Deisenroth v. Berryhill

Background

Scott D. Deisenroth applied for Social Security Disability Insurance benefits under Title II of the Social Security Act. He alleged disability based primarily on obstructive sleep apnea, chronic fatigue, depression, and heart issues. His application was denied initially and on reconsideration. After a hearing, Administrative Law Judge Betty R. Barbeito issued an unfavorable decision.

The administrative law judge found that Deisenroth had severe obstructive sleep apnea, obesity, and depression, but concluded that these impairments did not meet the regulatory requirements for disability. She determined that Deisenroth could perform medium work, including lifting 50 pounds occasionally and 20 pounds frequently, and found that he could work as a linen room attendant, industrial cleaner, or kitchen helper.

Deisenroth’s treating sleep specialist, Dr. Alex A. Clerk, had treated him for many years and was board-certified in sleep medicine and psychiatry and neurology. Dr. Clerk documented continuing daytime sleepiness, poor sleep quality, depression, and limitations involving concentration, interaction with coworkers and the public, deadlines, pace, and workplace hazards. Therapist Kit Chatsinchai also described depression, fatigue, sleep problems, and restrictions on public contact, close workplace interactions, and fast-paced work. Deisenroth testified that fatigue, forgetfulness, and difficulty recovering from exertion and stress affected his ability to work. His wife described limitations in daily activities, physical tasks, concentration, memory, and social interaction.

Parties’ Arguments

Deisenroth argued that the administrative law judge improperly rejected the opinions of Dr. Clerk and Chatsinchai, improperly discounted his testimony and his wife’s report, and relied on an incomplete hypothetical question to the vocational expert at the final step of the disability analysis.

The Commissioner argued that the administrative law judge’s decision was supported by substantial evidence, including opinions from examining doctors, state agency consultants, and medical experts. The Commissioner also argued that the administrative law judge properly evaluated the medical and nonmedical evidence.

Court’s Analysis

The court reviews a Social Security decision to determine whether it is supported by substantial evidence and is free of legal error. Substantial evidence means relevant evidence that a reasonable person could accept as adequate to support a conclusion.

The court held that the administrative law judge failed to provide legally sufficient reasons for discounting Dr. Clerk’s opinions. The administrative law judge incorrectly treated Dr. Clerk as not being a psychiatrist, even though the record showed that he was board-certified in psychiatry and neurology and had repeatedly diagnosed and treated Deisenroth’s depression. The court also found that the administrative law judge focused on evidence that the sleep apnea was controlled with continuous positive airway pressure treatment while overlooking evidence of continuing daytime hypersomnolence, daily naps, poor sleep quality, repeated waking, and fatigue.

The court rejected the asserted support from one-time examinations and non-examining opinions. Those sources did not adequately address the residual effects of Deisenroth’s long-term sleep condition, and Dr. Bell, the medical expert, had not examined or treated Deisenroth. The court also stated that the administrative law judge could not rely on reasons offered only by the Commissioner rather than by the administrative law judge herself.

The court further held that the administrative law judge improperly evaluated Chatsinchai’s opinions. Although a therapist was not an “acceptable medical source” for establishing a medically determinable impairment under the applicable regulation, the therapist was an “other source” whose evidence could be used to show the severity of an impairment and its effects on functioning. The administrative law judge therefore needed specific, germane reasons—meaning reasons that directly related to the evidence—for discounting Chatsinchai’s opinions. Merely identifying him as an unacceptable medical source and stating that his opinions were inconsistent with other opinions did not satisfy that requirement.

The court also found that the administrative law judge did not provide sufficiently specific, clear, and convincing reasons for discounting Deisenroth’s testimony. The administrative law judge generally stated that his statements were inconsistent with the record but did not identify the specific evidence that undermined particular parts of his testimony. The court concluded that she also focused on selected evidence that Deisenroth’s sleep apnea was controlled while failing to address evidence that fatigue and sleep problems continued or worsened.

Step-Five Analysis and Remedy

At the final step of the disability analysis, the administrative law judge must determine whether a claimant can perform work existing in significant numbers in the national economy. The court held that the hypothetical question given to the vocational expert was inaccurate because it did not include all of the limitations supported by Dr. Clerk’s and Chatsinchai’s opinions and Deisenroth’s testimony.

The court applied the Ninth Circuit’s “credit-as-true” standard, which allows a court to order benefits rather than send the case back for more proceedings when three conditions are met: the record is fully developed, the administrative law judge gave legally insufficient reasons for rejecting evidence, and crediting that evidence would require a finding of disability.

The court found all three conditions satisfied. The medical and therapy records and Deisenroth’s testimony fully developed the record; the administrative law judge had not given legally sufficient reasons for rejecting the evidence; and the vocational expert testified that a person who was off task for about 20 percent of the workday could not perform any work. The court found no reason to doubt that Deisenroth was disabled under that evidence.

Disposition

The court granted Deisenroth’s motion for summary judgment, denied the Commissioner’s cross-motion for summary judgment, and remanded the case for calculation and award of benefits.