D.K. v. Commissioner of Social Security

Background

D.K. sought judicial review of the Commissioner’s final decision denying his claim for disabled adult child insurance benefits under Title II of the Social Security Act. To receive these benefits, he had to show that his disability began before he turned 22. D.K. had previously received prospective Supplemental Security Income benefits based on then-current impairments, but his earlier application for disabled adult child benefits was denied because there was insufficient evidence of an impairment before age 22.

D.K. later reapplied, alleging autism-spectrum disorder and post-traumatic stress disorder before age 22, along with other physical and mental-health conditions. After a hearing, the Administrative Law Judge found that D.K. had not engaged in substantial gainful activity but concluded that, before age 22, there were no medical signs or laboratory findings establishing a medically determinable impairment. The Appeals Council denied review, making the Administrative Law Judge’s decision final.

Court’s Analysis

The court reviewed the decision under 42 U.S.C. § 405(g), which allows a district court to set aside the Commissioner’s decision for legal error or lack of substantial evidence. “Substantial evidence” means relevant evidence that a reasonable person could accept as sufficient to support a conclusion.

The court held that the Administrative Law Judge appeared to impose an improper requirement: that D.K. produce objective medical evidence from the period before he turned 22. The court explained that later-acquired objective medical evidence may establish that an impairment existed earlier, if the earlier onset can reasonably be inferred from that evidence.

The court focused on psychologist Dr. Patrick MacLeamy’s autism-spectrum assessment. Dr. MacLeamy reviewed records, interviewed D.K. and his mother, observed D.K.’s behavior and development, administered an intelligence test, and administered four clinical tests concerning autism. Dr. MacLeamy concluded that D.K. met the criteria for autism-spectrum disorder.

The court said these assessments were not medical opinions in the relevant regulatory sense because they did not describe what D.K. could still do despite an impairment. Instead, the assessments documented psychological abnormalities and psychological-test results, which could constitute objective medical evidence of a medically determinable impairment. The court also said the assessments could support an onset before age 22 because autism-spectrum disorder, by definition, begins in early childhood.

The court further held that the Administrative Law Judge’s reasons for rejecting Dr. MacLeamy’s assessments were legally and factually insufficient. The absence of examinations from before age 22 was not enough to reject later retrospective medical evidence. And the statement that the assessment was based mostly on D.K.’s mother’s report was not supported by substantial evidence, given the other sources of information and testing used by Dr. MacLeamy.

Disposition

The court found that these errors were not harmless because the finding that no objective medical evidence existed before age 22 was the basis for concluding that D.K. was not disabled during that period. The court determined that further proceedings were appropriate because the Administrative Law Judge had not yet addressed the remaining disability questions, including the severity of D.K.’s impairments, whether they met or equaled a listed impairment, his residual functional capacity, his ability to perform past work, and his ability to adjust to other work.

Judge Laurel Beeler granted D.K.’s motion for summary judgment, denied the Commissioner’s cross-motion for summary judgment, and remanded the case for further proceedings consistent with the order. The court did not direct an award of benefits.