Court: District Court, D. Rhode Island; July 1, 2015; Federal District Court
Mr. Renaud's Motion for Reversal of an Administrative Law Judge's (ALJ) decision denying his claim for supplemental security income (SSI) benefits is addressed. The ALJ initially denied the claim, concluding that Renaud was not under a disability and had the residual functional capacity (RFC) to work as a customer service representative. The ALJ found that Renaud did not have a severe anxiety impairment, despite acknowledging other severe impairments such as coronary heart disease, sleep apnea, and diabetes.
Renaud's claim for disability included multiple conditions, including anxiety characterized by frequent panic attacks. The Court finds that the ALJ's determination regarding the severity of Renaud's anxiety disorder lacked substantial evidence and failed to adequately consider the opinions of treating and consultative experts. Additionally, the ALJ did not sufficiently explain the dismissal of Renaud's claims about the limitations imposed by his anxiety. As a result, the Court remands the case for the ALJ to reconsider the severity of Renaud's anxiety disorder, as this finding is crucial to the overall RFC determination.
A mental state impairment assessment requires evaluating four functional areas: daily living activities, social functioning, concentration and persistence, and episodes of decompensation, per 20 C.F.R. 404.1520a(e)(3). In this case, there was no evidence of decompensation. Evidence of Mr. Renaud's anxiety disorder, characterized by panic attacks, was gathered from his treating physicians, state agency consultants, and his testimony.
Dr. Jeffrey Borkan, Mr. Renaud’s primary care physician since 2005, diagnosed him with a severe panic and anxiety disorder that significantly impaired his ability to work. Dr. Borkan began treatment with Buspar in July 2012, switched to Prozac by November 2012, and noted that despite dosage increases, Mr. Renaud's daily panic attacks would render work "difficult to impossible" by January 2013. Although there was slight improvement in February 2013, by April, Mr. Renaud reported returning to daily panic attacks. By July 2013, medication was adjusted to include Paxil and Klonopin due to inadequate control from Prozac.
Dr. Priya Kholi also treated Mr. Renaud, noting in June 2013 that his significant depression and anxiety, alongside other impairments, made full-time work unfeasible, citing fatigue as a notable effect of his anxiety. Psychologist Cara Fuchs provided therapy for Mr. Renaud from November 2012 to June 2013, helping him face situations like going to the supermarket alone. However, reports of daily panic attacks persisted, indicating instability in his condition.
Consulting physicians provided additional assessments. Dr. Ghulam Mustafa Surtí’s psychiatric examination in November 2012 revealed normal memory and concentration, but noted Mr. Renaud's anxious demeanor and assigned a GAF score of 45-50, diagnosing severe panic disorder without agoraphobia. Dr. Surtí concluded that Mr. Renaud’s symptoms impaired his employment capabilities. State agency psychologist Stacey Fiore reviewed the file on November 19, 2012, identifying a severe anxiety disorder with significant limitations in social functioning and work capacity, concluding that Mr. Renaud could manage only minimal social demands and simple routines.
Medical records indicate that Mr. Renaud frequently visited Memorial Hospital's emergency room due to chest pain, which was ultimately attributed to anxiety rather than cardiac issues. Notable visits occurred on multiple dates in 2012 and 2013. Consulting physician Surti noted that Mr. Renaud experienced several panic attacks weekly, with some so intense that he believed he was having a heart attack, prompting ER visits.
In his testimony, Mr. Renaud linked his health issues to his triple bypass surgery in 2011. Initially, he returned to work at an insurance call center, but soon after began experiencing anxiety attacks that led to an emergency hospital visit and the placement of a cardiac stent. These anxiety attacks intensified, occurring 2-3 times a day without medication, and 3-4 times a week with treatment, ultimately preventing him from working. He described difficulties with daily activities, such as driving and grocery shopping, and noted that his social life had diminished significantly, limited to interactions at home with his close family.
The standard of review for the district court regarding the Commissioner’s decision emphasizes that findings supported by substantial evidence are conclusive. 'Substantial evidence' is described as more than a mere scintilla and must be evaluated in the context of the entire record. The court should refrain from reinterpreting evidence or substituting its judgment for that of the Secretary, resolving conflicts in evidence as the Commissioner's responsibility. An ALJ's decision may be reversed if incorrect law is applied or if insufficient reasoning is provided for the decision.
Remand is unnecessary if all essential evidence was available to the Appeals Council at the time of its decision, clearly establishing that the claimant is disabled, as noted in Seavey v. Barnhart. Mr. Renaud contests the ALJ's Step 2 determination that his anxiety disorder was not severe, arguing the conclusion lacks substantial evidence. He points to the rejection of opinions from several treating and consulting physicians, including Dr. Borkan, Dr. Surt, Dr. Fiore, and medical expert Dr. Kaplan. Out of six experts, four assessed the severity of Mr. Renaud's anxiety and its workplace impact, yet the ALJ assigned little weight to their opinions.
