T.N. v. Kijakazi

Background

T.N. applied for Supplemental Security Income benefits on April 18, 2017. The application was denied initially and on reconsideration. After a hearing, an administrative law judge issued an unfavorable decision on August 19, 2019, and the Appeals Council denied review. T.N. then sought judicial review under 42 U.S.C. § 405(g).

The administrative law judge found that T.N. had not engaged in substantial gainful activity and had several severe impairments, including polysubstance abuse disorder, spinal conditions, post-traumatic stress disorder, depressive disorder, and borderline intellectual functioning. The administrative law judge found that T.N. did not meet a listed impairment, could not perform past relevant work, and had the residual functional capacity for limited light work. Based on vocational-expert testimony, the administrative law judge concluded that T.N. could perform jobs such as motel or hotel housekeeper and stock shop apparel, and therefore was not disabled.

Medical Opinions

The court reviewed the administrative law judge’s treatment of opinions from nurse practitioner Cynthia Sharpe and psychologists Dr. Franklin and Dr. Touhy. Under the regulations applicable to T.N.’s claim, medical opinions are evaluated primarily for supportability and consistency, and the administrative law judge must explain how those factors were considered.

The administrative law judge found Nurse Practitioner Sharpe’s opinion unpersuasive because it appeared to be a checklist without adequate reasoning and because its extensive limitations were inconsistent with examinations showing normal range of motion, no swelling or tenderness, and an ability to walk. The court rejected both reasons. The opinion identified CT imaging, physical examinations, severe scoliosis, disc bulges, canal stenosis, right-arm soft-tissue problems, and balance issues as bases for its conclusions. The administrative law judge did not adequately explain what additional reasoning was required or how the cited examination findings contradicted Sharpe’s specific limitations.

The administrative law judge also found Dr. Franklin’s opinion unpersuasive based on her examination findings, other records, and the fact that T.N. saw her through an attorney referral and she was presumably paid for the report. The court held that these reasons were not supported by substantial evidence. Dr. Franklin’s opinion was supported by psychological testing and observations of slow work and speech, impaired sustained attention, below-average memory, low test scores, and impaired executive functioning. The court also held that an attorney referral, without other evidence of bias, was not enough to discredit the opinion.

The administrative law judge gave nearly identical reasons for rejecting Dr. Touhy’s opinion. The court found that being alert, cooperative, and able to make eye contact during a structured evaluation did not contradict findings of cognitive difficulties, impaired memory, depression, anxiety, post-traumatic stress symptoms, and difficulty focusing. The court also found that general medical visits with unelaborated normal mental-status findings did not substantially contradict psychological testing and mental-health findings supporting Dr. Touhy’s opinion. The attorney referral and presumed payment likewise did not establish unreliability.

Other Issues and Remedy

T.N. also challenged the administrative law judge’s findings that T.N. did not meet a listed impairment and could perform other jobs at the fifth step of the disability analysis. Because those findings depended substantially on the evaluation of the medical opinions, the court remanded those issues for reconsideration based on a proper assessment of the opinions.

The court considered whether to order immediate payment of benefits under the credit-as-true rule. It concluded that further proceedings were appropriate because, although the administrative law judge had failed to give adequate reasons for rejecting the medical opinions, it was not clear that the administrative law judge would be required to find T.N. disabled after properly evaluating the record.

Disposition

The court granted T.N.’s motion for summary judgment, denied Kijakazi’s cross-motion, reversed the administrative law judge’s decision, and remanded the case for further administrative proceedings consistent with the order. The court stated that a separate judgment would be entered and that the clerk would then terminate the case.