Opinion
Civil Action No. 02-2142-GTV
February 24, 2003.
MEMORANDUM AND ORDER
Plaintiff Debra L. Stuart brings this action pursuant to 42 U.S.C. § 405(g), 1383(c)(3), and D. Kan. Rule 83.7, seeking judicial review of the decision of the Commissioner of Social Security ("Commissioner") to deny her application for a period of disability, disability insurance benefits, and supplemental security income benefits under Titles II and XVI of the Social Security Act. Plaintiff is thirty-eight years old and has a history of substance abuse. The record also includes evidence of mental illness and arthralgias.
The Commissioner concluded that Plaintiff was disabled, but denied Plaintiff benefits because he concluded that Plaintiff's substance abuse was material to the finding of disability. After reviewing the record, the court concludes that the Commissioner failed to properly analyze whether Plaintiff's substance abuse was material to her disability, and the court reverses and remands the case for further consideration in accordance with this opinion.
I. Procedural Background
On June 18, 1999, Plaintiff filed an application for supplemental security income, and on September 3, 1999, she filed an application for a period of disability and disability insurance benefits. Plaintiff claimed that she had been disabled since January 1, 1997. The claims were consolidated and denied initially and upon reconsideration. At Plaintiff's request, an administrative law judge ("ALJ") held a hearing on May 15, 2001, at which Plaintiff and her counsel were present. On June 21, 2001, the ALJ rendered a decision in which he determined that although Plaintiff was disabled as defined by the Social Security Act, her substance abuse was material to the finding of disability. The ALJ denied Plaintiff benefits. After the ALJ's unfavorable decision, Plaintiff requested review by the Appeals Council. The Appeals Council denied Plaintiff's request for review on January 30, 2002, rendering the ALJ's decision the final decision of the Commissioner.
II. Standard of Review
The Commissioner's findings are binding on this court if supported by substantial evidence. 42 U.S.C. § 405(g); Dixon v. Heckler, 811 F.2d 506, 508 (10th Cir. 1987). The court's review is limited to determining whether the Commissioner's decision is supported by substantial evidence in the record and whether the Commissioner properly applied relevant legal standards. Marshall v. Chater, 75 F.3d 1421, 1425 (10th Cir. 1996) (citing Castellano v. Sec'y of Health Human Servs., 26 F.3d 1027, 1028 (10th Cir. 1994)). "Substantial evidence is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Castellano, 26 F.3d at 1028 (citations and internal quotation marks omitted). The court may not reweigh the evidence or substitute its judgment for that of the Commissioner. Hamilton v. Sec'y of Health Human Servs., 961 F.2d 1495, 1500 (10th Cir. 1992).
III. ALJ's Findings
In his June 21, 2001 decision, the ALJ made the following findings:
• Claimant met the special earnings requirement of the Act on January 1, 1997, the date she stated she became unable to work and continued to do so through the date of this decision.
• Claimant has not engaged in substantial gainful activity at any time since January 1, 1997, but did have earnings subsequent thereto.
• Medical evidence on file establishes that claimant has a substance addiction disorder; a secondary substance-induced affective disorder; borderline intellectual functioning; and arthralgias in multiple anatomical areas of undetermined etiology.
• Claimant's substance addiction disorder and secondarily her affective disorder meet a listing level of severity under Section 12.09 in the Listing of Impairments evaluated under Section 12.04 as is set forth above.
• When claimant is drug and alcohol free, taking her prescribed medications and following her treatment regimen, she retains the residual functional capacity for a range of light or sedentary work where she is able to perform less stressful work.
• Claimant is a chronic drug and alcohol abuser, and as a result, lacks the residual functional capacity for competitive employment at any exertional level due to the social dysfunction, deficiencies of concentration and repeated episodes of deterioration and decompensation [sic] in work or work-like settings, all secondary to her substance addiction disorder and the residuals therefrom.
• Claimant's past relevant work as a checker/cashier and as a waitress are not prohibited by claimant's residual functional capacity when she is sober.
• Claimant's impairments, symptoms and resulting residual functional capacity, when she is drug and alcohol free, do not prevent her from performing her past relevant work nor is she prevented from performing other work that exists in significant numbers in the economy, including small parts assembler and agriculture sorter.
• Claimant is currently 38 years old, defined as a "younger" individual.
• Claimant has a 9th grade education.
• Medical evidence on file establishes that claimant would not be disabled if she stopped using drugs and alcohol. Therefore, in accordance with Section 105 of Public Law 104-121, enacted on March 21, 1996, claimant is ineligible for disability benefits under Titles II or XVI of the Social Security Act, as amended.
• Claimant's active and unremitting substance addiction disorder is a factor material to the finding of disability.
