Shelley C. v. Comm’r of Soc. Sec. Admin., 61 F.4th 341 (4th Cir. Feb. 22, 2023) (Decision by Chief Judge Gregory, in which Judges Wynn and Floyd joined)

Shelley C. v. Comm’r of Soc. Sec. Admin., 61 F.4th 341 (4th Cir. Feb. 22, 2023) (Decision by Chief Judge Gregory, in which Judges Wynn and Floyd joined)

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Briefs for purchase:

  • Brief of the Appellant
  • Appellant’s Reply Brief 

Issues briefed:
1) The Commissioner failed to comply with controlling law in evaluating the

opinion of Dr. Beale, Appellant’s longtime treating psychiatrist.

2) The Commissioner reversibly erred by failing to properly assess Appellant’s allegations and subjective complaints.

Court decision:
The Fourth Circuit held that (1) the ALJ failed sufficiently to consider the requisite regulatory factors set forth in 20 C.F.R. § 404.1527(c)(1)-(6) and the record evidence by extending little weight to the opinion of Shelley C.’s longtime treating psychiatrist; (2) the ALJ improperly disregardedg Shelley C.’s subjective statements; and (3) in an issue of first impression, “the“ALJ’s analysis did not account for the unique nature of the relevant mental health impairments, specifically chronic depression.” 61 F.4th at 341, 346. As the court held that “substantial evidence clearly establishes Shelley C.’s disability,” the Fourth Circuit reversed and remanded “with instructions to grant disability benefits.”
Id. at 369.

In addressing the issue of first impression – the evaluation of chronic depression – the court explained:

In Arakas, we held that ALJs could not rely upon the absence of objective medical evidence to discredit “a claimant’s subjective complaints regarding symptoms of fibromyalgia or some other

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disease that does not produce such evidence.” 983 F.3d at 97 (emphasis added). Today, we hold that depression — particularly chronic depression — is one of those other diseases. Characterized as a “mood disorder,” [Major Depressive Disorder (MDD)] “causes a persistent feeling of sadness and loss of interest . . . it affects how you feel, think and behave[.]” . . . Notably, the DSM-V declares that “no laboratory test has yielded results of sufficient sensitivity and specificity to be used as a diagnostic tool for [MDD.]” But most importantly, “[s]ymptoms caused by major depression can vary from person to person.” (emphasis added). Stated differently, symptoms of MDD, like those of fibromyalgia, are “entirely subjective,” determined on a case-by-case basis. Arakas, 983 F.3d at 96 (emphasis added). Ultimately, because of the unique and subjective nature of MDD, subjective statements from claimants “should be treated as evidence substantiating the claimant’s impairment.” Id. at 97-98.

61 F. 4th at 361-62 (citations omitted) (citing Arakas v. Comm’r, Soc. Sec. Admin., 983 F.3d 83 (4th Cir. 2020)). After the issuance of the decision, the Commissioner filed a Petition for Rehearing seeking to delete this paragraph of the decision, which was denied.

The court also commented on the ALJ’s “deep misunderstanding of mental health impairments, particularly severe depression.” Id. at 356. The court cited from decisions in other circuits in observing:

The fact is “people with chronic diseases can experience good and bad days” even “under continuous treatment for it with heavy drugs.” Schink v. Comm’r of Soc. Sec., 935 F.3d 1245, 1267 (11th Cir. 2019). “Suppose that half the time she is well enough that she could work, and half the time she is not. Then she could not hold down a full-time job.” Id. (citing Bauer v. Astrue, 532 F.3d 606, 609 (7th Cir. 2008); Singletary v. Bowen, 798 F.2d 818, 821 (5th Cir. 1986)).

Id. at 357. The Fourth Circuit “joined our sister circuits’ growing conversation surrounding chronic diseases, highlighting, in particular, the unique and subjective nature of chronic depression.” Id. at 368.

