Reyes v. Commissioner of Social Security
6:16-cv-06070
W.D.N.Y.Aug 9, 2017Background
- Plaintiff Lucesita Reyes applied for SSI and DIB alleging disability from mental impairments (depression with psychotic features, anxiety, hallucinations), asthma, hypertension, hearing loss, and learning disorder; claims denied by ALJ who found non-disabled.
- Extensive treating mental-health records (2010–2015) document chronic depression, anxiety, auditory command hallucinations, dissociative episodes, poor concentration, and functional instability; treating providers (LMSW Keefer and NP Calnan) completed a January 2015 questionnaire describing severe-to-moderately-severe work-related limitations.
- Consulting psychologist (Dr. Lin, 9/8/2014) found borderline intellectual functioning, moderate impairments in attention/concentration, and marked limitation in dealing with stress; state nonexamining reviewer (Dr. Reddy) assessed only mild-to-moderate limitations (9/22/2014).
- ALJ’s RFC: avoid respiratory irritants; limited to simple, routine tasks; occasional coworker interaction; no public interaction; concluded jobs exist (industrial cleaner, kitchen helper) and denied benefits.
- ALJ gave limited weight to the treating providers’ January 2015 opinion because (1) they were "other sources," not acceptable medical sources, (2) their functional ratings allegedly contradicted their own GAF scores (57–58), and (3) their opinion was inconsistent with treatment notes. Court found these reasons insufficient and remanded for calculation and payment of benefits.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Weight given to treating "other source" opinion (Keefer & Calnan) | ALJ improperly discounted their January 2015 opinion; treating relationship and detailed notes warrant significant weight | Opinion is from non-acceptable medical sources and inconsistent with treatment GAFs and records, so limited weight was appropriate | Court: ALJ failed to give "good reasons"; cannot discount solely because they are "other sources" or based only on GAF inconsistency; opinion entitled to significant weight and supports disability finding |
| Use of GAF scores to reject treating opinion | GAF scores do not, standing alone, rebut a treating source's functional opinion; ALJ erred relying on them | GAF scores in treatment notes were inconsistent with extreme limitations alleged | Court: Reliance on GAF alone is improper; GAF not dispositive and ALJ needed broader analysis under the regulatory factors |
| Sufficiency of nonexamining reviewer (Reddy) and examining opinion (Lin) | Treating opinion, when credited, is consistent with Lin and outweighs Reddy, especially because Reddy’s review predated later worsening | Reddy’s assessment supports less restrictive RFC; ALJ properly relied on mixed evidence | Court: Reddy’s opinion was dated before 2015 deterioration; Lin’s findings align with treating providers; overall record supports disability when treating opinion is credited |
| Remedy on review (remand for further proceedings vs. benefits) | Record is fully developed and treating opinion, properly credited, establishes disability; remand for benefits calculation appropriate | Any unresolved issues justify further administrative proceedings | Held: Court concluded no useful purpose to further development; remanded solely for calculation and payment of benefits |
Key Cases Cited
- Butts v. Barnhart, 388 F.3d 377 (2d Cir.) (standard for district court review and remand authority under 42 U.S.C. § 405(g))
- Schaal v. Apfel, 134 F.3d 496 (2d Cir.) (substantial-evidence review limits)
- Richardson v. Perales, 402 U.S. 389 (Sup. Ct.) (definition of substantial evidence)
- Diaz v. Shalala, 59 F.3d 307 (2d Cir.) (ALJ discretion in weighing non-acceptable medical source opinions)
- Kohler v. Astrue, 546 F.3d 260 (2d Cir.) (GAF score explanatory note and limitations)
- Rosa v. Callahan, 168 F.3d 72 (2d Cir.) (when remand for benefits is appropriate)