The ALJ also deemed Mr. Renaud not fully credible regarding his limitations without adequately explaining the reasoning behind discounting his testimony. A treating physician's opinion should generally receive controlling weight unless unsupported by substantial evidence or inconsistent with the overall record. In this case, the ALJ dismissed Dr. Borkan’s assessment of Mr. Renaud's panic attacks as inconsistent with the record, but failed to clarify how the record contradicted it. Moreover, mere inconsistencies do not automatically justify rejecting a treating physician's opinion, especially when it aligns with other treating physicians’ assessments.
Dr. Fiore, while indicating moderate impairment, acknowledged the severity of Mr. Renaud's anxiety disorder. The ALJ must provide clear and convincing reasons to reject a treating physician's opinion when no other physician contradicts it. Mr. Renaud’s testimony regarding his panic attacks aligns with Dr. Borkan's assessment, suggesting significant interference with his daily activities. The ALJ also minimized Dr. Surt's opinion based on subjective complaints, despite recognizing that such complaints are crucial for assessing mental health conditions per Social Security regulations. These regulations express that subjective complaints cannot be disregarded merely due to lack of objective medical evidence.
In Adaire v. Colvin, the court examined the assessment of Mr. Renaud's mental health by Dr. Surtí, who assigned him a GAF score of 45, indicating serious symptoms or impairment in functioning. Dr. Surtí observed Mr. Renaud exhibiting anxious effects and a nervous mood, corroborating his clinical opinion with subjective complaints. The Administrative Law Judge (ALJ) questioned Mr. Renaud’s credibility regarding his anxiety attacks, suggesting inconsistencies in his memory and concentration without expert evidence to support this assessment, which is deemed impermissible. Mr. Renaud expressed a desire to return to work, and the ALJ acknowledged his work history as supporting his credibility. However, the ALJ partially discredited Mr. Renaud's claims about the severity of his anxiety attacks, lacking specific reasons for this rejection. The ALJ's findings did not adequately address the limitations imposed by these panic attacks, and Mr. Renaud's treating physician’s actions—prescribing and increasing medication—indicated belief in the severity of his symptoms. The court noted that the ALJ’s conclusion regarding the non-severity of Mr. Renaud's anxiety disorder was unsupported by medical opinion, emphasizing that it is beyond the ALJ's lay qualifications to make such determinations without expert testimony. Consequently, there was a significant disconnect between Mr. Renaud's reported symptoms and the ALJ's description, leading to an inadequate evaluation of the impact of his anxiety disorder on his functioning.
The ALJ's credibility assessment of Mr. Renaud's testimony appears unsupported, as no clear explanation is provided for why his testimony was deemed not fully credible. Mr. Renaud demonstrated significant capabilities in August 2012, such as shopping and driving, but by the time of the hearing, his anxiety had intensified, resulting in a sheltered lifestyle where he rarely left home without his mother. His limitations significantly impact his employability, particularly his inability to work in settings with multiple employees or tolerate crowds. The vocational expert failed to adequately consider Mr. Renaud's agoraphobia in their assessment, undermining its reliability. Moreover, Mr. Renaud's reported symptoms, including daily panic attacks, align with both treating and consulting physicians' medical opinions, with no evidence indicating exaggeration of his condition. The Social Security Act is intended to be liberally construed to support claimants, emphasizing that individuals should be viewed as beneficiaries of a social insurance program rather than recipients of government assistance. The ALJ's rejection of consistent medical opinions and Mr. Renaud's testimony lacks adequate justification, necessitating a reconsideration of the Step 2 finding regarding the severity of Mr. Renaud's anxiety disorder. The case is therefore remanded for further review.
Mr. Renaud presented evidence of hypertension, hyperlipidemia, and HIV, which the ALJ deemed non-severe as they resulted in only minimal limitations on his ability to perform basic work activities. Consequently, further discussion of these conditions was deemed unnecessary due to the remand for reconsideration of Mr. Renaud’s anxiety disorder at Step 2 of the evaluation process. The ALJ's review follows a well-established sequential five-step process:
1. Determine if the claimant is engaged in substantial gainful activity; Mr. Renaud had not worked since June 6, 2012, and this finding was unchallenged.
2. Assess whether the claimant suffers a severe condition that significantly limits work-related functions; the ALJ found certain impairments disabling but excluded the anxiety disorder.
