Lager v. Bisignano

Background

Scott L. applied for disability insurance benefits (DIB) under Title II of the Social Security Act, alleging disability beginning February 1, 2020. His alleged impairments included Ehlers-Danlos syndrome (EDS, a connective tissue disorder), degenerative disc disease, sleep apnea, hearing loss, chronic pain, chronic fatigue, spinal and hand arthritis, and stroke history.

The Social Security Administration denied his application at the initial and reconsideration stages. An administrative law judge (ALJ) held a hearing on February 6, 2023, at which Scott L. and a vocational expert (VE) testified. The ALJ issued a written decision on March 8, 2023, finding Scott L. not disabled. The Appeals Council denied review, making the ALJ's decision the Commissioner's final decision subject to judicial review under 42 U.S.C. § 405(g).

The ALJ's Five-Step Sequential Analysis

Disability determinations follow a five-step sequential process. The ALJ found: - Step 1: Scott L. had not engaged in substantial gainful activity since the alleged onset date. - Step 2: Severe impairments included lumbar spine degenerative disc disease, EDS, and bilateral hearing loss. Depression, anxiety, chronic pain syndrome (not separately evaluated), hand pain, cervical pain, and other conditions were found non-severe. - Step 3: No impairment or combination of impairments met or equaled a listed impairment in the regulatory appendix. - RFC Assessment (between Steps 3 and 4): The ALJ determined Scott L. could perform light work (as defined at 20 C.F.R. § 404.1567(b)) with additional restrictions on pushing/pulling, overhead reaching, vibration exposure, postural activities, and noise levels. No mental limitations were included. - Step 4: With this RFC, Scott L. could perform his past work as a parts repair worker, product engineer, sales engineer, and technical salesperson. He was therefore found not disabled.

Medical Evidence

Key medical evidence included: - Dr. Matthew Schumann, Ph.D., L.P. (October 2019): Diagnosed chronic pain syndrome and several pain-related conditions following a pain psychology consultation; after three cognitive-behavioral therapy sessions, Scott L. reported well-managed pain and wellbeing. - Dr. Elizabeth Osborne, M.D. (treating provider): Documented progressive physical and mental decline, including emotional and mental fatigue from EDS. In February 2022, she completed an EDS questionnaire opining Scott L. was incapable of low-stress work, could not stand more than 2 hours or sit more than 4 hours in an 8-hour day, and needed frequent unscheduled breaks. In January 2023, she completed physical and mental RFC questionnaires opining constant interference with concentration and attention, inability to sit or stand more than 2 hours respectively, and marked limitations in interacting with others, concentrating/persisting, and managing himself. - Chiropractic and pain management records: Documented substantial improvement — including reports of 100% pain relief after medial branch blocks and 60% improvement after steroid injections — as well as Scott L.'s self-reported ability to walk, bicycle, and exercise regularly. - Imaging: Showed degenerative changes in the cervical, thoracic, and lumbar spine, including significant scoliosis and moderate/severe degenerative disc disease, but also findings characterized as mild or benign in the cervical and thoracic spine.

Issues on Judicial Review

Issue 1: Non-Severity of Mental Impairments

Scott L. argued the ALJ erred at step two in finding his depression and anxiety non-severe. The ALJ applied the required "paragraph B" criteria — rating four mental functioning areas (understanding/remembering/applying information; interacting with others; concentrating/persisting/maintaining pace; adapting/managing oneself) — and found only mild limitations in all four, making the mental impairments non-severe.

The court found substantial evidence supported this conclusion. The ALJ pointed to: routine, conservative, and sporadic mental health treatment; rapid and significant improvement with medication; treatment notes reflecting normal attention and concentration, euthymic mood, and only mild depressive symptoms; the absence of mental health records or findings from any provider other than Dr. Osborne; and daily activities and socialization that were generally intact.

The court addressed each of Scott L.'s counterarguments. A treatment note citing concentration difficulties actually documented that those difficulties "ha[d] resolved." A note documenting high anxiety also documented decreased pain and normal attention. His report of being "short fused" was not shown to have had more than a minimal impact on work activities or to have met the required 12-month duration. Dr. Osborne's mental RFC opinion was found not persuasive by the ALJ, and Scott L. did not challenge the ALJ's compliance with the regulatory framework governing how ALJs must evaluate medical opinions (20 C.F.R. § 404.1520c).

Issue 2: Chronic Pain Syndrome at Step Two

Scott L. argued the ALJ erred by not expressly evaluating whether chronic pain syndrome was a severe impairment. The Commissioner disputed that a valid diagnosis existed and argued any error was harmless.

The court found that chronic pain syndrome was, in fact, diagnosed — by Dr. Schumann in October 2019, by Dr. Barksdale in December 2019, and in at least two records postdating the alleged onset date. However, the court held the ALJ did not err by failing to specifically address it, because under Eighth Circuit precedent, failure to list a specific impairment at step two is not error unless the impairment is "separate and apart" from the listed impairments. Here, the ALJ had considered all relevant sources of pain — including pain potentially separate from EDS and degenerative disc disease, such as hand, cervical, and thoracic pain — and found none of those caused significant work limitations. Scott L. did not identify any pain the ALJ had overlooked.

Furthermore, the court held that even if there was error, it was harmless. An ALJ's failure to consider an impairment at step two is harmless when the ALJ considers the effects of that impairment in the later RFC assessment. The court found the ALJ had thoroughly evaluated Scott L.'s chronic pain at the RFC stage, citing numerous medical records, noting benign physical findings, crediting significant improvement with treatment, and addressing the inconsistency between Scott L.'s testimony and the objective record.

Issue 3: RFC Assessment

Scott L. argued the RFC should have included limitations related to mental impairments and chronic pain syndrome. The court rejected both arguments.

On pain: The court incorporated its analysis from Issue 2 and found substantial evidence supported the ALJ's pain-related RFC limitations.

On mental limitations: Scott L. identified no specific mental limitation the ALJ should have included beyond Dr. Osborne's opinion, which the ALJ properly found unpersuasive because it was unsupported by her own treatment notes, clinical findings, and conservative treatment course, and inconsistent with other providers' records. The court also found the hypothetical question posed to the VE was proper because it included all limitations the ALJ found supported by substantial evidence.

Standard of Review

The court reviewed the Commissioner's decision under the substantial evidence standard: evidence that "a reasonable mind would find adequate to support the Commissioner's conclusion," even if the court might have decided the case differently. The court may not reverse simply because other substantial evidence could support a different outcome.

Disposition

The court denied the relief requested in Scott L.'s memorandum, granted the relief requested in the Commissioner's brief, and affirmed the Commissioner's final decision.