Pagan v. Berryhill

Background

Diana Pagan applied for Supplemental Security Income on March 5, 2015, alleging disability based on bipolar disorder, depression, post-traumatic stress disorder, anxiety, trouble sleeping, and difficulty controlling her mood. The Social Security Administration denied the application. After a hearing, an administrative law judge found on June 1, 2017, that Pagan was not disabled. The Appeals Council denied review, making that decision final for purposes of judicial review.

The administrative law judge found that Pagan had severe impairments including bipolar disorder, depression, anxiety, and obesity. The judge determined that she could perform simple, routine, and unskilled work with occasional interaction with the public, and found that jobs existed in the national economy that she could perform.

Pagan received mental-health treatment from Federal Employment and Guidance Services and the Jewish Board Family and Children Services. Dr. Joseph Charles was her treating psychiatrist at both institutions. In two 2014 reports, Dr. Charles stated that Pagan was unable to work for at least twelve months, but he did not explain the specific medical reasons or functional limitations supporting that conclusion.

Issues and Analysis

The court reviewed Pagan’s objections to a magistrate judge’s recommendation that the Commissioner’s position be accepted. The court reviewed the objected-to portions independently. It explained that an administrative law judge has an affirmative duty to develop a complete medical record, including seeking clarification when a treating physician’s opinion leaves a clear gap in the evidence. That duty is especially important in mental-health cases.

The court held that the administrative law judge should have obtained additional information from Dr. Charles about the functional limitations caused by Pagan’s psychological conditions. Although the record contained Pagan’s treatment records, it did not adequately explain the basis for Dr. Charles’s opinions that she could not work for at least twelve months. The administrative law judge therefore could not rely on that gap in the record when evaluating the opinions.

The court also addressed the treating-physician rule, which generally requires an administrative law judge to give appropriate deference to a claimant’s treating doctor and to explain the reasons for the weight assigned to that doctor’s opinion. The administrative law judge gave Dr. Charles’s opinions little weight because they predated Pagan’s application and because the ultimate disability decision belonged to the Commissioner. The court found those reasons inadequate. The administrative law judge did not discuss the required factors, including the length and nature of Dr. Charles’s treatment relationship, the medical support for his opinions, their consistency with the record, and his specialization.

The court rejected the magistrate judge’s conclusion that these errors were harmless. Dr. Charles had offered medical opinions about Pagan’s conditions and symptoms, and the missing explanation about work-related limitations was information the administrative law judge had a duty to seek before discounting those opinions.

Disposition

Judge John G. Koeltl granted Pagan’s motion for judgment on the pleadings and denied the Commissioner’s motion for judgment on the pleadings. The court remanded the case to the Commissioner for further proceedings. On remand, the administrative law judge was directed to clarify the bases for Dr. Charles’s opinions, provide adequate reasons for the weight assigned to them, and reconsider other conclusions in light of the expanded record. The decision did not award Pagan benefits or determine that she was disabled.