Lauren E. M. v. Saul

Background

Lauren E. M. sought disability insurance benefits under Title II of the Social Security Act. She alleged disability beginning March 1, 2011, based on mental impairments including adjustment disorder with depressed mood and post-traumatic stress disorder. The Administrative Law Judge, Michael A. Cabotaje, limited the relevant period to December 28, 2012, through March 31, 2016, because of an earlier benefits application.

The Administrative Law Judge found that Lauren E. M. had severe adjustment disorder and post-traumatic stress disorder. He determined that these impairments did not meet or equal a listed impairment and found that she retained the capacity to perform work at all physical exertion levels, subject to limits involving simple tasks, simple decisions, limited interaction with others, and occasional workplace changes. He concluded that she was not disabled. The Social Security Appeals Council declined review, making the Administrative Law Judge’s decision final.

The parties filed cross-motions for summary judgment. Summary judgment is a decision based on the record when there is no material factual dispute requiring a trial.

Department of Veterans Affairs determination

The Department of Veterans Affairs had diagnosed Lauren E. M. with post-traumatic stress disorder, assigned a Global Assessment of Functioning score of 40, and rated her post-traumatic stress disorder as 100 percent disabling. The determination described her as permanently and totally disabled effective July 5, 2011.

The court held that the Administrative Law Judge did not provide adequate reasons for rejecting that determination. Under binding Ninth Circuit precedent, an Administrative Law Judge ordinarily must give great weight to a Department of Veterans Affairs disability determination and may give it less weight only for persuasive, specific, and valid reasons supported by the record.

The Administrative Law Judge cited differences between the Social Security and Department of Veterans Affairs programs. The court held that those differences could not by themselves justify rejection of the determination because they exist in every case. The Administrative Law Judge also relied on the fact that the determination concerned an earlier adjudicated period. The court held that the earlier decision did not prevent consideration of the Department of Veterans Affairs determination for the later, unadjudicated period.

The Administrative Law Judge further relied on Lauren E. M.’s lack of mental-health treatment during the relevant period. The court held that this reasoning was inadequate because the Administrative Law Judge did not properly analyze her explanations, including that the Department of Veterans Affairs stopped treating her because of an influx of patients, that she distrusted the Department of Veterans Affairs because of her brother’s treatment experiences, that she feared medication and psychiatric hospitalization, and that she had lost insurance and lacked other insurance. The court concluded that the Administrative Law Judge failed to provide specific, clear, and convincing reasons supported by substantial evidence for rejecting the Department of Veterans Affairs determination.

Medical opinions and listed impairments

The court upheld the Administrative Law Judge’s rejection of Dr. James Tanley’s opinion for reasons that included the timing of his examination and the lack of longitudinal evidence. Although the court found that the Administrative Law Judge improperly relied in part on the treatment gap, it held that this error was harmless because the other reasons were sufficient under the court’s analysis.

The court reached a different conclusion regarding Dr. Aparna Dixit’s opinion. Dr. Dixit examined Lauren E. M. after the date she was last insured and reported impaired memory, marked anxiety and mood symptoms, and marked impairments. The court held that the Administrative Law Judge erred by rejecting the opinion solely because it was issued after the insured period. Medical opinions issued after the disability period can be relevant to assessing earlier disability, and the later date alone did not justify rejecting Dr. Dixit’s opinion.

The court also held that Dr. Dixit’s independent examination itself constituted substantial evidence and that her opinion was not contradicted by other medical evidence. Therefore, the Administrative Law Judge needed clear and convincing reasons to assign it little weight. The court found that the treatment gap did not provide such a reason because the Administrative Law Judge had not properly analyzed why Lauren E. M. did not pursue treatment.

The court did not decide whether Lauren E. M.’s impairments actually met or equaled a listed impairment. It also did not reach her arguments concerning later steps of the disability analysis because the errors in evaluating the Department of Veterans Affairs determination and medical evidence required further proceedings.

Disposition

The court held that the errors were not harmless because they went to the heart of the disability determination and could have affected the residual functional capacity finding and the ultimate benefits decision. It granted Lauren E. M.’s motion for summary judgment, denied the Commissioner’s cross-motion, and remanded for further proceedings consistent with the order. The order disposed of Docket Nos. 13 and 14.