Wright v. Bisignano

Background

Plaintiff Ashley D. W. applied for Supplemental Security Income (SSI) — a federal program providing benefits to financially needy individuals who are disabled — on March 20, 2020, alleging disability onset on December 31, 2015. Her alleged impairments included bipolar disorder, PTSD, and ADHD. The relevant period for SSI eligibility ran from the application date, March 20, 2020, through the ALJ's decision date, August 3, 2022.

Two treating providers submitted opinions during the administrative process. Steven F. Taylor, M.A., Plaintiff's therapist, assessed her mental residual functional capacity (RFC) — meaning the most she could still do despite her limitations — in March and August 2021, rating numerous mental functioning abilities as markedly or moderately limited, and opining that her impairments would substantially interfere with her ability to work at least 20% of the time. Larry Elj, APRN, treated Plaintiff from March through at least July 2022 and wrote a letter opining that her extreme anxiety and panic impaired her concentration, caused irritability, and adversely affected her social relationships and daily functioning.

In April 2024 — approximately 20 months after the ALJ's decision — a provider informed Plaintiff that imaging and laboratory results were "supportive of multiple sclerosis diagnosis." In July 2024, a neurologist's diagnostic impression was "Demyelinating disorder most consistent with primary progressive multiple sclerosis" (PPMS). The neurologist noted Plaintiff had reported noticing hand-shaking difficulties with make-up application and dexterity problems about four years prior. Plaintiff also submitted a letter to the court stating she experienced shakiness and weakness three years before the diagnosis.

Procedural History

After her SSI application was denied at the initial and reconsideration stages, Plaintiff received an administrative hearing on July 27, 2022. The ALJ issued a decision on August 3, 2022, denying benefits. The ALJ applied the standard five-step sequential analysis for disability determinations.

At step three, the ALJ found that with Plaintiff's substance abuse included, the severity of her impairments met Listing § 12.06 (anxiety and obsessive-compulsive disorders), establishing she was disabled. However, the ALJ next found that if Plaintiff ceased substance use, her impairments would not meet or equal a listed impairment — they would produce only moderate (rather than marked) limitations in all four areas of mental functioning. The ALJ assessed Plaintiff's RFC as permitting a full range of work at all exertional levels, with significant non-exertional restrictions (for example, simple tasks only, no production-rate pace, no face-to-face public interaction, only occasional co-worker and supervisor interaction). At step five, the ALJ found Plaintiff could work as a Laundry Worker I, Electronics Worker, or Addresser. Because Plaintiff's substance use was a contributing factor material to her disability — meaning she would not be disabled absent substance use — she was not entitled to benefits. The Appeals Council denied review, making the ALJ's decision the Commissioner's final decision.

Plaintiff then filed this action under 42 U.S.C. § 405(g), seeking judicial review.

Legal Standards

Judicial review of the Commissioner's denial of benefits is limited. The court asks only whether substantial evidence on the record as a whole supports the decision — defined as less than a preponderance but enough that a reasonable mind would find it adequate to support the conclusion — or whether the ALJ committed a legal error. The court may not reverse simply because substantial evidence would support a different outcome.

For evaluating medical opinions, 20 C.F.R. § 416.920c requires ALJs to assess five factors — supportability, consistency, relationship with the claimant, specialization, and other relevant factors — with supportability and consistency being the most important. An ALJ must explain how those two factors were considered for each medical opinion; failure to do so is a legal error requiring remand.

When evidence of drug addiction or alcoholism exists, the ALJ must first determine disability, then assess whether the substance use is a "contributing factor material to the disability determination." The claimant bears the burden of proving she would still be disabled without the substance use.

Analysis

Medical Opinions of Taylor and Elj

The court found the ALJ adequately considered both the supportability and consistency factors for each opinion.

Regarding Taylor, the ALJ explained that his treatment notes from March 2020 and August 2021 documented largely normal findings — cooperative behavior, coherent thought, appropriate affect, intact memory and judgment — that did not support the marked limitations he opined. The ALJ also noted Taylor used checkbox forms without objective findings, relying instead on Plaintiff's self-reports. On consistency, the ALJ found Taylor's opinion inconsistent with Plaintiff's self-reported daily activities (preparing meals, shopping, household chores, caring for children) and mental status examinations from other providers. The court found this analysis supported by substantial evidence.

Regarding Elj, the ALJ explained his recommended limitations were not supported by his own treatment records showing cooperative behavior, appropriate affect, and intact thought processes. The ALJ also found the opinion not consistent with records from periods when Plaintiff was sober and demonstrated greater capabilities, and noted Elj failed to account for Plaintiff's methamphetamine relapse and discontinuation of psychotropic medications in May 2022. The brief treatment relationship was also properly noted as a relevant factor. The court upheld this analysis as well.

2024 PPMS Diagnosis

The court held that a court reviewing a Social Security decision generally may not consider evidence outside the administrative record. A remand for new evidence is permitted only if the evidence is material — meaning non-cumulative, relevant, and probative of the claimant's condition during the period for which benefits were denied.

The PPMS diagnosis was made in April 2024, approximately 20 months after the relevant period closed on August 3, 2022. The court considered whether pre-diagnosis symptoms might relate back to the relevant period, given Plaintiff's statements about noticing shaky hands approximately four years before diagnosis and shakiness/weakness approximately three years before diagnosis. The court found Plaintiff had not identified any record evidence documenting such symptoms before August 3, 2022. To the contrary, records from October 2021 showed normal muscle strength and tone; records from June 2022 showed Plaintiff denied shakiness and a physician review showed no weakness. The court therefore found the new evidence not probative of Plaintiff's condition during the relevant period and not reasonably likely to have changed the ALJ's decision. The court noted, without deciding any future claim, that the PPMS diagnosis could potentially support a new SSI application.

Substance Use Analysis

Plaintiff argued that because mental illness can cause people to self-medicate with substances, the ALJ's substance-use analysis was flawed. The court rejected this argument. The ALJ followed the required regulatory sequence: first determining Plaintiff was disabled (with substance use included), then determining whether she would still be disabled without substance use. The ALJ found she would not be — her remaining limitations would produce only moderate restrictions and an RFC sufficient to meet work requirements. The ALJ supported that determination with specific objective medical evidence and Plaintiff's own reports to providers. The court found this analysis legally correct and supported by substantial evidence.

Disposition

The court denied the relief requested in Plaintiff's brief, granted the relief requested in the Commissioner's brief, and affirmed the Commissioner's final decision. Judgment was ordered entered accordingly.