United States District Court, D. New Hampshire
ORDER ON APPEAL
N. Laplante United States District Judge
Williams appeals the Social Security Administration's
("SSA") denial of her application for disability
benefits. An Administrative Law Judge ("ALJ") found
that Williams suffered from bipolar disorder, anxiety
disorder, borderline personality disorder, and alcohol abuse.
The ALJ nevertheless found that Williams was not disabled
within the meaning of the Social Security Act because she has
sufficient residual functional capacity ("RFC") to
work at jobs that exist in significant numbers in the
national economy. See 42 U.S.C. § 423(d)(2)(A). The SSA
Appeals Council subsequently denied Williams's request
for review of the ALJ's decision, rendering the ALJ's
decision final. Williams timely appealed to this court,
pursuant to 42 U.S.C. § 405(g). In due course, Williams
moved to reverse the SSA's decision and the SSA's
Acting Commissioner moved to affirm the denial of benefits.
argues that the RFC constructed by the ALJ was flawed because
it did not correctly weigh the evidence of Williams's
non-exertional limitations, leading to a conclusion that
those limitations had little or no effect on the occupational
base of unskilled work. Thus, Williams argues, the ALJ
improperly relied upon the Medical Vocational Guidelines
("Grid") rather than consulting a vocational expert
to identify jobs that Williams could perform. After review of
the pending motions, the parties' joint statement of
material facts and the administrative record, the court finds
that substantial evidence does not support the ALJ's RFC
determination. The court therefore grants Williams's
motion, denies the Acting Commissioner's motion, and
remands the case to the SSA.
Standard of Review
review of a final decision of the Commissioner is limited to
(1) whether substantial evidence supports the
Commissioner's decision and (2) whether the Commissioner
applied the correct legal standards. Seavey v.
Barnhart, 276 F.3d 1, 9 (1st Cir. 2001). The
responsibility for weighing conflicting evidence and
resolving issues of credibility belongs to the Commissioner
and her designee, the ALJ. Id. at 10; Rodriguez
v. Sec'y of Health & Human Servs., 647 F.2d 218, 222
(1st Cir. 1981). The Commissioner's findings "as to
any fact, if supported by substantial evidence, shall be
conclusive." 42 U.S.C. § 405(g). Substantial
evidence is such evidence as a reasonable mind might accept
as adequate to support a conclusion. Richardson v.
Perales, 402 U.S. 389, 401 (1971). This is less evidence
than a preponderance but "more than a mere
scintilla." Id.; Consolo v. Fed. Mar.
Comm'n, 383 U.S. 607, 620 (1966). Accordingly, the
court must affirm the ALJ's findings "if a
reasonable mind, reviewing the evidence in the record as a
whole, could accept it as adequate to support [the pertinent]
conclusion." Rodriguez, 647 F.2d at 222. This
is true "even if the record arguably could justify a
different conclusion." Rodriguez Pagan v. Sec'y
of Health & Human Servs., 819 F.2d 1, 3 (1st Cir. 1987).
analyzing Williams's benefit application, the ALJ invoked
the required five-step process. See 20 C.F.R. § 416.920.
First, she concluded that Williams had not engaged in
substantial work activity after the alleged onset of her
disability on May 11, 2009. Next, the ALJ determined that
Williams suffered from several severe impairments: bipolar
disorder, anxiety disorder, borderline personality disorder,
and alcohol abuse. See 20 C.F.R. § 416.1920(c). At the
third step, the ALJ concluded that Williams impairments -
either individually or collectively - did not meet or
"medically equal" one of the listed impairments in
the Social Security regulations. See 20 C.F.R. §§
416.920(d), 416.925, & 416.926. The ALJ next found that
Williams had the RFC to perform a full range of work at all
exertional levels, but with certain non-exertional
limitations: (i) she is able to understand, remember, and
carry out short and simple instructions and maintain
attention and concentration for two-hour blocks of time over
an eight-hour workday; (ii) she is able to ask simple
questions, accept instructions, and respond appropriately to
criticism from supervisors; and (iii) she can respond
appropriately to changes in the work setting. See 20 C.F.R.
§§ 404.1567(b) and 416.967(b).
finding at step four that Williams could not perform any past
relevant work, the ALJ proceeded to step five, at which the
SSA bears the burden of showing that a claimant can perform
other work that exists in the national economy. Freeman
v. Barnhart, 274 F.3d 606, 608 (1st Cir. 2001). Here,
the ALJ, relying on Williams's testimony and medical
records, concluded that Williams's non-exertional
limitations - consisting of mental health issues -
compromised her ability to work at all exertional levels, but
that those limitations had little or no effect on the
occupational base of unskilled work. The ALJ used the
framework of section 204.00 of the Grid and found Williams
not disabled within the meaning of the Social Security Act.
asserts two related arguments. First, that the ALJ erred in
finding that her non-exertional impairments had little or no
effect on the occupational base of unskilled labor, and
second, that the ALJ then erred by applying the Grid as a
framework for her decision, rather than consulting a
vocational expert. The court agrees with both assertions.
the ALJ concluded that Williams's mental health
impairments could reasonably be expected to cause her
symptoms, the ALJ also found Williams not credible concerning
the intensity, persistence and limiting effects of those
impairments (Admin. R. at 16). The ALJ's reasoning was
the ALJ discounted Williams's testimony regarding the
severity of her symptoms because of gaps in her treatment
between 2009 and 2012. "Such lack of treatment, "
the ALJ opined, "tends to indicate that the
claimant's mental health symptoms are not nearly as
limiting as her hearing testimony would suggest." Admin.
R. at 17. While treatment gaps are ordinarily a valid basis
for making such a decision, see Irlanda Ortiz v.
Sec'y of Health and Human Servs., 955 F.2d 765, 769
(1st Cir. 1991), the ALJ "must not draw any inferences
about an individual's symptoms and their functional
effects from a failure to seek or pursue regular medical
treatment without first considering[, ]" inter
alia, whether the claimant can afford treatment. See SSR
96-7p, 1996 WL 374186 at *8; Hainey v. Colvin, 2014
DNH 254, 14. Here, the record is clear that Williams not only
stopped treatment because she lacked health insurance, Admin.
R. at 40, 335, but she resumed it shortly after a
Medicaid-based insurance plan was in place because she was
feeling suicidal. Id. at 350. There is no
indication in her decision that the ALJ considered this
sequence of events.
court also notes that the ALJ rather dismissively described
Williams's 2009 mental health treatment as having been
pursued "to avoid going to jail." In fact, Williams
described the treatment as an alternative sentence imposed in
a "mental health court" after a 2009 assault
arrest. Id. at 42. Rather than simply an effort to
"avoid going to jail, " the mental health court is
a long-standing "alternative sentencing" program in
Cheshire County, New ...