Wright v. Bisignano

Background

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

After denials at the initial and reconsideration stages, an ALJ held a hearing and issued a written decision on August 3, 2022. The ALJ applied the standard five-step sequential evaluation used in Social Security disability cases. At step three, the ALJ found that when Plaintiff used methamphetamines, her impairments met Listing § 12.06 (anxiety and obsessive-compulsive disorders), meaning she was disabled. However, under the regulatory framework governing drug and alcohol use (20 C.F.R. § 416.935), the ALJ then determined that if Plaintiff stopped substance use, she would retain only moderate — not marked — limitations across all four areas of mental functioning, and would be capable of performing jobs such as Laundry Worker I, Electronics Worker, or Addresser. Because substance use was a contributing factor material to the disability finding, the ALJ concluded Plaintiff was not entitled to benefits.

Two treating sources offered opinions. Therapist Steven F. Taylor, M.A., assessed Plaintiff's mental residual functional capacity (RFC — the most a person can do despite their limitations) in March and August 2021, rating numerous abilities as markedly or moderately limited and opining that her impairments would substantially interfere with work at least 20% of the time. Nurse practitioner Larry Elj, APRN, treated Plaintiff from March through July 2022 and wrote a letter opining that her extreme anxiety and panic severely impaired her concentration, caused irritability, and adversely affected social functioning. The ALJ rated both opinions only minimally persuasive.

In April and July 2024 — approximately 20 months after the ALJ's decision — Plaintiff received a diagnosis of Primary Progressive Multiple Sclerosis (PPMS), a neurological condition. She submitted this evidence to the district court and argued it warranted reversal.

The Appeals Council denied review, making the ALJ's decision the final decision of the Commissioner. Plaintiff then filed this action for judicial review under 42 U.S.C. § 405(g).

Legal Standards

Judicial review of Social Security disability denials is narrow. The court may reverse only if the ALJ's decision lacks substantial evidence — meaning less than a preponderance but enough that a reasonable mind would find it adequate to support the conclusion — or if the decision reflects a legal error. The court must consider evidence both supporting and detracting from the ALJ's decision but may not reverse merely because substantial evidence would support a different outcome.

Analysis

Medical Opinion Evidence (Mr. Taylor and Mr. Elj)

Under 20 C.F.R. § 416.920c, an ALJ must evaluate medical opinions based on five factors, with supportability (how well the opinion is backed by the source's own objective findings) and consistency (how well it aligns with evidence from other sources) being the most important. The ALJ must explicitly explain consideration of both factors.

The court found the ALJ adequately addressed both factors for each opinion.

For Mr. Taylor: On supportability, the ALJ noted that Taylor's own treatment notes documented cooperative behavior, coherent thought, appropriate affect, neutral mood, and intact memory — findings inconsistent with the marked limitations he recommended. The ALJ also noted Taylor used checkbox forms relying on Plaintiff's self-reports rather than objective clinical findings. On consistency, the ALJ found Taylor's opinion inconsistent with Plaintiff's self-reported daily activities (preparing meals, shopping, caring for children, using public transportation) and with mental status examinations from other providers showing generally intact functioning during sober periods.

For Mr. Elj: On supportability, the ALJ found Elj's own treatment notes described cooperative behavior, appropriate affect, and intact thought processes — again inconsistent with the severe limitations he opined. On consistency, the ALJ found the opinion failed to account for Plaintiff's methamphetamine relapse and discontinuation of psychotropic medications in May 2022, which the record showed materially worsened her functioning. The ALJ also properly considered the brevity of the treatment relationship as a permissible factor under 20 C.F.R. § 416.920c(c)(3)(i).

The court concluded the ALJ's treatment of both opinions was legally adequate and supported by substantial evidence.

PPMS Diagnosis

The court may not consider evidence outside the administrative record in reviewing an SSI denial. A remand to consider new evidence is permitted only if the evidence is material — meaning non-cumulative, relevant, and probative of the claimant's condition during the time period for which benefits were denied.

The court found the 2024 PPMS evidence did not meet this standard. The diagnosis came approximately 20 months after the relevant period ended. Although Plaintiff reported to her diagnosing neurologist that she had noticed hand shakiness about four years before the diagnosis, and stated in a letter to the court that she experienced shakiness and weakness three years before diagnosis, the court found no corroborating evidence in the administrative record. To the contrary, records from October 2021 showed normal muscle strength and tone, and records from June 2022 showed Plaintiff denied shakiness with no documented weakness. The court therefore found no reasonable likelihood the new evidence would have changed the ALJ's decision. The court noted, without expressing a view on the merits, that a new SSI application based on the PPMS diagnosis would be the appropriate vehicle for Plaintiff to seek benefits for a different time period.

Substance Use Analysis

Under 20 C.F.R. § 416.935, when the record contains evidence of drug addiction or alcoholism, the ALJ must first determine whether the claimant is disabled, then assess whether substance use is a contributing factor material to that determination. The key question is whether the claimant would still be disabled absent the substance use. The claimant bears the burden of showing she would remain disabled if sober.

Plaintiff argued that mental impairments can drive substance use as self-medication, suggesting the ALJ should not have used substance use as a reason to deny benefits. The court did not adopt this argument. It found the ALJ followed the required regulatory framework: first finding disability (because substance use produced marked limitations meeting Listing § 12.06), then determining that without substance use, only moderate limitations remained that would not meet a listed impairment and would permit work. The ALJ supported this second determination with specific references to objective medical evidence and treatment records, all of which the court found constituted substantial evidence.

Disposition

The court denied the relief Plaintiff requested, granted the relief the Commissioner requested, and affirmed the Commissioner's final decision in full.