17 F. Supp. 3d 128
D.N.H.2014Background
- Richard Wilson applied for Disability Insurance Benefits (DIB) alleging onset July 1994; his date last insured (DLI) was December 31, 1999. The ALJ denied benefits; Appeals Council denied review. District court review followed.
- Wilson's contemporaneous medical records during the insured period are lacking; first mental-health treatment notes appear in 2009–2010. Multiple treating mental-health providers (Drs. Finn, Noordsy, Zayfert, Bryant) diagnosed long‑standing social anxiety, PTSD, OCD, and depression and stated symptoms predated the DLI.
- A non‑examining state psychologist concluded there was no evidence of a severe impairment during the insured period because treatment began after the DLI.
- At the administrative hearing Wilson testified he stopped working in 1994 because of anxiety and described longstanding avoidance and functional limitations; the ALJ found no medically determinable impairment before the DLI and denied at step two.
- The ALJ did not cite SSR 83‑20 or consult a medical advisor to assist with the onset-date determination; the ALJ relied primarily on absence of pre‑DLI treatment records to reject retrospective opinions.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ALJ was required to consult a medical advisor under SSR 83‑20 when onset date is ambiguous | Wilson: SSR 83‑20 required a medical advisor when evidence about onset is ambiguous; treating clinicians gave retrospective opinions that disability predated the DLI | Commissioner: Calling a medical advisor is discretionary; SSR 83‑20’s “should” is not mandatory and does not apply where ALJ found claimant not disabled | Court: ALJ erred. Under First Circuit precedent (May), SSR 83‑20 requires a medical advisor when onset is ambiguous; ALJ must consult one or otherwise fully develop record before rejecting uncontradicted retrospective medical opinions |
Key Cases Cited
- May v. Soc. Sec. Admin. Comm’r, 125 F.3d 841 (1st Cir. 1997) (SSR 83‑20 requires medical‑advisor consultation where onset evidence is ambiguous)
- Bird v. Comm’r of Soc. Sec. Admin., 699 F.3d 337 (4th Cir. 2012) (post‑DLI records can be cogent proof of pre‑DLI disability when linkage not ruled out)
- Blea v. Barnhart, 466 F.3d 903 (10th Cir. 2006) (post‑DLI evidence may show pre‑DLI disabling condition)
- Grebenick v. Chater, 121 F.3d 1193 (8th Cir. 1997) (absence of contemporaneous treatment is a factor but does not eliminate need for medical‑expert inference when onset ambiguous)
- Morgan v. Sullivan, 945 F.2d 1079 (9th Cir. 1991) (courts have required expert assistance in onset determinations when record ambiguous)