Cox v. Kijakazi

Background

Jolene Cox applied for disability insurance benefits in February 2017, alleging several mental impairments. The Social Security Administration denied her application and denied it again on reconsideration. After an earlier court-related remand for additional administrative proceedings, an administrative law judge held another hearing in March 2021 and denied Cox’s claim in June 2021.

The administrative law judge found that Cox had severe post-traumatic stress disorder, major depression, borderline personality disorder, and anxiety. The judge determined that Cox could perform work at all physical exertional levels, subject to limits such as routine tasks, no regular interaction with the public, occasional interaction with coworkers and supervisors, and work focused primarily on things rather than people. The judge concluded that Cox could not return to her past work but could perform jobs such as packager, industrial cleaner, and marker.

Medical opinions and the parties’ arguments

Several health professionals described greater mental limitations than those adopted by the administrative law judge. Psychiatrist Martin Epson stated that Cox had serious limitations in dealing with others, completing a normal workday and workweek, handling work pressures, and maintaining acceptable production levels. He also stated that she would likely miss work several times per month. Psychotherapist Leslie Forell described moderate and marked limitations in several areas. Brendan Yee stated that Cox would need unscheduled breaks, reduced work hours, and several absences each month. Consulting psychologist Aparna Dixit found that Cox could follow simple instructions but had moderate to marked limitations in other functional areas.

The administrative law judge gave little or reduced weight to the opinions of Epson, Forell, and Yee, and partial weight to Dixit’s opinion and the state-agency assessments. The judge relied in part on treatment notes showing occasional improvement, Cox’s ability to perform activities such as attending tai chi and writing classes, shopping, riding a bicycle, and providing some in-home support services, and her limited work history. Cox argued that the judge improperly discounted opinions from professionals who had treated or examined her. The Commissioner argued that the evaluation of the opinions was supported by substantial evidence.

Court’s analysis

The court held that the administrative law judge improperly evaluated the medical-opinion evidence. Because the claim was governed by regulations predating March 2017, the court explained that treating physicians’ opinions generally receive greater weight than examining physicians’ opinions, and examining physicians’ opinions generally receive greater weight than opinions from doctors who neither treated nor examined the claimant. The judge must give legally sufficient, evidence-based reasons for rejecting or discounting these opinions.

The court concluded that the administrative law judge did not adequately show that the treating and examining professionals’ opinions conflicted with the treatment record. Occasional improvement in mood or energy did not necessarily mean that Cox’s depression no longer seriously affected her ability to function at work. The court also concluded that Cox’s ability to attend classes, shop, perform other daily activities, or work part time did not automatically conflict with the described mental limitations. A person need not be completely incapacitated to qualify for benefits.

The court further found that the administrative law judge appeared to substitute her own interpretation of the treatment records for the medical professionals’ opinions. The judge also relied on speculation about what Cox’s doctors intended and about what Cox’s limited work history showed. The court stated that the record did not demonstrate employment capacity sufficient to contradict the moderate and marked limitations described by the treating and examining professionals.

Disposition

The court held that the administrative law judge committed reversible error by rejecting medical opinions about Cox’s mental condition. It did not decide Cox’s other arguments because the medical-opinion error required a remand. The court also determined that an immediate award of benefits was not appropriate because further administrative proceedings could resolve outstanding issues.

The court granted Cox’s motion for summary judgment, denied her request for an immediate determination of benefits, remanded the matter for further administrative proceedings consistent with the order, and denied the Acting Commissioner’s cross-motion for summary judgment.