Heather L. v. Berryhill

Background

Heather L. sought Social Security Disability Insurance benefits for a closed period beginning May 31, 2013. She initially requested benefits through April 21, 2017, the day before she began part-time work at Jameson Ranch that paid above the substantial-gainful-activity level. The administrative law judge found that she was not disabled through December 31, 2016, and the Appeals Council later found that she was not disabled through January 24, 2018. The Appeals Council also corrected the date last insured to at least September 30, 2018.

Heather L. had a history of back pain, spinal surgeries, degenerative disc disease, osteoarthritis, obesity, depression, and anxiety. In December 2015, she received an implanted pain pump. Her treating physician, Dr. Jacqueline Weisbein, and treating nurse Kimberly Schwartz submitted opinions describing serious limits on sitting, standing, walking, lifting, and maintaining a full-time work schedule. State agency medical consultants Drs. L. Pancho and J. Allen gave less restrictive opinions.

Administrative Decision and Parties’ Arguments

The administrative law judge found that Heather L. had severe obesity, degenerative disc disease, and osteoarthritis, but that her mental impairments were not severe. The judge found that she could perform the full range of sedentary work, could not perform her past work, and could perform other jobs existing in significant numbers in the national economy. The judge gave little weight to the opinions of Dr. Weisbein and FNP Schwartz and found that Heather L.’s statements about the severity of her symptoms were inconsistent with the medical and other evidence.

Heather L. argued that the administrative law judge improperly discounted the treating providers’ opinions and her symptom testimony. The Commissioner argued that the judge properly evaluated the medical opinions and gave valid reasons for rejecting the testimony.

Court’s Analysis

The court held that the administrative law judge did not provide the required specific and legitimate reasons for rejecting Dr. Weisbein’s opinions. Calling those opinions “too extreme” was conclusory. The judge also relied on a few treatment notes stating that Heather L.’s pain had improved after the pump was placed and that she had returned to the gym. The court found that those notes did not adequately address Dr. Weisbein’s opinions, particularly because some opinions predated the pump placement and because the judge did not investigate what Heather L. did at the gym or for how long. The judge also failed to apply the regulatory factors for weighing a treating provider’s opinion, including the length and nature of the treatment relationship, supportability, consistency, and specialization.

The court also found that the administrative law judge improperly rejected Heather L.’s symptom testimony. The judge listed household activities, an internship, volunteer work, gym visits, and improved pain control, but did not adequately explain how those activities conflicted with the claimed limitations. The court noted that Heather L. reported taking six to seven hours over two days to do laundry, needing help with household tasks, and spending much of the day lying down before the pump placement. The judge also improperly used later improvement after the pump placement to reject testimony concerning the entire disability period.

The court held that the administrative law judge likewise failed to give adequate reasons for discounting FNP Schwartz’s opinion. The judge’s statement that the opinion was “too extreme” was conclusory. The judge also compared the May 2015 opinion with activities and treatment occurring after the December 2015 pump placement, and incorrectly described Heather L. as having completed an internship. The court found that the use of a check-box form, without more, was not a sufficient reason to reject the opinion when the underlying treatment records were available.

Remedy and Disposition

The court applied the rule that allows a court to credit improperly rejected evidence as true and order benefits when the administrative judge gave legally insufficient reasons, no material issues remain, and the record leaves no doubt about disability. The court found those conditions satisfied for May 31, 2013, through December 3, 2015. During that period, the medical record showed severe symptoms and functional limitations, and the vocational expert testified that a person with the limitations identified by Dr. Weisbein would have no available full-time jobs.

The court found that the record did not establish the exact date on which disability ended after the pump placement. Evidence suggested substantial improvement, but the record did not adequately describe Heather L.’s limitations between January 2016 and April 2017. The vocational expert also had not addressed whether a person absent from work about one day per month could work. The court therefore ordered further administrative proceedings to determine when, between December 4, 2015, and April 21, 2017, Heather L.’s disability ended.

The court reversed the Commissioner’s decision and remanded the matter for (1) immediate calculation and payment of benefits from May 31, 2013, through December 3, 2015, and (2) further administrative proceedings to determine when the disability ended between December 4, 2015, and April 21, 2017.