ALJ’s Omitted Reason For Disability Decision Troubles 7th Circuit

An administrative law judge’s failure to meet the minimum requirement of explaining her decision in a disability benefits case drew criticism from the 7^th Circuit Court of Appeals on Friday.

In the case of Susan Spicher v. Nancy Berryhill, 17‐3399, an ALJ failed to explain her reasoning as to why she denied Susan Spicher’s request for social security disability insurance benefits and supplemental security income.

Spicher suffers from a series of chronic health problems, including osteoarthritis, degenerative disc disease, chronic obstructive pulmonary disease, fibromyalgia and morbid obesity. She applied for benefits in 2010, dating her limitations back to 2003.

Spicher’s case has come up for judicial review twice, and both times the ALJ concluded that Spicher had not become disabled until September 20, 2012. At the second hearing in 2016, Spicher narrowed her case, focusing on whether she had been disabled since December 31, 2008, when her insured status expired.

The ALJ reconsidered Spicher’s obesity in consulting with a second doctor but said those findings did not motivate her to change her decision, which rested on her finding that Spicher could hold a sedentary position and perform three jobs identified by a vocational expert. In addition, the ALJ found Spicher could occasionally crouch, crawl, balance, stoop and kneel.

However, Spicher argued the ALJ did not address contradictory medical evidence when determining the types of sedentary jobs that Spicher could hold and that the ALJ failed to consider the interaction between her obesity and her non‐severe impairments.  The 7^th Circuit Court agreed with Spicher’s arguments, noting that although the ALJ is not required to adopt the recommendations of an examining physician, she must provide enough analysis to allow a reviewing court some idea of why she rejected significant evidence that cut against her conclusion.

At the second hearing, the ALJ did not address either of her residual‐functional‐capacity findings that were undercut by the consultative examiner, Dr. Crystal Strong. Strong concluded Spicher was severely overweight, “recommended that she does not have a completely sedentary job” and said she can ambulate for up to 20 minutes at a time with rests in between.

Despite according “great weight” to Strong’s findings and opinions, the ALJ omitted them in her required analysis.

“Because Dr. Strong’s recommendation suggested further limitations, it contradicted the ALJ’s finding on residual functional capacity,” Chief Judge Diane Wood wrote for the panel. “the ALK was therefore required to provide enough analysis to allow a reviewing court to determine why she rejected it. Because the ALJ failed to do so, her decision to deny benefits cannot satisfy the substantial evidence standard.”

Other findings by Strong concluded that Spicher could not, in fact, balance, stoop, kneel, crouch and crawl, as the ALJ had decided she could. Findings also showed Spicher’s inability to walk on her heels cast doubt in the 7^th circuit on the ALJ’s finding that Spicher could regularly balance.

“The ALJ did nothing to address these concerns,” Wood said. “That alone is a ground for remand.”

Finally, the 7^th circuit found the ALJ ignored the interaction between Spicher’s obesity and her non‐severe impairments, including prolonged effects of a humerus fracture and carpal tunnel syndrome.

It concluded that on remand, the ALJ must address—but is not required to accept—Strong’s recommendation that Spicher regularly ambulates, address the evidence in Strong’s report that Spicher could not perform certain postural activities and account for the effects of Spicher’s humerus fracture and carpal tunnel syndrome.