Nicole M. v. Kijakazi

Background

Nicole M. sought review under 42 U.S.C. § 405(g) of the Commissioner of Social Security’s final decision denying her applications for disability insurance benefits and supplemental security income. She alleged disability beginning March 15, 2020. The administrative law judge found severe impairments including anxiety, asthma, attention deficit hyperactivity disorder, bipolar disorder, depression, dissociative disorder, narcolepsy, post-traumatic stress disorder, and social anxiety disorder. The administrative law judge found that Nicole M. could not perform her past work but could perform other jobs available in the national economy, including automotive detailer and laundry worker.

The administrative law judge assessed a residual functional capacity, meaning the most work a person can perform despite her limitations. The assessment allowed work at all physical exertion levels, with restrictions involving climbing, environmental hazards, pulmonary irritants, task complexity, pace, workplace interactions, and changes in the work setting. It did not include a limitation for excessive time off task related to narcolepsy.

Issues and Analysis

Nicole M. argued that the administrative law judge improperly evaluated the medical source statements from her treating advanced practice nurse, Nurse Brown, and treating therapist, Ms. Lorsung. She also argued that the residual functional capacity did not fully account for her narcolepsy. The Commissioner argued that the administrative law judge adequately evaluated the opinions and properly accounted for the limitations supported by the record.

The court held that the administrative law judge’s discussion of Nurse Brown’s and Ms. Lorsung’s opinions was incomplete. Under the applicable regulations, supportability measures how well a medical opinion is supported by medical evidence and explanation, while consistency measures how well it fits with the other evidence in the record. The court concluded that the administrative law judge did not clearly analyze those factors as to either opinion.

As to Nurse Brown, the administrative law judge found the opinion not entirely persuasive because it was not supported by the medical record and stated that there was no evidence of excessive absenteeism. The court found that parts of the record contradicted that broad statement, including evidence concerning Nicole M.’s reported difficulty waking, missing work, and inability to maintain a job. The court stated that the administrative law judge could consider Nicole M.’s part-time work and could reject Nurse Brown’s conclusory opinion about whether Nicole M. was able to work, but the administrative law judge needed to explain the separate supportability and consistency analyses.

As to Ms. Lorsung, the administrative law judge found the degree of limitation unsupported by the medical evidence and relied on Nicole M.’s part-time work. The court stated that the administrative law judge could consider the part-time work when evaluating consistency, but the written decision did not clearly analyze consistency and supportability. The court therefore remanded for further explanation.

The court rejected Nicole M.’s challenge to the narcolepsy portion of the residual functional capacity. The court found substantial evidence supporting the administrative law judge’s decision not to include an excessive off-task limitation, citing improvement with medication, a report that stimulant medication lasted through much of the day, and the state consultants’ opinions that did not support the additional limitations requested.

Disposition

The court ordered that Nicole M.’s motion for summary judgment be granted in part and denied in part and that the Commissioner’s motion for summary judgment be granted in part and denied in part. It remanded the Commissioner’s decision for further analysis of the consistency and supportability of Nurse Brown’s and Ms. Lorsung’s medical source statements. The order also directed that judgment be entered accordingly. Judge Docherty did not award benefits in this order.