Kimberley S. v. Commissioner of Social Security

Background

Kimberley S. applied for Disability Insurance Benefits and Supplemental Security Income under Titles II and XVI of the Social Security Act. She alleged that she became unable to work on June 5, 2015, because of mental impairments including post-traumatic stress disorder, anxiety, and depression. The applications were denied, and Administrative Law Judge David LaBarre later denied them after a hearing. The Appeals Council declined review, making the Administrative Law Judge’s decision the Commissioner’s final decision.

The Administrative Law Judge found that Kimberley S. had severe post-traumatic stress, anxiety, and depressive disorders, but concluded that she could perform work at all physical exertion levels subject to certain nonphysical restrictions. Based on that finding, the Administrative Law Judge determined that she could perform her past relevant work as a mail clerk and was not disabled.

Medical opinions

Treating psychiatrists Dr. Streett and Dr. Fullar diagnosed chronic and severe post-traumatic stress disorder and major depressive disorder. They opined that Kimberley S.’s symptoms prevented her from working. The Administrative Law Judge gave Dr. Streett’s opinions little weight and gave only some weight to Dr. Fullar’s descriptions of symptoms, while giving little weight to Dr. Fullar’s conclusions about work limitations.

The court held that the Administrative Law Judge did not provide the specific and legitimate reasons supported by substantial evidence that were required to reject the treating psychiatrists’ opinions. The Administrative Law Judge characterized Kimberley S.’s treatment as sporadic, but the record showed that insurance problems and unaffordable co-payments limited her access to treatment and medication. The record also showed that treatment ended on at least two occasions because therapists retired or stopped treating her for reasons unrelated to her willingness to continue.

The court also held that the Administrative Law Judge improperly rejected the doctors’ opinions because they addressed whether Kimberley S. could work. Although the Commissioner makes the ultimate disability determination, the Administrative Law Judge could not reject treating physicians’ opinions on that basis alone. The Administrative Law Judge also failed to apply the regulatory factors for evaluating treating-source opinions, including the length and nature of the treatment relationship, supportability, consistency, and the physicians’ specialization.

Symptom testimony

The court separately reviewed the Administrative Law Judge’s decision to discount Kimberley S.’s testimony about the intensity and limiting effects of her symptoms. Because the Administrative Law Judge found an underlying impairment capable of causing the alleged symptoms and identified no evidence of malingering, the Administrative Law Judge needed specific, clear, and convincing reasons supported by substantial evidence to reject the testimony.

The court found that the Administrative Law Judge’s reasons did not meet that standard. Treatment difficulties were not a valid reason in this record because they were substantially explained by the inability to afford care. The court also found that the cited records did not support the conclusion that Kimberley S.’s conditions caused less dysfunction than she reported. Some cited records lacked mental-status findings, while others documented depression, worsening symptoms, hopelessness, decreased concentration, and other serious mental-health problems. The court further found that the Administrative Law Judge wrongly treated the mental-health providers’ opinions as based only on subjective reports, even though the providers relied on treatment histories, clinical interviews, observations, testing, and reviewed records.

Remedy and disposition

The court applied the rule allowing improperly rejected testimony or medical opinions to be treated as true when the legal errors are established, no important issues remain unresolved, and the record leaves no serious doubt about disability. The court found all of those conditions satisfied. It concluded that the record did not need further development and that additional administrative proceedings would not be useful.

The court relied in part on vocational-expert testimony that a person with marked limitations in concentration, persistence, or pace, who was off task at least 15 percent of the time, or who was consistently absent more than once a month, could not maintain employment. After crediting the improperly rejected evidence as true, the court concluded that Kimberley S. was disabled.

The court GRANTED plaintiff’s motion for summary judgment, DENIED defendant’s cross-motion for summary judgment, and REMANDED the case under sentence four of 42 U.S.C. § 405(g) for immediate payment of benefits.