Administrative law judges overseeing Social Security Disability Insurance benefits claims do have a fair amount of discretion in determination of cases. They can decide whether certain expert witnesses deserve more credence than others, if some evidence should be discounted and whether they find the claimant to be believable.
However, our Boston Social Security Disability Insurance attorneys recognize that despite the sometimes subjective nature of these proceedings, there is an important check on these powers in the form of the appellate courts. If the ALJ does not provide adequate reasoning for the conclusion reached, the appellate courts have the option to reverse.
In the recent case of Garrison v. Colvin, the U.S. Court of Appeals for the Ninth Circuit found the ALJ’s rejection of an SSDI claim failed to meet the standard of offering specific, clear and convincing reasoning. Further, the appellate court found evidence in the case afforded “no doubt” as to the fact the claimant was disabled. Therefore, the court not only remanded, but did so with instructions to reach a finding of disability and determine an award amount.
According to court records, the claimant, who was 37 at the time of her initial claim in 2007, had previously worked as a bus driver, cashier, convenience store clerk, customer service manager and pizza cook.
She asserted she’d been disabled due to a combination of physical and mental impairments. Those ailments included chronic back and neck pain, sciatica, degenerative joint disease, obesity, asthma and herniated discs. Although she had received a variety of treatments, many of these conditions either continued or got worse. An especially serious problem was her neck and back pain. No treatments appeared to help, and it was slowly creeping into her shoulders, arms and legs. It was interfering with her daily life. Her primary care doctor noted the radiating pain, and observed prolonged standing and turning her head aggravated the condition.
The doctor also took note of what the patient described as “seizures,” but what he indicated were more than likely panic attacks, in which she “heard voices yelling at her” and her body began to seize up. These episodes continued despite treatment, and affected her ability to concentrate or complete certain tasks in a timely manner.
A second doctor also indicated the patient suffered severe neck and back pain, which remained constant, despite epidural steroid injections and physical therapy.
The patient underwent a hysterectomy, which abated some, but not all symptoms, for a time. However, her medications made her extremely lethargic, and she stopped taking several. This then made the pain worsen.Her feet began to feel as if they were “on fire.”
She also began to experience powerful headaches that affected her ability to function. Doctors additionally diagnosed her with insomnia, anxiety, depression, paranoia, post-traumatic stress disorder and possibly bipolar disorder. Additionally, her full scale IQ was placed at 77, which is in the 6th percentile, meaning she was of “borderline intelligence.” Her short-term memory was listed at boderline and concentration in the low range. She performed very poorly complex tasks requiring concentration. She also burst into tears at numerous points during testing, with doctors noting she did not have sufficient emotional control.
Both doctors indicated the patient’s prognosis for returning to work is poor. She could barely complete a grocery shopping trip without having a panic attack, even despite being on powerful medications to control these issues. Her mother had taken to caring for her – driving her to church, doctor’s appointments, to the grocery store and doing her laundry.
Despite this, the ALJ issued a decision finding the claimant was not disabled. She concluded the claimant might be limited to simple work, but she was capable of performing past relevant work. The ALJ found the claimant’s testimony to be “inconsistent” and reasoned her mental health was functional so long as she took her medication (this was contrary to what the medical professionals had indicated). Conceding she gave “little weight to the medical opinions reflected in these assessments,” the ALJ rejected the claim for benefits.
Upon review, the district court found there was not enough sufficient explanation from the ALJ as to why she did not fully consider the opinions of the two treating physicians. The court therefore remanded the case back to the ALJ.
The woman appealed, arguing the district court abused its discretion by remanding the case for further proceedings, as opposed to remanding for a calculation and award of benefit. The U.S. Court of Appeals for the Ninth Circuit agreed.
The appellate panel found the ALJ erred in rejecting the medical opinions of two treating physicians, that she misunderstood the administration doctor’s opinion regarding the woman’s impairments and she failed to offer any clear, specific and convincing basis for her rejection of the claimant’s personal testimony.
Therefore, the ruling was reversed and the case remanded for calculation of benefits.
If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at (617) 777-7777.
Garrison v. Colvin, July 14, 2014, U.S. Court of Appeals for the Ninth Circuit
More Blog Entries:
Millions of Americans Eligible for Social Security Disability, Aug. 30, 2014, Boston Social Security Disability Lawyer Blog