W.W. v. Saul

Background

W.W. sought disability insurance benefits under the Social Security Act. She alleged that depression, abdominal pain related to prior surgery, and pre-diabetes limited her ability to work. Her application alleged disability beginning January 12, 2016. The administrative law judge, Kevin Gill, found that W.W. had one severe impairment—status post remote abdominal surgery—but that her depression, cannabis-related substance-use disorder, diabetes, obesity, Crohn’s disease, cataracts, and overactive bladder were not severe. The administrative law judge found that W.W. could perform the full range of medium work and could return to her past work as a customer service representative and bank teller.

W.W. moved for summary judgment, asking the court to reverse the agency’s decision and remand for a new hearing. She argued that the administrative law judge improperly discounted the opinions of her treating psychiatrist, Mariposa McCall, M.D., and treating social worker, Tenzin Youdon, LCSW. She also argued that the judge failed to recognize pre-diabetes and worsening depression as changed circumstances after her earlier disability denial, and failed to make the factual findings required to determine whether she could perform her past relevant work. The Commissioner filed a cross-motion for summary judgment, arguing that the administrative law judge properly evaluated the evidence and reasonably relied on the vocational expert’s testimony.

Medical-opinion evidence

The court held that the administrative law judge did not adequately justify giving little weight to Dr. McCall’s opinions. Dr. McCall treated W.W. over multiple appointments during five months and reported continuing depression, anxiety, irritability, lack of motivation, isolation, fatigue, poor concentration, forgetfulness, and difficulty completing tasks consistently and on time. The court concluded that the administrative law judge selectively relied on perceived conflicts while failing to address evidence from Dr. McCall, LCSW Youdon, and PA Rene that was consistent with serious depression, isolation, and limited improvement despite medication changes.

The court also held that the administrative law judge failed to give germane reasons—reasons specifically connected to the witness—for rejecting LCSW Youdon’s opinion. Youdon had provided weekly therapy for almost two years and documented repeated severe-depression scores and specific functional findings. The court found that the administrative law judge overlooked evidence supporting Youdon’s opinion, including later reports that W.W. was unable to manage home improvements because they had become too much for her.

The court further questioned the weight given to other opinions. Dr. Prosise evaluated W.W. in 2013, three years before the alleged disability period, yet the administrative law judge gave his opinion great weight while rejecting Dr. Friedmann’s 2014 opinion as outside the relevant period. The court found that the explanation for giving Dr. Kollath’s one-time examination great weight was inadequate and that W.W.’s attentiveness during the examination and hearing did not substantially support rejecting her treating providers. The court also held that the administrative law judge failed to explain why the non-examining state-agency doctors should receive greater weight than W.W.’s treating providers, especially because they had not reviewed later treatment records.

Changed circumstances after the earlier denial

A prior administrative denial creates a presumption that a claimant continued to be able to work. The claimant may rebut that presumption by showing changed circumstances, including a new impairment or increased severity of an impairment. The court held that W.W.’s new diagnosis of pre-diabetes was enough to raise a new issue and rebut the continuing presumption; she did not have to prove that the new impairment was severe before the presumption could be rebutted.

The court also held that the later evidence from W.W.’s treating mental-health providers was new and material. That evidence included reports that W.W. was more depressed, repeated medication increases and changes, and continuing symptoms despite treatment. The court found that this differed from the earlier finding that W.W. had been stable on antidepressants. It therefore concluded that the administrative law judge erred in finding that W.W. had failed to rebut the presumption of continuing non-disability.

Past relevant work

At the fourth step of the disability analysis, an administrative law judge must make specific findings about the claimant’s residual functional capacity, the physical and mental demands of the past relevant work, and how those demands relate to the claimant’s capacity. The administrative law judge found that W.W. could perform her past work as it was actually and generally performed, but did not make adequate findings about the work’s specific physical or mental requirements.

Because the court found errors in the evaluation of the medical evidence, it was not convinced that substantial evidence supported the finding that W.W. had no mental limitations. As a result, the court could not determine whether W.W. could perform her past work, whether the mental demands of that work were relevant, or whether she could perform other substantial gainful work.

Disposition

The court granted W.W.’s motion for summary judgment and denied the Commissioner’s motion for summary judgment. It reversed the administrative law judge’s decision and remanded W.W.’s claim for further administrative proceedings consistent with the order. The clerk was directed to enter judgment in W.W.’s favor and close the case. The order did not direct an award of benefits.