In a recent district court case that sheds light on how courts view the approval of California disability insurance benefits, a plaintiff asked for review of the Commissioner’s denial of his request for Social Security disability insurance benefits. The plaintiff had completed 12th grade and worked as a security guard. His date of birth was in 1951.
He applied for disability insurance benefits claiming disability since 2008 due to bipolar disorder, lymphadenopathy, hyperlipidemia, arthralgia, hepatitis B, and dermatitis. His application was denied at first and then reconsidered. He asked for a hearing before an administrative law judge. The hearing was in 2015, and at that time both the plaintiff and a vocational expert testified. In his decision the administrative law judge determined he wasn’t disabled because he had a substance abuse disorder that was a contributing factor that was germane to determining his disability.
The district court reviewed the denial to determine whether it was based on substantial evidence — evidence that was enough for a reasonable person to accept it as sufficient to support the conclusion drawn.
The court explained that someone is disabled such that he or she can receive Social Security benefits if he isn’t able to be involved in any substantial gainful activity because of an impairment anticipated to result in death or one that has lasted for a continuous year. The court considered the five-step sequence that the administrative law judge undertook to determine disability. It explained that a claimant that is addicted to drugs or is an alcoholic, whereby this condition is a contributing factor that is material to deciding disability, isn’t able to recover Social Security disability benefits.
When there is a past history of alcohol or drug abuse, the five steps are undertaken without extricating the effects of alcohol or addiction. When the claimant isn’t disabled under the five steps, the claimant isn’t entitled to benefits and there’s no need to go forward with the analysis. However, if the administrative law judge decides the claimant is disabled, and medical evidence exists to find alcoholism or drug addiction, he will need to look at whether there would still be disability if there was a cessation in drug and alcohol use. The claimant, rather than the government must show that alcoholism and drug addiction aren’t contributing factors.
In this case, there had been no substantial gainful activity between the date his disability started and the claimant’s date last insured. He was found to have severe impairments, but these included substance abuse disorders. The administrative law judgment found that if the plaintiff stopped the substance use he wouldn’t have as severe an impairment. In other words, his substance use contributed materially to determining his disability.
In this case, the plaintiff argued that the administrative law judge should have found that changed circumstances overcame the presumption of a continuing non-disability in his earlier determination and that the ALJ had failed to consider certain criteria and rejected his subjective symptom testimony. The court found the rejection of subjective symptom testimony to be in error.
The court explained that an administrative law judge’s evaluation of a claimant’s allegations about the severity of his symptoms should be given substantial weight. The administrative law judge conducts a 2-step analysis in which it (1) first looks at whether the claimant had shown objective medical evidence of an underlying impairment, and (2) if that exists, the administrative law judge is not supposed to reject a claimant’s testimony only because there’s no proof the impairment could reasonably produce the degree of symptom claimed.
If there’s no finding or affirmative proof that the claimant is malingering, the administrative law judge is supposed to give clear and convincing reasons for rejecting a claimant’s testimony. Factors that go into a credibility assessment include the claimant’s reputation, inconsistent statements, unexplained failure to get treatment or follow a doctor’s orders, testimony from doctors and others, work record, and the claimant’s daily actions.
In this case, the plaintiff had a history of multiple diagnoses. He went to therapy and was required to comply with Breathalyzer tests. The administrative law judge didn’t believe he was credible with regard to his statements about substance abuse. He’d refrain from using alcohol but admitted to relapse. The administrative law judge found that inconsistent statements about drinking provided a clear and convincing reason not to believe the plaintiff’s testimony.
However, in this case, the record didn’t reflect any dramatic inconsistencies, and so there was no clear and convincing reason to disbelieve him. The court sent the case back to the administrative law judge to reconsider the plaintiff’s statements about substance abuse.
It can be challenging to meet the requirements necessary to start receiving Social Security Disability benefits. Often, an experienced Social Security lawyer can make a difference to the outcome of your case. If you believe you may need to apply for Social Security Disability benefits in Fresno, please call Peña & Bromberg, PLC at 559-439-9700 or via our online form.