Digna T. v. Kijakazi

Background

Digna T. applied for Disability Insurance Benefits and Supplemental Security Income in March 2016, alleging that her disability began on November 2, 2015. The Social Security Administration denied the applications. After a hearing, Administrative Law Judge Lori Romeo denied benefits in September 2018. In an earlier round of this case, the district court approved a stipulation sending the matter back for additional administrative proceedings. The Appeals Council then vacated the first decision and sent the matter back to the administrative law judge.

After another hearing, the administrative law judge again denied benefits on July 27, 2021. The judge found that Digna T. had several severe impairments, including spinal, hip, knee, circulatory, weight-related, mental-health, and headache conditions. The judge determined that Digna T. retained the residual functional capacity—her ability to work despite her impairments—to perform light work with physical and mental restrictions. The judge found that she could not return to her past work as a home health aide but could perform other jobs existing in significant numbers in the national economy.

Issue

Digna T. challenged the evaluation of the medical opinion evidence, particularly the opinions concerning her ability to stand and walk for prolonged periods. The court reviewed whether the Commissioner’s decision was supported by substantial evidence, meaning relevant evidence that a reasonable person could accept as adequate, and whether the correct legal standards were applied.

Medical opinions and court’s analysis

Three physicians provided opinions that conflicted with the finding that Digna T. could stand or walk for six hours during an eight-hour workday:

- Dr. Casilda Balmaceda, a treating physician, opined that Digna T. could sit, stand, or walk for less than two hours in an eight-hour workday and would likely miss more than four workdays per month. - Dr. Silvia Aquiar, who performed a consultative examination, assessed limitations in standing and walking and stated that Digna T. could stand or walk for one hour in an eight-hour workday. - Dr. Robert Thompson, a medical expert who testified at a hearing, opined that Digna T. could stand or walk for four hours in an eight-hour workday after considering anemia and cardiac factors.

The administrative law judge discounted Dr. Aquiar’s opinion as based mostly on Digna T.’s self-reports, found Dr. Balmaceda’s opinion inconsistent with the clinical records, and considered Dr. Thompson’s testimony about standing and walking speculative and outside his expertise. The district court held that the administrative law judge improperly considered these opinions in isolation rather than evaluating their consistency with one another. The court also noted that Dr. Balmaceda’s treating-physician opinion required particular consideration under the rules applicable to Digna T.’s claim.

The court identified additional evidence supporting significant limitations in standing and walking, including spinal imaging, repeated findings of positive straight-leg raising, muscle spasms, reduced spinal movement, Digna T.’s use of a walker since September 2019, and her receipt of home-health-aide assistance for 35 hours per week beginning in December 2020. The court concluded that the administrative law judge’s evaluation of the evidence could not be sustained.

Disposition

The court held that remand for further administrative proceedings was required so the evidence concerning Digna T.’s ability to stand and walk could be properly considered. The court recommended assigning the matter to a different administrative law judge because the same judge had already made two unsuccessful attempts to analyze the evidence properly. The court also directed that the administrative proceedings be completed within 120 days. If the resulting decision denied benefits, a final decision was to be issued within 60 days after any appeal by Digna T.

The court granted Digna T.’s motion for judgment on the pleadings, denied the Commissioner’s motion for judgment on the pleadings, and remanded the case for further administrative proceedings. The court did not award benefits or decide that Digna T. was disabled.