3. Examine impairments listed in 20 CFR Part 404, Subpart P, Appendix A, which was not at issue here.
4. Determine the claimant’s residual functional capacity (RFC) if a severe impairment is found; the ALJ’s RFC finding was criticized for not accounting for the severe anxiety impairment.
5. If the claimant cannot perform past relevant work, the Commissioner must demonstrate available work in the economy, which was not reached in this case.
The Commissioner argued that the ALJ's finding of Mr. Renaud’s anxiety disorder as non-severe should be upheld based on insufficient evidence of the disorder lasting 12 months. However, the Court noted that the ALJ did not base their decision on this durational criterion, emphasizing that agency decisions must be upheld based on the reasons articulated in the original order. It was established that Mr. Renaud had documented complaints of anxiety and panic attacks for approximately 12 months, with ongoing treatment and substantial medical documentation supporting the persistence of his symptoms.
The Commissioner based findings on treatment notes from April 2013, where Mr. Renaud reported no recent panic attacks to psychologist Dr. Cara Fuchs, though the lack of specificity about "recent" and subsequent notes suggested this absence was short-lived. Mr. Renaud attended both group and individual therapy sessions shortly thereafter, with a treatment note by June 11, 2013, indicating weekly anxiety attacks with chest pain. By July 2013, he testified to experiencing these attacks 3-4 times weekly. State agency expert Dr. Stacey Fiore classified Mr. Renaud’s anxiety as a severe impairment likely lasting at least 12 months. Dr. Borkan diagnosed him with Somatization Disorder on April 1, 2013, and Dr. Fuchs later noted symptoms indicative of major depression. Medical expert Dr. Stephen Kaplan acknowledged the well-documented nature of Mr. Renaud's panic disorder and suggested his atypical chest pain could stem from anxiety, although he did not provide direct evidence on the anxiety itself.
Mr. Renaud criticized the ALJ for not addressing this evidence, arguing it constituted a failure to evaluate all medical opinions as mandated by regulation; however, the ALJ did not dispute the existence of a panic disorder, focusing instead on its severity. A GAF score of 41 to 50 indicates serious impairment in functioning. The ALJ assigned little weight to Dr. Surti’s opinion, citing its reliance on subjective complaints rather than objective evaluations showing Mr. Renaud's cognitive abilities were intact. The ALJ’s conclusion was criticized for potentially relying on lay understanding rather than expert testimony. Medical assessments during a stay in July 2012 showed no cardiac abnormalities despite complaints of chest tightness, and earlier visits for chest pain were noted. Mr. Renaud's testimony also highlighted physical health issues impacting his daily activities, such as needing rest during household tasks due to impairments from neuropathy and edema. As the ALJ acknowledged Mr. Renaud's severe physical impairments and the case is being remanded for reevaluation of the Step 2 determination, a detailed recount of physical impairment evidence is deemed unnecessary. Vocational expert Dr. Thomas Bennett had submitted an opinion prior to Mr. Renaud formally presenting his anxiety disorder.
Dr. Kaplan, a vocational expert, provided an opinion regarding the claimant's work capacity without considering the impact of his panic disorder. The rejection of an expert's opinion based on a claimant's subjective complaints is only warranted if the credibility of those self-reports is properly questioned. Although Mr. Renaud's Motion to Reverse does not directly dispute the ALJ's assessment of his credibility, the credibility of Mr. Renaud's claims about his panic attacks is integral to the ALJ's determination that his anxiety disorder does not significantly limit his ability to perform basic work activities and is thus non-severe.
The ALJ deemed Mr. Renaud's allegations not fully credible, citing treatment notes that did not support claims of a disabling condition. Medical records indicated stable cardiac conditions and satisfactory management of diabetes, with minimal physical limitations. While Mr. Renaud testified to significant functional limitations due to edema, there was scant evidence in his medical records to substantiate this claim. He also indicated he could perform daily activities with minor difficulty, supported by an impartial medical expert's conclusion that he could work at a sedentary level.
The ALJ acknowledged Mr. Renaud's limitations but found them less severe than claimed. In assessing daily living activities, the ALJ noted Mr. Renaud's ability to perform self-care and some household tasks, drive, and manage finances, without recognizing his testimony that his anxiety had deteriorated post-claim, preventing him from shopping or driving alone due to panic attacks. Although he had previously reported being able to drive alone, by the hearing date, he required his mother's company for these activities.
In terms of social functioning, the ALJ reported only mild limitations, noting Mr. Renaud's ability to interact socially, albeit not fully accounting for his distinction between pre- and post-panic attack capabilities. His attempts to return to work were hindered by frequent panic attacks, which he described in detail. The ALJ found mild limitations in concentration and persistence but noted no evidence of episodes of decompensation.
