N.N. v. Social Security Administration

Background

N.N. sought judicial review of the Commissioner of Social Security’s denial of her application for disability insurance benefits under Title II of the Social Security Act. She alleged disability beginning June 1, 2004, based on spinal conditions, multiple spinal surgeries, nerve compression, arthritis, and other conditions. The administrative law judge found that N.N. was insured through December 31, 2009; had severe physical impairments including degenerative disc disease, prior cervical and lumbar fusions, right carpal tunnel syndrome, and right patellofemoral syndrome; and had the residual functional capacity (RFC)—the most she could still do despite her impairments—to perform sedentary work with specified restrictions. The administrative law judge concluded that N.N. could perform her past relevant work as an administrative assistant and was not disabled through December 31, 2009.

The parties filed cross-motions for summary judgment, asking the court to decide the case based on the administrative record.

Carpal Tunnel Syndrome

N.N. argued that the administrative law judge improperly found her carpal tunnel syndrome severe but included no related hand limitations in the RFC. The court explained that an administrative law judge must consider all medically determinable impairments when assessing the RFC, including impairments found not severe. The court nevertheless found no error because the administrative law judge explained that N.N.’s carpal tunnel symptoms responded to conservative treatment, did not affect her grip strength, sensation, or wrist movement during a January 2009 examination, and did not lead to surgery until after the date last insured. The court denied N.N.’s motion and granted the Commissioner’s motion on this issue.

Periods of Disability and Spinal Surgeries

N.N. argued that her three spinal surgeries and recovery periods established periods of disability between 2004 and 2006. She also argued that those periods should have extended her insured status through a later date under a disability “freeze.”

The court upheld the administrative law judge’s findings concerning the cervical spine. The record showed improvement after the April 2004 cervical surgery, and N.N. did not identify specific evidence showing that neck pain prevented all work through July 2005. The court also upheld the findings concerning the lumbar spine. Although N.N. continued to have lumbar pain and mild radiculopathy, the record showed medically managed pain, normal gait and strength, stable imaging, improvement after treatment, and continued daily activities including travel. The court denied N.N.’s motion and granted the Commissioner’s motion on both spinal-surgery issues.

The court also found no error in the administrative law judge’s decision to give little weight to Dr. Ravinder Bains’s certifications stating that N.N. could not work during various periods from May 2004 through August 2005. The court agreed that the certifications were temporary, did not themselves determine disability, and did not describe specific functional limitations. The court further noted that the forms contained functional-assessment checkboxes that Dr. Bains did not complete.

Potential Absenteeism

N.N. separately argued that the administrative law judge failed to consider whether her surgeries, recovery periods, and medical appointments would have caused excessive absenteeism. The court treated this as an argument that absenteeism should have been included as an RFC limitation.

The vocational expert testified that no jobs would be available for a person with the assessed RFC who was off task or absent 20 percent of the workday or workweek, or who missed two days of work per month. The record showed that N.N. spent a week in the hospital for each lumbar surgery and had an average of four to five follow-up visits per year concerning her spinal conditions. The court stated that it could not clearly determine whether medically necessary treatment required more than two absences per month. Because the administrative law judge did not expressly address the possible effect of surgery, recovery, and treatment on absenteeism from June 1, 2004, through August 1, 2005, the court remanded the matter for that limited further consideration.

Depending on the administrative law judge’s findings about absenteeism, the administrative law judge was also directed to consider the effect, if any, on N.N.’s disability-freeze argument.

Subjective Symptom Testimony

The court found no error in the administrative law judge’s evaluation of N.N.’s statements about her pain and other symptoms. The administrative law judge relied in part on medical evidence showing improvement, conservative treatment, medically managed lumbar pain, and findings consistent with N.N.’s reports to medical providers. The administrative law judge also considered N.N.’s ability to travel. Although N.N.’s work history could support a more favorable decision, the court found the administrative law judge’s evaluation rational and supported by substantial evidence.

Past Relevant Work and Requested Benefits

Because the court ordered a remand concerning possible excessive absenteeism, it did not decide whether the administrative law judge correctly found at step four of the disability analysis that N.N. could perform her past relevant work.

The court also rejected N.N.’s request for an immediate award of benefits under the credit-as-true doctrine. The court found that further issues remained to be resolved before disability could be determined.

Disposition

The court granted in part and denied in part N.N.’s motion for summary judgment, granted in part and denied in part the Commissioner’s cross-motion for summary judgment, and remanded the matter for further administrative proceedings consistent with the order. The court directed the Clerk to enter judgment and close the file.