T.R. v. Saul

Background

T.R. sought judicial review of the Commissioner of Social Security’s final decision denying her claim for supplemental security income under Title XVI of the Social Security Act. The Administrative Law Judge found that T.R. had severe impairments involving osteoarthritis of the knees and back, cervical disc disease, and obesity, but found her mental impairments non-severe. The Administrative Law Judge determined that T.R. could not perform her past work but could perform other jobs existing in significant numbers in the national economy.

T.R. alleged limitations from arthritis, a pinched neck nerve, post-traumatic stress disorder, depression, carpal-tunnel syndrome, asthma, anxiety, and obesity. She relied in part on opinions from Kelley Stewart, a treating nurse practitioner, and evidence from mental-health providers. The Administrative Law Judge gave Stewart’s opinions limited or little weight and found that T.R.’s statements about the intensity and effects of her symptoms were not entirely consistent with the record.

Issues and Analysis

T.R. argued that the Administrative Law Judge erred by finding her mental impairments non-severe, rejecting medical opinions, discounting her testimony, finding that she could perform work available in significant numbers, and presiding without proper authority under the Constitution’s Appointments Clause.

Mental impairments. The court held that the Administrative Law Judge improperly found T.R.’s mental impairments non-severe based primarily on Stewart’s treatment notes. The record also included an examining psychologist’s finding that T.R. had mild-to-moderate difficulty interacting with the public, along with evidence of depression and mental-health treatment. Because an impairment may be found non-severe only when the evidence shows no more than a slight abnormality with a minimal effect on the ability to work, the court remanded on this ground.

Medical opinions. The court held that the Administrative Law Judge erred by giving little weight to Stewart’s opinions. Although nurse practitioners generally are not treated as acceptable medical sources for establishing an impairment, they are “other” sources whose opinions may be considered when evaluating the severity of an impairment. The court found that Stewart had treated T.R. nearly monthly, and sometimes twice monthly, for more than three years; had documented knee, back, and mental-health problems; had ordered imaging; had recommended physical therapy; had provided steroid injections; and had prescribed medication. The Administrative Law Judge therefore should have considered Stewart’s opinion rather than discounting it for the reasons given.

T.R.’s testimony. The court held that the Administrative Law Judge did not give specific, clear, and convincing reasons for rejecting T.R.’s testimony about her pain and limitations. The Administrative Law Judge relied on the supposed lack of completed knee physical therapy, the lack of imaging, and T.R.’s trips to Las Vegas and camping. The court found that the record showed knee physical therapy, repeated steroid injections, falls, use of a cane, housing instability, transportation difficulties, and spinal imaging. It also found that T.R. described limited activities during the trips: her sister drove, she walked only briefly, and she spent most of the camping trip sitting near her cabin. The court remanded on this ground as well.

Step-five work finding. At step five of the disability evaluation, the Commissioner must show that a claimant can perform other work existing in significant numbers in the national economy. The court held that the vocational expert’s testimony rested on an assessment of T.R.’s limitations that was affected by the errors identified in the order. Because the hypothetical questions and resulting work finding did not necessarily include all supported physical and mental limitations, the court remanded on this ground too.

Appointments Clause issue. The court did not decide whether the Administrative Law Judge had legal authority under the Appointments Clause because its other rulings required a remand.

Disposition

The opinion’s introduction and analysis describe T.R.’s summary-judgment motion as granted in part. The order denied the Commissioner’s cross-motion for summary judgment and remanded for further proceedings. The conclusion states that the court granted T.R.’s motion for summary judgment, denied the Commissioner’s cross-motion, and remanded the case for further proceedings consistent with the order. The court did not award benefits directly.