The court further commented on the ALJ’s finding that Shelley C.’s treatment regimen was “routine and conservative,” stating:

A growing number of district courts have held that in cases where claimants consume antidepressant, anticonvulsant, and/or antipsychotic drugs, consistently attend visits with mental health professions, and endure constant medication adjustment and management, their treatment is classified as anything but “routine and conservative.” Thus, at a

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minimum, Shelley C.’s constant medication management and sessions with Dr. Beale and Bernstein cannot be so classified.

Id. at 363. The court commented that when “medication management did not appear to abate her symptoms with any longevity, Dr. Beale recommended that Shelley C. enroll in either TMS or ECT,” treatment which are “only offered and administered tothosewiththemostseverecasesofdepression.”Id.at363-64. “Overlookingthe extensive and nuanced treatment Shelley C. received, the ALJ inappropriately ‘play[ed] doctor in contravention of the requirements of applicable regulations’ Lewis, 858 F.3d at 869 (cleaned up), by concluding that her treatment was “‘routine and conservative.’” Id. at 364 (citing Lewis v. Berryhill, 858 F.3d 858, 861 (4th Cir. 2017)).

The court also held that the ALJ erred by improperly increasing Shelley C.’s burden of proof in requiring that her subjective statements be validated by objective medical support. Id. at 362. The court found the ALJ erred in discounting Shelley C.’s subjective complaints upon the belief that they were not corroborated by the record’s medical evidence, noting “the Fourth Circuit has long held that ‘while there must be objective medical evidence of some condition that could reasonably produce the pain, there need not be objective evidence of the pain itself or its intensity.’” Id. at 360 (citation omitted). Accordingly, the court found Shelley C. was entitled to rely entirely on subjective evidence to demonstrate that her condition was sufficiently persistent and severe to support a disability finding, and that the record contained no shortage of such evidence. Id. at 360-61.

Regarding the evaluation of Shelley C.’s treating psychiatrist, the Fourth Circuit held that the ALJ not only failed to properly consider or acknowledge the regulatory factors, the ALJ failed to identify which medical evidence in “Shelley C.’s extensive record presented inconsistencies with Dr. Beal’s opinion.” Id. at 354-55. The ALJ is required to provide a “narrative discussion of how the evidence supported his conclusion and, as such, the analysis is incomplete and precludes meaningful review.” Id. at 34 (citing Arakas, 983 F.3d at 106) (citing Monroe v. Colvin, 826 F.3d 176, 190-91 (4th Cir. 2016) (cleaned up)). Additionally, that his opinion briefly touched on an opinion reserved for the Commissioner, did not allow the ALJ to “extend ‘little weight’ to the entire opinion on this ground.” Id. at 356 (emphasis in original). The court concluded that, consistent with his opinion, Dr. Beale’s treatment notes reveal that Shelley C. suffers from significant and severe symptoms that would undoubtedly hinder her from performing even basic work activities. Id. at 358.

Finally, the Fourth Circuit held that the ALJ had “inadequately grappled with the unique nature of Shelley C.’s mental health impairments, particularly chronic depression,” and that if “analyzed correctly, Shelley C.’s depression demonstrated both marked and extreme limitations that would instantly qualify her as disabled.” Id. at 364. Thus, the court concluded that substantial evidence in the record clearly established Shelley C.’s disability, and reversed the Commissioner’s decision and remanded with instructions to grant disability benefits. Id. at 369.

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Topics addressed:

  • Specific impairments - depression

  • Treating physician opinions (old law) - good casue

  • Treating physician opinions (old law) - regulatory factors

  • Treating physician opinions (old law) - issue reserved to the Commissioner

  • Subjective symptoms - treatment regimen

  • Subjective symptoms - improper focus on objective evidence

  • Remand for an award of benefits

  • Comm’r Brief - misstatement of evidence

  • Post hoc justification

    Rulings addressed:

  • Social Security Ruling 92-2p (old law)

  • Social Security Ruling 96-8p