[William N.] v. Kijakazi, No. 4:20 CV 1422 CDP, 2022 WL 832328 (E.D. Mo. Mar. 21, 2022)

[William N.] v. Kijakazi, No. 4:20 CV 1422 CDP, 2022 WL 832328 (E.D. Mo. Mar. 21, 2022) (Decision by U.S. District Judge Catherine D. Perry)

Briefs Included: 

• Plaintiff’s Brief
• Plaintiff’s Statement of Uncontroverted Facts
• Plaintiff’s Reply Brief

Topics addressed:

• Specific impairments: headaches

• Medical equivalence to a lising

• ALJ must build an accurate and logical bridge from the evidence to his conclusion

• RFC - outdated assessments of the State agency medical consultants

• RFC - failure to consider headaches

• RFC - lack of support for findings

• Subjective complaints - need for specificity

• Improvement does not equal the ability to work 
  

Rulings addressed:

• Social Security Ruling 96-8p

• Social Security Ruling 19-4p

 Issues briefed: 

1)  The ALJ failed to properly evaluate the impact of Plaintiff’s migraine headaches on his ability to work.

2) The ALJ’s RFC assessment, which is based solely on the outdated assessment of a State agency nonexamning medical consultant, is not supported by substantial evidence.

Court decision:
The court found the ALJ inadequately explained what “objective evidence” or “examination findings” were inconsistent with Plaintiff’s statements about his pain relating to his headaches, as he was required to specify those inconsistencies and did not do so. 2022 WL 832328 at *4. The inconsistency between Plaintiff’s pain testimony and his providers’ treatment notes was insufficient for the ALJ to discount it as not credible, since the ALJ cannot pick and choose only evidence supporting his conclusion and should at least “minimally articulate [its] reasons for crediting or rejecting evidence of disability.” Id. at *5.

The ALJ also erred in failing to explain how Plaintiff’s persistent headaches affected his functional abilities to work. Id. Under SSR 96-8p an “RFC assessment must include a narrative discussion describing how the evidence supports each conclusion, citing specific medical facts (e.g., laboratory findings) and nonmedical evidence (e.g., daily activities, observations)” and must resolve inconsistencies in the evidence, and set forth a logical explanation of the effects of symptoms on the individual’s ability to work. Id. The ALJ erred in adopting functional limitations assessed by the State agency nonexamining consultant, since this opinion did not discuss Plaintiff’s headaches, as the bulk of evidence documenting them post-dated his opinion. Id. at *6.

The court emphasized that even though the record shows Plaintiff’s:

headaches improved with medication, “it is possible for a person’s health to improve, and for the person to remain too disabled to work.” Cox v. Barnhart, 345 F.3d 606, 609 (8th Cir. 2003); see also Hutsell v. Massanari, 259 F.3d 707, 712 (“[D]oing well for the purposes of a treatment program has no necessary relation to a claimant’s ability to work or to her work-related functional capacity.”).

The court also held that the opinion of the State agency medical consultant was inconsistent with the medical evidence documenting continuing headaches, and it is not clear that the ALJ attributed any functional limitations to Plaintiff’s headaches. Id. at *6. Therefore, the ALJ’s RFC assessment was not supported by substantial evidence because he ignored medical evidence corroborating Plaintiff’s continuing headaches, did not discuss or consider the effects of Plaintiff’s continuing headaches on his ability to work, and adopted opinion evidence that did not evaluate Plaintiff’s headaches. Id.

The court recognized that under SSR 19-4p “[w]hile uncommon, a person with primary headache disorder may exhibit equivalent signs and limitations to those detailed in listing 11.02 [for Epilepsy] (paragraph B or D for dyscognitive seizures). Id. at *7. The court found the ALJ’s rejection of Plaintiff’s contention that he met this listing was not supported by substantial evidence, because the ALJ did not consider all the evidence relating to Plaintiff’s continuing headaches and did not consider the effects of the headaches on his functional abilities. Id. Moreover, the court noted it was not clear that the ALJ compared Plaintiff’s migraine headaches to both listing 11.02 paragraphs B and D, as the ALJ did not identify either paragraphs in his reasoning, and both paragraphs require different severity and frequency of symptoms. Id. at *7-*8, nt.8.

The court reversed the Commissioner’s final decision and remanded for reevaluation of Plaintiff’s RFC:

which must include an assessment of record evidence and [Plaintiff’s] statements about the intensity, persistence, and limiting effects of his symptoms. This RFC assessment shall be accompanied by a discussion of the evidence in a manner that shows how the evidence supports each RFC conclusion, and how [Plaintiff’s] vestibular migraines and chronic migraines limit his functional abilities. Whether and to what extent the Commissioner finds opinion evidence persuasive in assessing [Plaintiff’s] RFC must be properly informed and supported by the record as a whole.

Id. at *8.