Pomales v. Acting Commissioner of Social Security

Background

Millie Cabrera Pomales sought judicial review under 42 U.S.C. § 405(g) of the Acting Commissioner of Social Security’s final decision denying her applications for disability insurance benefits and supplemental security income. She alleged that she became disabled on December 17, 2017, because of anxiety, depression, diabetes, panic attacks, and foot pain.

An administrative law judge, Dina R. Loewy, first found Pomales not disabled. The Social Security Administration’s Appeals Council later vacated that decision and sent the case back for further proceedings. A second administrative law judge, Raymond Prybylski, held a telephone hearing on September 2, 2020, at which Pomales again appeared without a lawyer and testified. Prybylski found her not disabled on September 24, 2020. The Appeals Council declined further review, making that decision the Commissioner’s final decision.

Prybylski found that Pomales had several severe impairments, including depressive disorder and anxiety disorder. He determined that she could perform light work with restrictions, including simple tasks, few workplace changes, and being off task for five percent of the workday. Based on testimony from a vocational expert, he found that she could perform jobs such as usher, greeter, and furniture rental consultant.

Issues Presented

Pomales argued that the administrative law judge failed to fully develop the record, that the Appeals Council should have considered new evidence, and that the judge improperly evaluated her statements about her symptoms. The Commissioner argued that the administrative law judge’s decision was supported by substantial evidence and should be affirmed.

Court’s Analysis

The court focused on whether the administrative law judge adequately developed the record concerning Pomales’s mental impairments. Social Security proceedings require the administrative law judge to investigate the facts and develop evidence supporting and opposing benefits. That duty is heightened when a claimant is not represented by a lawyer and when the claimant asserts a mental impairment.

The Social Security regulations require reasonable efforts to obtain necessary medical evidence from treating providers. The record showed that the agency made two requests for records from providers connected to Pomales’s mental-health treatment. But the administrative law judge did not issue subpoenas, did not advise Pomales of the importance of obtaining the records herself, and did not specifically appear to seek opinions from her treating providers about her mental limitations.

The court found an obvious gap in the record. Before issuing his decision, the administrative law judge had no mental-health treatment records or treating-source opinions from Pomales’s mental-health providers. Although Pomales later submitted treatment records and an opinion from Nurse Practitioner Shamara Alterno to the Appeals Council, that submission did not eliminate the administrative law judge’s separate duty to develop the record. The court also found it unclear whether the later-submitted evidence included all of Pomales’s mental-health records or whether other treating sources could provide opinions.

The administrative law judge had relied partly on the view that Pomales received minimal mental-health treatment consisting mainly of medication management and had declined psychiatric referrals. The court concluded that this view was incomplete because the records later submitted to the Appeals Council showed that Pomales had received psychiatric treatment during periods relevant to the disability determination. The court also noted that the administrative law judge found none of the existing medical opinions persuasive, making treating-source information particularly important.

Disposition

The court held that the incomplete record prevented a proper decision about Pomales’s mental limitations and residual functional capacity, meaning the most she could still do despite her impairments. It therefore ordered a sentence-four remand under 42 U.S.C. § 405(g) for further administrative proceedings on a fully developed record. The court did not decide Pomales’s other arguments because the failure to develop the record independently required remand.

The court granted Pomales’s motion for judgment on the pleadings, denied the Commissioner’s cross-motion, remanded the matter for further administrative proceedings, and directed the Clerk of Court to enter judgment in Pomales’s favor.