Ortega v. Commissioner of Social Security

Background

Jennifer Noami Ortega asked the court to review an administrative law judge’s decision denying her application for supplemental security income under Title XVI of the Social Security Act. Ortega had initially received a favorable disability decision in September 2016, but the Appeals Council vacated that decision and sent the matter back for additional evaluation of medical evidence concerning her seizure disorder and medication compliance.

After a supplemental hearing, the administrative law judge again denied benefits on March 9, 2018. The administrative law judge found that Ortega had not engaged in substantial gainful activity, had a partial and grand mal seizure disorder, borderline intellectual functioning, and a learning disorder, and could perform a full range of work with limits to simple and routine tasks, simple work-related decisions, and occasional interaction with coworkers and the public. The administrative law judge found that Ortega had no past relevant work but could perform jobs such as housekeeping cleaner and marker.

The Parties’ Arguments

Ortega argued that the administrative law judge failed to give specific, clear, and convincing reasons for rejecting her testimony about the intensity, persistence, and limiting effects of her seizures. She argued that the administrative law judge did not identify which testimony was being rejected or what evidence contradicted it. She also argued that medication noncompliance did not adequately explain her symptoms because the record showed seizures despite therapeutic medication levels, and because the medical evidence did not establish that compliance would enable her to work.

The Commissioner argued that the administrative law judge properly considered medication noncompliance, inconsistencies in Ortega’s statements, medical opinions, and evidence suggesting that her seizures improved with medication.

Court’s Analysis

The court held that the administrative law judge’s stated reason for rejecting Ortega’s testimony was not specific, clear, or convincing. The administrative law judge said that Ortega’s symptoms were not entirely consistent with the record, then summarized the medical evidence without clearly identifying the testimony being rejected or the evidence contradicting it.

The court also found that the record contained medical evidence of seizures despite medication compliance. The record included therapeutic medication levels in December 2013, January 2014, and May 2014, as well as a treating neurologist’s note that Ortega continued to have seizures once or twice a week despite compliance. The court therefore concluded that the record did not clearly establish that medication compliance would eliminate Ortega’s seizures or restore her ability to work.

The court further found that the administrative law judge did not adequately investigate why Ortega did not consistently take her medication. Ortega had testified that she relied on her mother and sister for reminders, that they sometimes forgot or became busy, and that some previously prescribed medication increased her seizures. The administrative law judge did not ask further questions about these circumstances, despite also finding that Ortega had borderline intellectual functioning and a learning disorder.

The court additionally discussed the administrative law judge’s reliance on a note describing Ortega as an inaccurate historian. The court found it inconsistent to discount Ortega’s account as unreliable while relying heavily on another part of her account to support the conclusion that medication improved her condition. A medical expert had also testified that the evidence was insufficient to determine whether Ortega’s seizure frequency resulted from medication noncompliance or whether her condition met or equaled a listed impairment.

Disposition

Judge Robert M. Illman granted Ortega’s motion for summary judgment and denied the Commissioner’s motion for summary judgment. The court remanded the case for further proceedings, including further development of the record about whether medication compliance was likely to resolve Ortega’s seizures and why she struggled with medication compliance. The opinion ordered a remand rather than awarding benefits itself.