Cain v. Berryhill

Background

Arthur Lee Cain applied for Supplemental Security Income, alleging that he was disabled. An Administrative Law Judge found severe impairments including antisocial personality disorder, substance-induced psychotic disorder, depressive disorder, adjustment disorder, and methamphetamine dependence. The judge determined that Cain’s impairments met certain regulatory listings when substance use was included, but that Cain would not be disabled if he stopped using drugs and alcohol. In that circumstance, the judge found that Cain could perform work at all exertion levels, limited to simple work with limited contact with the public and no teamwork. The judge identified cleaner, harvest-worker, and laundry-worker jobs as available in significant numbers.

Cain sought judicial review and moved for summary judgment, asking the court to reverse the Commissioner’s final decision. The Commissioner moved for summary judgment affirming the decision.

Medical-opinion evidence

Cain argued that the Administrative Law Judge improperly discounted the opinions associated with Dionne Childs and Dr. Lesleigh Franklin and Dr. Bob Kennedy, while giving too much weight to the testimony of non-examining medical expert Dr. Marian Martin.

The court held that the Administrative Law Judge gave specific and legitimate reasons, supported by substantial evidence, for discounting the Childs/Franklin assessment. The judge relied on inconsistencies between Cain’s newly reported symptoms and earlier medical records, questions about the testing results, Cain’s prior statements and conduct, and the lack of evidence that the reported limitations would continue for at least 12 months if Cain abstained from drugs and alcohol and received treatment and support.

The court also upheld the decision to give Dr. Kennedy’s opinions very little weight. The opinions were contained in check-off forms without a narrative explanation, did not adequately address the effects of substance use, and appeared to have been based on an incomplete understanding of Cain’s ongoing drug and alcohol use.

The court upheld the greatest weight given to Dr. Martin’s opinion. Medical records showed that Cain often had serious psychiatric symptoms during periods associated with substance use, while examinations during periods of incarceration or abstinence often showed improved functioning. Although one reason the Administrative Law Judge gave for crediting Dr. Martin—that she had reviewed the entire record—was technically incorrect because additional evidence was submitted later, the court found that the error did not undermine the decision.

Credibility assessment

Cain also challenged the Administrative Law Judge’s assessment of his statements about his symptoms and functioning. The court found that the judge identified sufficiently specific reasons for finding those statements only partly consistent with the evidence. Those reasons included Cain’s incomplete account of his work history, inconsistencies about his drug and alcohol use, reports of symptoms that were not documented elsewhere, and medical records suggesting that he sometimes exaggerated or feigned symptoms to obtain food or shelter.

Substance-use analysis

Under the Social Security Act and related regulations, a claimant cannot be found disabled if drug addiction or alcoholism would be a contributing factor material to the disability determination. The required question is whether the claimant would still be disabled if he stopped using drugs or alcohol. The claimant bears the burden of showing that he would remain disabled without substance use.

The court held that the Administrative Law Judge did not rely only on Dr. Martin’s medical expertise. The judge also considered Cain’s medical records, testimony, and evaluations by other providers. The record showed that Cain’s psychotic symptoms often improved within one or two days or after detoxification. The court rejected Cain’s argument that improvement during incarceration could be attributed only to medication or the structure of institutional living. The court acknowledged that reasonable people could disagree about the reason for the improvement, but concluded that the Administrative Law Judge’s materiality finding was supported by substantial evidence and was free of legal error.

Disposition

The court granted the Commissioner’s motion for summary judgment and denied Cain’s motion for summary judgment. The opinion did not order a remand.