Abel J. v. Kijakazi

Background

Abel J. applied for a period of disability and disability insurance benefits in December 2014. After the Commissioner denied the application, the case was remanded for further proceedings in an earlier round of the case. Following another hearing, the administrative law judge again found that Abel J. was not disabled. The Appeals Council denied further review, and Abel J. filed this action under 42 U.S.C. § 405(g) seeking judicial review.

The parties submitted a joint stipulation instead of separate motions for judgment on the pleadings. The administrative law judge found that Abel J. had not engaged in substantial gainful activity from the alleged onset date of April 30, 2014, through the date last insured of March 31, 2019. The judge found severe impairments including seizure disorder, bipolar disorder, and a history of opioid dependence. The judge concluded that Abel J.’s seizure disorder did not meet or equal Listing 11.02, concerning seizure disorder, partly because of alleged failure to comply with anti-seizure medication. The judge then found that Abel J. could perform medium work with limitations and that jobs existed in the national economy that he could perform.

Standard of Review

The court reviewed whether substantial evidence supported the Commissioner’s findings and whether the correct legal standards were applied. Substantial evidence means relevant evidence that a reasonable person could accept as adequate to support a conclusion. The court could not decide independently whether Abel J. was disabled; it had to review the administrative record.

Because Abel J.’s claim was filed before March 27, 2017, the treating physician rule applied. Under that rule, a treating physician’s opinion generally receives controlling weight when it is well supported by medically acceptable techniques and is not inconsistent with other substantial evidence. If the administrative law judge declines to give such an opinion controlling weight, the judge must provide good reasons and consider relevant factors, including the treatment relationship and the physician’s specialization.

Analysis

The court held that the administrative law judge failed to properly evaluate the evidence at step three of the disability analysis. The judge rejected the opinions of Abel J.’s treating physicians, who diagnosed epilepsy and described the frequency and severity of the seizures, but did not provide a good reason for doing so. The stated reason—that the ultimate disability determination was reserved to the Commissioner—did not permit the judge to disregard the treating source’s entire opinion. The judge still had to evaluate the supporting medical evidence.

The court also found that the administrative law judge misapplied the treatment-noncompliance doctrine. An administrative law judge may consider unjustified failure to follow prescribed treatment, but the claimant must be informed that noncompliance can lead to denial of benefits and must have an opportunity to explain or challenge the alleged failure. The record also must be developed concerning whether the failure was justified.

The administrative law judge did not further develop the record before relying on the opinion of medical expert Dr. Pollack to conclude that Abel J. was noncompliant and therefore did not satisfy Listing 11.02. The court found that reliance insufficient, particularly because the record included treating physicians’ descriptions of seizures as intractable while taking Dilantin and evidence that different medications had been tried. The court also found that the judge did not properly consider this evidence or Abel J.’s testimony.

Disposition

Judge Ona T. Wang granted Abel J.’s motion for judgment on the pleadings and denied the Commissioner’s motion for judgment on the pleadings. The case was remanded for further proceedings consistent with the opinion and order. The court directed the Clerk to enter final judgment and close the file. The opinion did not award benefits or determine that Abel J. was disabled.