Saturday, March 25, 2006

disability - failure to keep exam. appt. - VE hypo

Williams v. Barnhart - ED Pa. - March 17, 2006

ALJ should have sought a psychiatric evaluation of claimant (CL) even where CL had failed to keep prior appointment for consultative exam. CL did not offer any reason for missing the appt., but neither did the ALJ inquire into the matter at the hearing. Failure to appear for a scheduled exam "is rarely seen as a definitive bar to benefits....[C]ourts will look to see if the ALJ had substantial evidence for his decision in the absence of the evaluation."

There was no such substantial evidence in this case. The ALJ improperly rejected the CL's subjective complaints w/o an adequate explanation. The CL had been hospitalized at least 2x for depression, attends an outpatient psych. treatment program 4 days/week, and has an intensive case manager, who (along with CL's daughter) assists in activities of daily living. The objective evidence, as well as the CL's subjective complaints, point to the need in this case for a psychiatric evaluation.

The ALJ also erred in by failing to explain his reasons for rejecting CL's attorney's supplemental hypo to the VE, which included the CL's subjective complaints. The hypo must reflect all of a CL's impairments that are supported by the record.

Case remanded.

social security disability case - multiple issues

Thompson v. Barnhart - ED Pa. - March 15, 2006

This case was remanded because the ALJ decision not supported by substantial evidence and ALJ did not apply correct legal standards.

de facto reopening
Claimant (CL) had filed several prior applications. The ALJ decision being reviewed by the court constituted a de facto reopening of the case. "'Where the administrative process does not address an earlier decision but instead reviews the entire record in the new proceeding and reaches a decision on the merits, the agency has effectively reopened the prior claims and waived application of res judicata.'"

failure to follow remand order
The Commissioner had moved for a remand earlier in the case, stating that it would benefit from further inquiry into CL's mental status, "including obtaining a mental status evaluation and a medical source statement...." The ALJ did not order a further examination but rather got the expert opinion of a non-examining psychiatric expert. This was error. "Medical source statements are to be based on the medical sources' records and examination of the individual; i.e., their personal knowledge of the individual.'" SSR 96-5p, 1996 Lexis 2, at *11 (emphasis supplied by court).

use of GAF
The ALJ found the the CL's mental impairment was non-severe, despite one GAF score of 50. The Commissioner argued in court that GAF assessments are not reliable indicators of mental functioning because they are subjective and vary among practitioners. The court rejected this argument, stating that "[w]hile this response may in fact be true, the ALJ did not include that same critique of GAF score in his decision, and this Court can only review the decision on the basis upon which it was made. Fragnoli v. Halter, 247 F.3d 34, 43-44 n. 7 (3d Cir. 2001). The Court also said that if the ALJ were to reject the GAF score, case law required that he explain his reason for doing so, citing Cotter v. Harris, 642 F2d 700, 707 (3d Cir. 1981) and other ED Pa. cases specifically involving GAF scores.

hypo to vocation expert not complete
In his hypo to the VE, the ALJ omitted some of the mental limitations that he had found to exist. The hypo 'must include all of a claimant's impairments that are supported by the record. Ramirez, 372 F3d 546, 552 (3d Cir. 2004). As in Burns, 312 F3d 113, 122-3 (3d Cir. 2002), a reference to simple tasks does not specifically convey the claimant's intellectual limitations; greater specificity is required."

onset date
The ALJ chose an onset date based solely on the fact that SSI benefits are not retroactive and the chosen date was the earliest he could have awarded benefits under the SSI law, i.e. "for no other reason than the fact that [the claimant] filed a piece of paper on that day." This was not consistent with SSR 83-20, which provides an analytical framework for determining an onset date.