Nestor S. v. Kijakazi

Background

Nestor S. sought judicial review under 42 U.S.C. § 405(g) of the Commissioner of Social Security’s final decision denying his Title II disability-benefits application. He alleged disability based on physical impairments including right-knee arthritis, arthritis and a finger injury in his hands, hypertension, high cholesterol, type two diabetes mellitus, low back pain, and leg pain.

An administrative law judge (ALJ) held a telephonic hearing on March 15, 2022, at which Nestor S., assisted by an interpreter, and a vocational expert testified. On April 5, 2022, the ALJ found that Nestor S. was not disabled under the Social Security Act. The Appeals Council denied review. The parties then filed cross-motions for summary judgment.

Subjective-Symptom Testimony

The court held that the ALJ failed to give specific, clear, and convincing reasons supported by substantial evidence for rejecting Nestor S.’s testimony about the severity and effects of his symptoms. The ALJ used conclusory language and did not connect Nestor S.’s testimony to particular portions of the record showing why it should be rejected.

The court also rejected the ALJ’s reliance on several other reasons. The ALJ cited normal examination findings but failed to address contrary evidence, including records documenting bone-on-bone right-knee arthritis and a possible future need for total knee replacement. The ALJ stated that Nestor S. had refused or failed to pursue physical therapy but did not consider records showing later physical-therapy assessments and attendance, or the effect of the COVID-19 pandemic and lockdown on access to treatment.

The ALJ also relied on medication and chiropractic treatment as conservative treatment. The court explained that this could not support rejecting Nestor S.’s testimony without identifying appropriate, more aggressive treatment options and considering why he did not pursue them. The record indicated that Nestor S. had been told he needed to lose weight before becoming a candidate for surgery. Finally, the ALJ relied on Nestor S.’s use of a stationary bicycle and weight lifting but did not connect those activities to work-related tasks or address his testimony that riding the bicycle caused less pain than standing or walking and was intended to help him qualify for knee surgery.

Medical-Opinion Evidence

The court found that the ALJ’s treatment of the medical opinions was not supported by substantial evidence. Under the applicable regulations, the key factors for evaluating the persuasiveness of medical opinions are supportability—how well the medical source explains the opinion using objective evidence—and consistency—how well the opinion fits with other evidence. The ALJ must explain how those factors were considered.

Dr. Waterhouse, Nestor S.’s treating physician, assessed limitations involving lifting, sitting, standing, and walking. The ALJ found the opinion unpersuasive because the conclusions about walking, standing, and sitting were allegedly inconsistent, because the form included cervical limitations, and because the need to walk every ten minutes was unclear. The court held that the ALJ did not explain which conclusions were inconsistent or why the other stated reasons undermined the opinions about sitting, standing, and walking. The court could not accept explanations supplied later by the Commissioner because the court reviews the reasons and factual findings actually given by the ALJ.

Dr. Luu, another treating physician, assessed limitations involving standing, squatting or kneeling, knee bending, and lifting, carrying, pushing, and pulling. The ALJ found the opinion unpersuasive because the limitations applied for only one month and Dr. Luu did not identify supporting findings or a diagnosis. The court held that the time limitation reflected the nature of the work-status report and that the ALJ ignored treatment records documenting chronic knee pain and bone-on-bone arthritis over Dr. Luu’s three years of care.

The ALJ found the opinion of state-agency medical consultant Dr. Sampley persuasive. Dr. Sampley assessed a light residual functional capacity, meaning the ability to perform work involving the level of physical demands described by that category. The court held that the reasons supporting this assessment were the same reasons the ALJ improperly used to reject Nestor S.’s symptom testimony, including the alleged refusal of physical therapy, exercise, limited visits, and few clinical abnormalities.

The ALJ did not analyze Dr. Sclafani’s workers’ compensation medical opinion. The court stated that such decisions are not binding on the Social Security Administration and that an ALJ is not required to analyze the other entity’s disability determination, although the ALJ should consider the underlying supporting evidence. Nestor S. did not argue that the ALJ failed to do so.

Other Issues and Remedy

Because the ALJ’s analysis of the medical evidence and symptom testimony lacked substantial evidence, the court did not need to decide Nestor S.’s additional arguments about his residual functional capacity or the ALJ’s step-five determination concerning available work. The court found the errors were not harmless because a properly supported evaluation could lead to a different disability determination.

Nestor S. requested either payment of benefits or further proceedings. The court chose further proceedings because the record was not fully developed, unresolved issues remained, and it was not clear that properly crediting the medical opinions and symptom testimony would require a finding of disability. The ALJ must address the conflicting medical opinions and other evidence and then determine at step five whether Nestor S. can perform any jobs available in the national economy.

Disposition

Judge Jacquelyn Corley granted Nestor S.’s motion for summary judgment, denied the defendant’s cross-motion, and remanded the action for further proceedings consistent with the order. The clerk was directed to enter judgment by separate order.