IV. Discussion
Plaintiff makes several arguments why the court should reverse the Commissioner's decision. The validity of all of the arguments hinges on whether the ALJ correctly determined that Plaintiff's substance abuse was material to his finding of disability. The court cannot determine whether the ALJ's decision is supported by substantial evidence, however, because the ALJ did not explain his decision in accordance with relevant law.When an ALJ makes a finding of disability and the record includes evidence that the plaintiff suffers from alcoholism and/or drug addiction, the ALJ must make a determination whether the addiction is "a contributing factor material to the [ALJ's] determination that the [plaintiff] is disabled." 42 U.S.C. § 423(d)(2)(C), 1382c(a)(3)(J). To make this determination, the ALJ must determine whether the plaintiff would be found disabled if he or she stopped using drugs and/or alcohol. 20 C.F.R. § 404.1535(b)(1), 416.935(b)(1). The pertinent regulations state, "In making this determination, we will evaluate which of your current physical and mental limitations, upon which we based our current disability determination, would remain if you stopped using drugs or alcohol and then determine whether any or all of your remaining limitations would be disabling." Id. If a plaintiff's only impairment is drug and/or alcohol addiction, the analysis should be fairly simple. The analysis may be more complicated, however, when a plaintiff has other impairments in addition to a drug and/or alcohol addiction. The Social Security Administration has published a bulletin that addresses the situation:
29. Q. The most complicated and difficult determinations of materiality will involve individuals with documented substance use disorders and one of [sic] more other mental impairments. In many of these instances, it will be very difficult to disentangle the restrictions and limitations imposed by the substance use disorder from those resulting from other mental impairment(s). Can any examples be provided for how to handle the materiality determination in these situations, or can any guidance be provided for the type of information that should be used in trying to assess the impact of each impairment?
A. We know of no research data upon which to reliably predict the expected improvement in a coexisting mental impairment(s) should drug/alcohol use stop. The most useful evidence that might be obtained in such cases is that relating to a period when the individual was not using drugs/alcohol. Of course, when evaluating this type of evidence consideration must be given to the length of the period of abstinence, how recently it occurred, and whether there may have been any increase in the limitations and restrictions imposed by the other mental impairments since the last period of abstinence. When it is not possible to separate the mental restrictions and limitations imposed by [drug and alcohol abuse] and the various other mental disorders shown by the evidence, a finding of "not material" would be appropriate.
Cox, Dale, Social Security Administration, Emergency Teletype, August 30, 1996, available at http://www.ssas.com/daa-qa.htm; see also McGoffin v. Barnhart, 288 F.3d 1248, 1253 (10th Cir. 2002) (citing the Social Security Administration's teletype).
In this case, there is medical evidence suggesting that Plaintiff may have suffered from one or more mental illnesses and arthralgias, in addition to her drug and alcohol addictions. There is also evidence indicating that several times, Plaintiff may have temporarily stopped using drugs or alcohol. At the hearing, Plaintiff testified that she had been essentially drug- and alcohol-free for eighteen months prior to the hearing. The ALJ focused not on her periods of being substance-free, however, but on the fact that the record contained evidence of her drug and alcohol abuse in every year since 1997. He concluded that the record indicated that her substance abuse had been consistent to 2001. In doing so, he relied heavily on the testimony of Dr. George R. Chance, a non-examining medical expert who testified at the hearing. The ALJ indicated that Dr. Chance "believed that [Plaintiff's] current functioning or dysfunction was primarily related to [Plaintiff's] mixed substance abuse that he found to be material."
The court determines that the ALJ's analysis is flawed for several reasons. First, the ALJ failed to discuss the medical evidence in the record of Plaintiff's mental illness(es) and/or arthralgias. He acknowledged that Plaintiff claimed to be suffering from depression, post-traumatic stress disorder, hallucinations, bipolar disorder, and some physical impairments. He explained why he considered Plaintiff's testimony not fully credible. However, he did not discuss Plaintiff's treating and/or examining physician's diagnoses of her problems other than substance addiction.
Second, the ALJ misrepresented Dr. Chance's testimony. Dr. Chance did not testify that he found Plaintiff's substance abuse to be "material." Even if he had, "material" is a legal term that the ALJ would have needed to ask Dr. Chance to explain, to determine whether Dr. Chance's definition of the word mirrored the legal definition. Dr. Chance merely testified that he considered Plaintiff's "primary" diagnosis to be substance addiction disorder.
Finally, the ALJ assumed that because Dr. Chance testified that substance addiction was Plaintiff's "primary" disorder, then all of Plaintiff's limitations must have been due to that disorder. The ALJ failed to specifically examine which limitations were due to substance abuse and which were due to any mental illness and/or arthralgias that she has. The regulations require that he make such an analysis. Moreover, the Social Security Administration teletype reprinted above provides that if he cannot separate the limitations, he should make a finding of "not material."
In sum, the ALJ failed to apply the relevant legal standards in this case. Because the court cannot properly review whether the ALJ's determination that Plaintiff's substance abuse was a factor material to his finding of disability, the case is remanded for further consideration. The court does not address Plaintiff's other arguments because their resolution hinges on whether the ALJ made a proper finding that Plaintiff's substance abuse was material.
IT IS, THEREFORE, BY THE COURT ORDERED that the Commissioner's decision is reversed. Pursuant to 42 U.S.C. § 405(g), sentence four, the case is remanded for further consideration in accordance with this opinion.
Copies of this order shall be transmitted to counsel of record.
The case is closed.