210 F. Supp. 3d 1198
D.S.D.2016Background
- James Dillon applied for Title II disability insurance benefits alleging onset Feb 3, 2009; insured through Dec 31, 2009. ALJ denied benefits on Nov 21, 2013; Appeals Council denied review.
- Medical history during the relevant period: diagnosed bipolar disorder, anxiety with panic, impulse control disorder, diabetes, recurrent right-leg DVT, lumbar degenerative disease, and sleep apnea. Records show episodes of hospitalization for DVT in Feb 2009 and recurrent leg swelling; intermittent treatment and use of TED hose.
- VA granted Dillon 100% disability and housebound status in Dec 2009 for service-connected bipolar disorder and right leg DVT. The ALJ did not discuss the VA disability rating in the decision.
- Treating physician Dr. Kaplan stated (via questionnaire) that in 2009 Dillon medically needed to elevate his legs periodically during the workday; the ALJ rejected this opinion as attorney-precipitated and inconsistent with records.
- ALJ found Dillon could perform a range of light work (RFC adopted) and relied on vocational testimony identifying light jobs. The vocational expert testified, however, that the jobs identified would not permit the leg-elevation accommodation Dr. Kaplan and Dillon described.
- District court found multiple legal errors by the ALJ (failure to address VA decision, improper rejection of treating physician and third-party testimony, and erroneous RFC evaluation) and reversed and remanded for award of benefits.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ALJ’s decision was supported by substantial evidence | Dillon: ALJ ignored VA 100% disability finding, improperly discounted treating physician and wife’s testimony, and omitted medically necessary leg-elevation in RFC, making the denial unsupported | Commissioner: ALJ considered VA medical records and consulting opinions; Dr. Pele/Atkins supported RFC; VA rating not binding so omission harmless | Court: ALJ erred—failed to address VA disability determination and improperly rejected treating and third-party evidence; RFC was incomplete without leg-elevation accommodation |
| Whether the ALJ adequately weighed the VA disability rating | Dillon: VA 100% rating must be considered and specifically addressed | Commissioner: ALJ reviewed the same VA medical records; explicit discussion not required because evidence underlying the rating was considered | Court: ALJ erred by not explicitly addressing and weighing the VA disability decision as required by precedent (Morrison) |
| Whether ALJ properly discounted treating physician Dr. Kaplan’s opinion | Dillon: Dr. Kaplan’s responses confirmed medical necessity to elevate legs in 2009; ALJ should have developed record rather than reject questionnaire because it was attorney-provided | Commissioner: The opinion was precipitated by claimant/attorney and inconsistent with objective records | Court: Dr. Kaplan’s opinion was supported by contemporaneous records and instructions to elevate legs; ALJ failed to develop record and improperly rejected treating opinion; accommodation should be included in RFC |
| Whether jobs identified by VE remain available with required accommodation | Dillon: VE testified the identified jobs would not permit reclining/elevating legs above chest; thus no jobs exist | Commissioner: RFC without elevation permits light work jobs identified | Court: Given VE testimony that jobs would not permit required elevation, with the elevation proviso no jobs exist and claimant is disabled |
Key Cases Cited
- Howard v. Massanari, 255 F.3d 577 (8th Cir. 2001) (substantial-evidence standard for SSA factual findings)
- Reed v. Barnhart, 399 F.3d 917 (8th Cir. 2005) (court must consider evidence that detracts from ALJ’s decision)
- Polaski v. Heckler, 739 F.2d 1320 (8th Cir. 1984) (framework for evaluating claimant credibility and pain allegations)
- Morrison v. Apfel, 146 F.3d 625 (8th Cir. 1998) (ALJ must consider and explicitly address VA disability findings)
- Pelkey v. Barnhart, 433 F.3d 575 (8th Cir. 2006) (ALJ’s consideration of VA rating may be adequate if underlying VA evidence and examinations are discussed)
- Snead v. Barnhart, 360 F.3d 834 (8th Cir. 2004) (ALJ’s duty to develop the record fully and fairly)
- Thompson v. Sullivan, 957 F.2d 611 (8th Cir. 1992) (court may reverse and award benefits when record overwhelmingly supports disability)