R.P. v. Kijakazi

Background

R.P. sought judicial review of the Social Security Administration Commissioner’s denial of her claim for Social Security disability-insurance benefits under Title II of the Social Security Act. She alleged disability based on a damaged right leg, knee arthritis, a back injury, a traumatic-brain injury, depression, severe headaches, fatigue, and insomnia. She ultimately sought benefits for a closed period from May 3, 2011, through October 30, 2016.

An administrative law judge, or ALJ, initially found that R.P. was not disabled. The ALJ determined that she could perform sedentary work with a limitation to simple tasks, could not perform her past work, but could perform other jobs existing in significant numbers in the national economy. In an earlier related proceeding, the court granted R.P.’s motion for summary judgment and remanded the case because the ALJ had improperly weighed medical-opinion evidence and R.P.’s testimony.

After remand, a different ALJ held another hearing and again found R.P. not disabled. The ALJ determined that R.P. had several severe impairments, including sciatica, lumbar spinal stenosis with radiculopathy, lower-back pain, knee and shoulder conditions, osteoarthritis, obesity, depressive disorder, and opioid dependence. The ALJ assessed a residual functional capacity for light work with restrictions, found that R.P. could not perform her past relevant work, and found that she could perform jobs such as inspector, produce weigher, and marker.

Issues and Analysis

R.P. argued that the ALJ improperly weighed medical evidence, improperly rejected her testimony, and lacked substantial evidence for the step-five finding that she could perform other work. The court remanded on all three grounds.

Medical-opinion evidence

The court held that the ALJ improperly discounted the opinion of examining physician Darien Behravan, D.O. Dr. Behravan examined R.P. in connection with a right-shoulder injury and limited her right-hand pushing, pulling, and lifting to no more than 15 pounds, with no more than occasional overhead reaching. The ALJ discounted those limitations because there was supposedly no probative medical evidence supporting them for a continuous period of twelve months.

The court found that reason unsupported by substantial evidence. Dr. Behravan’s examination documented pain with certain shoulder movements, a positive Speed’s test, AC-joint crepitus, restricted maneuvers, and tenderness over the right elbow’s lateral epicondyle. The examination occurred nine months after the injury, and other records documented continued shoulder pain more than a year after the accident. The court therefore found that the ALJ erred by rejecting Dr. Behravan’s limitations without a reason supported by substantial evidence.

The court reached a different conclusion about physician assistant Linda Deivert’s opinion. Deivert, who had treated R.P. at least 13 times, provided a note stating that R.P. was unable to work beginning November 14, 2015. Because a physician assistant is an “other source” under the applicable rules, the ALJ needed a germane, or specifically relevant, reason to discount that opinion. The court held that the ALJ met that standard by identifying inconsistencies between the opinion, R.P.’s work activity, and medical records showing normal gait, normal ambulation, and normal lower-extremity motion and strength. The court stated that this issue was not a basis for remand.

R.P.’s testimony

The court also held that the ALJ improperly rejected R.P.’s testimony about the intensity, persistence, and limiting effects of her symptoms. Because the ALJ found that R.P.’s medically determinable impairments could reasonably cause the alleged symptoms and did not identify evidence of malingering, the ALJ was required to give specific, clear, and convincing reasons for rejecting her testimony.

The court found the ALJ’s reasons insufficient. The ALJ relied on alleged inconsistencies, possible improvement in tenderness and decreased sensation, normal gait and ambulation at some appointments, and an orthopedic surgeon’s recommendation of conservative treatment. The court explained that varying cane use was consistent with R.P.’s testimony that she used a cane at times. The cited records did not establish that her tenderness and decreased sensation had improved enough to undermine her account of chronic knee and back pain. The records also showed both normal ambulation and periods of gait difficulty.

The court further held that R.P.’s treatment could not reasonably be treated as a sufficient reason to reject her testimony. She had received multiple steroid injections and heavy doses of opioid pain medication, and any relief was temporary. The court found that partial and short-lived relief did not undermine her testimony about the severity of her pain.

Step-five finding and remedy

The court remanded the step-five finding because the ALJ’s residual-functional-capacity assessment depended on the improper evaluation of the medical opinions and R.P.’s testimony. The court did not direct the Commissioner to award benefits. Instead, it concluded that additional administrative proceedings could remedy the defects and remanded for further proceedings consistent with the order.

Disposition

The court granted R.P.’s motion for summary judgment, denied the Commissioner’s cross-motion for summary judgment, and remanded for further proceedings. Judge Laurel Beeler signed the order as a United States Magistrate Judge.