Aquino v. Commissioner of Social Security

Background

Ramon Maria Aquino sought review of the Commissioner of Social Security’s decision denying his application for Disability Insurance Benefits. Aquino alleged that narcolepsy and chronic back pain prevented him from working. He appeared without a lawyer at two administrative hearings. The administrative law judge, or ALJ, found that Aquino had two severe impairments—narcolepsy and adjustment disorder—but concluded that he was not disabled under the Social Security Act.

The ALJ found that Aquino could perform work at all physical exertion levels, subject to limits on climbing ladders, ropes, and scaffolds and on exposure to unprotected heights and hazardous machinery. The ALJ determined that Aquino could not return to his previous work as a cable television line technician but that other jobs existed in significant numbers in the national economy.

The parties filed competing motions for judgment on the pleadings, asking the court to decide the case based on the administrative record and their written submissions.

Step-Three Analysis

Narcolepsy is not itself a listed impairment in the Social Security regulations. Social Security guidance directs that it be evaluated under Listing 11.02, which concerns epilepsy, while recognizing that narcolepsy and epilepsy are not truly comparable illnesses. The court explained that the Social Security Administration must also consider whether an unlisted impairment is medically equivalent to a closely analogous listed impairment. Medical equivalence means that the impairment is at least equal in severity and duration to the criteria of a listed impairment.

The court found that the ALJ analyzed Aquino’s symptoms under Listing 11.02 in a cursory and rigid way that failed to recognize the differences between narcolepsy and epilepsy. The ALJ relied on the absence of fainting, normal coordination and sensation, and an electroencephalogram showing no epileptic activity. The court explained that these findings were not relevant to narcolepsy because narcolepsy generally has no physical abnormalities and a routine electroencephalogram is usually normal. The ALJ also incorrectly described Aquino’s polysomnogram, or sleep study, as normal even though it resulted in a diagnosis of an unspecified sleep disorder.

The court concluded that the ALJ failed to conduct the required medical-equivalence analysis. It could not meaningfully review the ALJ’s step-three decision because the ALJ’s reasoning did not adequately address the nature of narcolepsy or the evidence concerning Aquino’s condition.

Residual Functional Capacity and Testimony

The ALJ also found that Aquino’s statements about the intensity, persistence, and limiting effects of his symptoms were not fully consistent with the record. The court found that this conclusion was unsupported because the ALJ relied on earlier records showing some improvement with medication while failing to address later records showing that the medication had become less effective.

The later records stated that Aquino’s medication no longer provided a sustained effect, that another medication did not increase his periods of wakefulness, and that the medication’s effectiveness lasted only about two to three hours. The records also documented difficulty completing tasks because of excessive sleepiness and a sudden sleep event. The court found that the ALJ appeared to have ignored this later evidence.

The court further found that the ALJ misread an August 2018 treatment note. The note said that Aquino should take modafinil in the morning, one hour before leaving the house, and that he was asked to refrain from driving, operating heavy equipment, climbing, or working at heights. The ALJ instead repeatedly stated that Aquino was instructed to take the medication one hour before driving.

Because Aquino was not represented at his administrative hearing, the ALJ had a heightened duty to develop the record by carefully questioning him about relevant facts. The court held that ignoring later medical records, selecting statements out of context, and failing to account for Aquino’s documented need to sleep several times a day constituted legal error. The court also noted that the vocational expert testified that no jobs would exist if a worker were off task for 15 percent of the workday.

Disposition

The Commissioner’s motion was DENIED, and Aquino’s motion was GRANTED. The court remanded the case to the Social Security Administration for further proceedings consistent with the opinion. On remand, the ALJ must conduct a proper medical-equivalence analysis, review the entire record, reconsider the evidence about the effectiveness of Aquino’s medication, and consider his need to sleep repeatedly during the day when evaluating his residual functional capacity. The opinion did not award Aquino benefits; it ordered further administrative proceedings.