M.F. v. Saul

Background

M.F. sought judicial review of the Commissioner of Social Security’s decision denying her applications for disability insurance benefits and supplemental security income. She alleged disability beginning January 1, 2013, based on several mental and physical conditions, including social anxiety, post-traumatic stress disorder (PTSD), agoraphobia, depression, panic disorder, memory problems, and fatty liver.

An administrative law judge (ALJ) found that M.F. had severe impairments of depression and substance abuse, but did not find PTSD to be a severe impairment. The ALJ determined that M.F. could perform work at all exertional levels with limits allowing only simple, routine tasks and simple work-related decisions, no contact with the public or coworkers, and occasional contact with supervisors. The ALJ found that M.F. could perform jobs existing in significant numbers in the national economy and therefore was not disabled. The Appeals Council declined review.

The parties filed cross-motions for summary judgment. M.F. argued that the ALJ improperly evaluated the opinions of examining psychologist Dr. San Pedro, failed to identify PTSD as a medically determinable severe impairment, improperly evaluated whether her impairments met or equaled a listed impairment, and assessed her residual functional capacity (RFC) incorrectly. RFC means the most a claimant can still do despite her limitations.

Evaluation of Dr. San Pedro’s Opinions

The court held that the ALJ’s reasons for finding Dr. San Pedro’s opinions only “partially persuasive” were not supported by substantial evidence. Under the regulations applicable to M.F.’s applications, medical opinions must be evaluated primarily for supportability and consistency, and the ALJ must expressly address those factors.

Dr. San Pedro diagnosed M.F. with bipolar II disorder, generalized anxiety disorder, PTSD, and alcohol and opioid use disorders in remission. Dr. San Pedro opined that M.F. had marked limitations in responding to criticism from supervisors, responding to changes and ordinary work stress, completing a normal workday and workweek, and maintaining regular attendance and punctuality.

The ALJ gave four reasons for discounting those opinions: purportedly normal objective findings, reliance on self-reported questionnaires, an alleged inconsistency between alcohol use and remission, and a treatment note indicating that M.F. was working. The court rejected each reason. It found that the ALJ did not adequately explain how the mental-status findings were inconsistent with the marked limitations, and noted that other findings and M.F.’s low neurocognitive test scores supported Dr. San Pedro’s assessment. The court also found that self-reported questionnaires provided additional support rather than a valid reason to discount the opinions.

The court found no inherent inconsistency between M.F.’s reported alcohol use in November 2018 and Dr. San Pedro’s January 2019 diagnosis of alcohol abuse in remission, given the record’s references to treatment and relapses. Finally, the court determined that the treatment note stating M.F. had recently started a job was outdated or inaccurate as of January 2019. The court held that this error alone warranted remand.

PTSD

The court also held that the ALJ failed to explain why M.F.’s PTSD was not a severe, medically determinable impairment. The record showed that M.F. had been diagnosed with PTSD since at least November 2015, that Dr. San Pedro found she likely met the criteria for PTSD, and that M.F. alleged PTSD limited her ability to work.

Although the ALJ mentioned PTSD twice, he did not discuss its work-related limitations or explain why it was not severe. The court rejected the Commissioner’s argument that any error was harmless because the ALJ had identified other severe impairments. The ALJ had not explained how PTSD affected the RFC analysis. The court directed the ALJ on remand to reconsider whether M.F. had a severe, medically determinable impairment of PTSD.

Listed Impairments and RFC

The ALJ found that M.F. had only mild or moderate limitations in the four areas of mental functioning used to evaluate mental-disorder listings. The court held that this finding necessarily depended on the ALJ’s unsupported decision to discount Dr. San Pedro’s marked-limitations assessment. The court therefore found that the listings determination lacked substantial-evidence support. If the ALJ found PTSD to be a severe, medically determinable impairment on remand, the ALJ also had to consider the PTSD listing.

The court likewise held that the RFC finding lacked substantial-evidence support because the ALJ did not include Dr. San Pedro’s marked limitations after improperly discounting them. The ALJ was required to reassess the RFC after properly evaluating the medical opinions and the other issues identified by the court.

Disposition

M.F. asked the court to remand for immediate payment of benefits under the credit-as-true doctrine. The court declined to do so because further issues remained, including the evaluation of Dr. San Pedro’s opinions, the severity of PTSD, the listings determination, and the RFC.

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