Rivers v. Saul

Background

Sandra Rivers sought disability insurance benefits, alleging that she became unable to work on December 21, 2018. Administrative Law Judge Vincent M. Cascio denied her claim after a May 15, 2020 hearing. The Social Security Appeals Council declined review, making the administrative decision subject to review in federal court.

Rivers challenged the decision under 42 U.S.C. § 405(g). She argued, among other things, that the administrative law judge failed to develop the record, assessed her residual functional capacity without adequate support, improperly evaluated medical opinions and her symptoms, and failed to account for her migraines, uncontrolled diabetes, sleep apnea, fibromyalgia, pain, and mental limitations. She also raised a constitutional challenge to the structure of the Social Security Administration.

The administrative law judge found that Rivers had numerous severe impairments, including degenerative disc disease, fibromyalgia, rheumatoid arthritis, asthma, sleep apnea, seizures, antiphospholipid antibody syndrome, migraines, transient ischemic attack, diabetes, knee problems, depression, anxiety, and post-traumatic stress disorder. He found that she could perform sedentary work with physical, environmental, social, and mental restrictions, including the ability to alternate sitting and standing and a limitation to no more than 5% off-task time. He concluded that she could not perform her past work but could perform other jobs existing in significant numbers in the national economy.

The court’s analysis

Duty to develop the record. An administrative law judge has an affirmative duty to develop a complete medical record. The court found a meaningful gap concerning Rivers’s worsening migraines and hyperglycemia. Rivers had received emergency treatment multiple times, and a provider had reported that her migraines occurred more than 15 days per month and lasted more than four hours. But the medical opinions in the record did not adequately explain how those conditions affected her ability to work, maintain concentration and pace, or avoid excessive absences.

The court also found that the administrative law judge should have clarified a February 2020 assessment by Nurse Practitioner Stephanie Feely. That assessment referred to a missing problem list, addressed exertional limits but did not adequately discuss migraines or the effect of diabetes on maintaining a regular work schedule, and did not explain which conditions supported the conclusion that Rivers could not work. The court further held that the administrative law judge should have obtained records from an emergency-room visit in Utica involving low blood sugar, a fall, and a concussion.

The court rejected Rivers’s separate argument that the administrative law judge had to obtain complete versions of two earlier, incomplete Department of Social Services forms. The court concluded that the existing record contained enough information about her fibromyalgia and her condition at the time those forms were prepared.

Residual functional capacity. The court found that the residual functional capacity assessment did not adequately address Rivers’s ability to maintain concentration, persistence, and pace, attendance, and a regular schedule. Although the administrative law judge found moderate limitations in concentration, persistence, and pace and included a 5% off-task limit, he did not explain how he reached that figure or whether it accounted for the worsening migraines, repeated diabetes-related emergency visits, and their combined effects.

The court also found that the administrative law judge omitted or failed to adequately consider several emergency-room visits for migraines and hyperglycemia. It concluded that he relied on benign findings, such as normal diabetic foot examinations and some normal neurological examinations, while failing to address evidence that Rivers’s diabetes remained uncontrolled, her vision problems worsened, and her emergency treatment increased. The court described this as improperly selecting supportive evidence while ignoring significant contrary evidence.

On remand, the administrative law judge must reconsider the combined effects of Rivers’s impairments, including migraines, hyperglycemia, fibromyalgia, sleep apnea, and chronic pain. The administrative law judge must identify the non-exertional limits supported by the record, explain the residual functional capacity, and obtain additional vocational-expert testimony if necessary.

Medical opinions and subjective complaints. The court held that the administrative law judge properly evaluated the medical opinions concerning Rivers’s ability to sit and stoop under the newer regulations, which focus principally on supportability and consistency rather than giving special weight to treating sources. However, because the administrative law judge did not properly consider the combined effects of Rivers’s impairments on concentration, persistence, and pace, he must reassess the medical opinions concerning those issues on remand.

The court also held that the administrative law judge did not err by considering Rivers’s part-time coursework, driving, other daily activities, and statements about her work history when evaluating her reported symptoms. But after the record is properly developed, the administrative law judge must reconsider her symptom statements as they relate to migraines and uncontrolled diabetes.

Constitutional claim. The court did not decide Rivers’s separation-of-powers challenge to the statutory protection limiting removal of the Social Security Commissioner. Because the court had already found grounds for remand, it concluded that deciding the constitutional issue was unnecessary.

Disposition

The court granted Rivers’s motion for judgment on the pleadings in part and denied it in part. It denied the Commissioner’s cross-motion for judgment on the pleadings and remanded the case to the Commissioner under sentence four of 42 U.S.C. § 405(g) for further proceedings consistent with the opinion. The Clerk was directed to terminate the pending motions and close the case.