.G. was disabled but that a substance-use disorder was a contributing factor material to the disability determination.

Court’s Analysis

The court held that the ALJ did not give sufficiently specific reasons for rejecting T.G.’s testimony about the severity and effects of her symptoms. The ALJ relied on general statements about inconsistency with the medical evidence and on T.G.’s ability to maintain employment. The court found that this reasoning did not adequately account for her testimony that she performed poorly at work, received write-ups, sometimes had to lie down during the workday, sometimes had to leave work, and needed additional help to complete tasks.

The court also found error in the ALJ’s treatment of missed consultative examinations. The ALJ treated the missed examinations as a reason to find T.G.’s statements unreliable, but did not consider T.G.’s stated reasons, including a canceled appointment, objections concerning the governing regulations, the burden of the examinations, and concerns about COVID-19 exposure. The court concluded that the ALJ failed to provide legally sufficient reasons for rejecting T.G.’s testimony and that the error was harmful because the testimony would support a disability finding if credited.

The court found that the ALJ applied the wrong regulatory framework to some medical opinions. Because T.G.’s claims were filed before March 27, 2017, the court stated that the earlier rules governing treating-provider opinions applied. The court also found errors in the ALJ’s evaluation of opinions from treating providers Dr. Crichlow, Nurse Practitioner Wale Adeniji, and Dr. Kirsch, as well as in the ALJ’s treatment of non-examining state-agency consultants. In particular, the court found that the ALJ did not adequately account for T.G.’s uneven work performance when evaluating the providers’ opinions.

The court further held that the ALJ erred by finding that T.G.’s rheumatoid arthritis was not severe. The record included a report of extreme pain and a specialist’s observations of swelling and pain. The court stated that the ALJ had applied too demanding a standard at the step-two severity determination.

The court also found that the ALJ’s conclusion that substance use was material to the disability determination ignored evidence from T.G.’s treating providers that her mental-health symptoms had not improved with sobriety and would likely continue. Finally, the court found that the ALJ summarily rejected the mental-disorder criteria and failed to base T.G.’s residual functional capacity—the work she could perform despite her limitations—on substantial evidence.

Disposition

The court concluded that the record was fully developed, that the ALJ had committed multiple errors, and that legally sufficient reasons had not been given for rejecting treating providers’ opinions that would require a disability finding if credited. Because T.G. had first applied for benefits more than eight years earlier and the ALJ had already denied her claim twice, the court determined that further delay would be unduly burdensome.

The court granted T.G.’s motion for reversal and remand. It remanded the case to the ALJ for the immediate calculation and payment of benefits.