Summary
This memorandum opinion from the U.S. District Court for the Eastern District of Missouri reviews the Commissioner of Social Security’s denial of Disability Insurance Benefits to plaintiff Sonya Usher. The court found that the Administrative Law Judge’s residual functional capacity assessment lacked support from substantial medical evidence in the record, particularly given the plaintiff’s prior remand on identical grounds. Consequently, the court reversed the agency’s decision and remanded the case for further proceedings consistent with the opinion’s guidance on developing the record.
Topics
Practice areas
Questions Presented
- Whether the ALJ's residual functional capacity assessment was supported by substantial evidence, including some medical evidence addressing Plaintiff's ability to function in the workplace.
- Whether the ALJ failed to fairly and fully develop the administrative record regarding Plaintiff's functional capacity.
- Whether the ALJ conducted a proper evaluation of Plaintiff's pain complaints.
Holdings
- The ALJ's residual functional capacity assessment was not supported by substantial evidence because the record lacked medical opinion evidence or other medical evidence addressing Plaintiff's ability to perform work-related activities, and the available treatment evidence appeared inconsistent with the assessed capacity for medium work.
- The ALJ was required to further develop the record because the existing medical evidence was insufficient to support a determination of Plaintiff's ability to function during the relevant period.
Key quotations
“Because a claimant’s RFC is a medical question, an ALJ’s assessment of it must be supported by some medical evidence of the claimant’s ability to function in the workplace.” (Section V)
“Well-settled precedent confirms that the ALJ bears a responsibility to develop the record fairly and fully, independent of the claimant’s burden to press his case.” (Section V)
“Accordingly, IT IS HEREBY ORDERED, ADJUDGED, AND DECREED that the decision of the Commissioner of Social Security is REVERSED and that this case is REMANDED under Sentence Four of 42 U.S.C. § 405(g) for reconsideration and further proceedings consistent with this opinion.” (Section VI)
Factual background
In November 2015, Sonya Usher fell from monkey bars and fractured her left leg, requiring surgery in December 2015. Treatment and physical therapy continued through April 2016, with persistent pain, inability to bear weight, reduced strength, and limited knee range of motion; at the final therapy appointment she used crutches and remained non-weightbearing. She testified that she had substantial limitations in standing, walking, lifting, and using stairs, and that she stopped receiving treatment because she lacked insurance.
Procedural history
Plaintiff applied for Disability Insurance Benefits in July 2019, and the application was denied initially and on reconsideration. Following a hearing, an ALJ found her not disabled in November 2020; the Appeals Council denied review. The district court previously remanded the case on March 30, 2023, because the residual functional capacity was not supported by some medical evidence addressing Plaintiff's workplace functioning. After a second hearing, the ALJ again found Plaintiff not disabled on February 22, 2024. The court reversed that decision and remanded for further proceedings.
Remand instructions
Remand under Sentence Four of 42 U.S.C. § 405(g) for reconsideration and further proceedings. The ALJ should further develop the record concerning Plaintiff's ability to function during the relevant time frame, potentially through a treating-physician inquiry, consultative examination, or medical-consultant review, and should evaluate Plaintiff's pain complaints under the relevant regulatory and case-law factors, including her lack of insurance and inability to afford ongoing treatment.