Abinacer v. Saul

Background

Dennise Abinacer sought disability insurance benefits and Supplemental Security Income under the Social Security Act. She alleged that she had been unable to work since January 1, 2009 because of rheumatoid arthritis, asthma, diabetes, depression, anxiety, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, and other conditions.

An administrative law judge, Lori Romeo, initially found that Abinacer was not disabled. The Social Security Administration’s Appeals Council later sent the matter back for further proceedings. After a second hearing, Judge Romeo again found that Abinacer was not disabled from January 1, 2009 through October 4, 2019. The Appeals Council declined further review, making that decision the Commissioner’s final decision.

The administrative judge found that Abinacer could perform a limited range of sedentary work, with restrictions including occasional cane use, limits on reaching and handling, avoidance of ladders and heights, limited exposure to respiratory irritants and cold, simple tasks, no public contact, and only occasional casual contact with coworkers. Based on testimony from a vocational expert, the judge found that she could perform jobs such as addresser, document preparer, and waxer.

Parties’ Positions

Abinacer asked the court to reverse the Commissioner’s decision or, alternatively, to remand the case for further administrative proceedings. She argued that the administrative judge improperly evaluated the medical evidence, failed to follow the treating-physician rule, did not give good reasons for discounting opinions from her treating physician, and adopted a residual functional capacity—the most a person can still do despite medical limitations—that was not supported by substantial evidence.

The Commissioner asked the court to affirm the denial of benefits, arguing that the administrative judge applied the correct legal standards and that the decision was supported by substantial evidence.

Court’s Analysis

The court reviewed whether the Commissioner applied the correct legal standards and whether the decision was supported by substantial evidence. The court focused on the treating-physician rule applicable to Abinacer’s claims. Under that rule, a treating source’s opinion may receive controlling weight when it is well-supported by acceptable medical evidence and is not inconsistent with the other substantial evidence. Even when controlling weight is not given, the administrative judge must consider specified factors, including the length and nature of the treatment relationship, supporting evidence, consistency with the record, and the source’s specialty. The judge must also give good reasons for the weight assigned.

Dr. Lorraine Tosiello, an internal-medicine specialist who had been Abinacer’s primary-care provider since 2011 and saw her monthly, provided several opinions about Abinacer’s physical impairments and one opinion about her mental impairments. The administrative judge did not give controlling weight to any of those opinions and assigned different lesser weights to various opinions or portions of them.

The court found that the administrative judge repeatedly failed to expressly apply the required factors when discounting Dr. Tosiello’s opinions. The judge also failed to provide adequate explanations for the weights assigned to several detailed opinions dated August 9, 2016, February 7, 2017, and February 28, 2019. For example, the administrative judge gave different weights to portions of the August 9, 2016 opinion without explaining the reasons for those distinctions. The judge relied in part on one consultative examiner’s findings about Abinacer’s hand strength and daily activities, but did not meaningfully address conflicting testimony from a medical expert who criticized that consultative opinion.

The court also found that the administrative judge did not adequately explain why Abinacer’s reported daily activities undermined Dr. Tosiello’s opinions. The record included evidence that Abinacer received help from her son, friends, or family with some activities. The court explained that performing some daily activities, eating, or occasionally crocheting does not necessarily show an ability to perform work-related activities throughout an eight-hour workday.

Regarding the February 7, 2017 opinion, the administrative judge relied mainly on Abinacer’s ability to eat and a treatment note stating that she could crochet. The court found that this did not justify rejecting the opinion in its entirety, particularly because the judge did not address most of the limitations in the opinion. Regarding the February 28, 2019 opinion, the judge stated that Dr. Tosiello’s opinions were inconsistent with one another and unsupported by treatment records or independent examinations but did not explain those conclusions. The court could not discern the reasoning behind the assessment.

Because the administrative judge failed to apply the correct legal standards and did not provide adequate reasons for discounting the treating physician’s opinions, the court could not conclude that the errors were harmless. The court therefore did not reach the parties’ arguments about whether the residual functional capacity was supported by substantial evidence or whether the jobs identified at the fifth step of the disability analysis were proper.

Disposition

The court granted Abinacer’s motion for judgment on the pleadings, denied the Commissioner’s cross-motion for judgment on the pleadings, and remanded the matter for further administrative proceedings under sentence four of 42 U.S.C. § 405(g). The court directed that judgment be entered in Abinacer’s favor. On remand, the administrative judge must reevaluate Dr. Tosiello’s opinions under the correct legal standard and, if the opinions are not given controlling weight, explain the application of the required factors and provide good reasons for the assessment. Judge Andrew E. Krause did not decide whether Abinacer was ultimately entitled to benefits.