Opinion ID: 765512
Heading Depth: 2
Heading Rank: 2

Heading: ALJ's Treatment of the Claimant's Mental Impairments

Text: 39 The most troublesome aspect of this case is the ALJ's treatment of the evidence relating to Plummer's mental impairments. As noted supra, there is substantial evidence in the record that the claimant suffers from both depression and anxiety. In addition, Plummer directly raised a psychiatric issue below in her comments on the Reconsideration Disability Report, which was not considered by the hearing officer on reconsideration. Admin. R. at 50. 40 Prior to the hearing, the ALJ offered Plummer's counsel an onerous choice: remand the case for a new reconsideration decision incorporating the psychiatric issues or proceed with no testimony concerning the claimant's mental health. This choice was particularly troublesome because it took eighteen months from the time of her appeal for Plummer to receive a hearing before an ALJ. 7 Faced with the daunting prospect of another lengthy delay, Plummer chose to proceed without raising any psychiatric claims. As a consequence, there was no testimony during the hearing concerning Plummer's mental impairments, nor did the ALJ order a psychological examination. Nonetheless, in her written decision, the ALJ made explicit conclusions, and worse, a finding, regarding Plummer's mental health. The ALJ wrote: 41 With regard to her mental health status, there is no evidence of record that the claimant has any thought disorder or significant deficit of memory or concentration or that she has any difficulties in routine interactions with other people. There is no evidence that she has ever been treated . . . on a regular basis by a psychologist or psychiatrist. Therefore, I specifically find that the claimant's mental health problem is `not severe' and imposes no significant restrictions on her ability to perform work-related activities. 42 In addition, the ALJ attached a PRT form in which she concluded the claimant suffered from mild affective and anxiety related disorders, which only caused slight restrictions on her daily activities, and thus had no effect on her residual functional capacity. 43 The ALJ's decision, the claimant argues, unfairly prejudiced her claim because the judge made explicit findings without giving the claimant an opportunity to fully testify, develop, and explore her mental impairments. We agree. We conclude the ALJ did not give proper consideration to the claimant's alleged mental impairments as is required by law. The ALJ cannot ignore evidence of a mental impairment in the record, nor can she effectively force a claimant to waive her rights to have the evidence considered in her disability determination. 44 When there is evidence of a mental impairment that allegedly prevents a claimant from working, the Commissioner must follow the procedure for evaluating mental impairments set forth in 20 C.F.R. S 404.1520a. Andrade v. Secretary of Health & Human Services, 985 F.2d 1045, 1048 (10th Cir. 1993). These procedures are intended to ensure a claimant's mental health impairments are given serious consideration by the Commissioner in determining whether a claimant is disabled. Faced with evidence of a mental impairment in the record, which was not considered below, the ALJ may remand for further consideration, or proceed with a hearing considering the mental health evidence. The ALJ must give all the evidence in the record the serious consideration required by law. 42 U.S.C. S 423(d)(5)(B) (Commissioner must consider all evidence available in an individual's case record in making a disability determination); 42 U.S.C. S 421(h). 45 The statute concerning the evaluation of mental impairments provides, an initial determination under subsection (a), (c), (g) or (i) of this section that an individual is not under a disability, in any case where there is evidence which indicates the existence of a mental impairment, shall be made only if the Commissioner of Social Security has made every reasonable effort to ensure that a qualified psychiatrist or psychologist has completed the medical portion of the case review and any applicable residual functional capacity assessment. 42 U.S.C. S 421(h). Thus, when the record contains evidence of a mental impairment, the Secretary [now Commissioner] cannot determine that the claimant is not under a disability without first making every reasonable effort to ensure that a qualified psychiatrist . . . has completed the medical portion of the case review and any applicable residual functional capacity assessment. Andrade v. Secretary of Health & Human Services, 985 F.2d 1045, 1048 (10th Cir. 1993). 46 Because 42 U.S.C. S 421(d), which covers hearings before an ALJ, is excluded from S 421(h)'s purview, an ALJ is not required to employ the assistance of a qualified psychiatrist or psychologist in making an initial determination of mental impairment. Instead, the Commissioner's regulations provide an ALJ with greater flexibility than other hearing officers. At the initial and reconsideration levels, a PRT form -- outlining the steps of the S 404.1520a procedure -- must be completed and signed by a medical consultant. 20 C.F.R. S 404.1520a(d)(1). However, the ALJ has several options available: she can complete and sign the document without the assistance of a medical adviser; she can call a medical adviser for assistance in completing the document; or, if new evidence is received or the issue of mental impairments arises for the first time, she can remand the case for completion of the document and a new determination. 20 C.F.R. S 404.1520a(d)(1)(i-iii). In summary, the regulations allow the ALJ to remand for further review, to proceed with a determination without the assistance of a medical adviser, or to call a medical adviser for assistance with the case. In all cases, however, the ALJ has a duty to consider all evidence of impairments in the record. 47 Clearly, the ALJ did not fulfill her duty to explore the claimant's alleged mental impairment. 8 The ALJ, as contemplated by the regulations, completed the mental impairment review, including the residual functional capacity assessment, by herself without the assistance of a medical consultant. S 404.1520a(d)(1)(i). The regulations explicitly require, however, that the evidence must be carefully reviewed and conclusions supported by it. S 404.1520a(b). There is no indication the ALJ did so, and her determination of the claimant's mental impairments is not supported by substantial evidence in the record. In addition, the ALJ did not solicit Plummer's testimony at the hearing as to how her anxiety and depression affected her activities of daily living, social functioning, concentration, persistence or pace, or caused deterioration or decompensation in work or work-like settings. 20 C.F.R. S 404.1520a(b)(3). These are the criteria which are measured in order to ascertain the degree of functional loss by the claimant's impairments. In fact, the ALJ barred the claimant from raising her mental disabilities altogether, but then inexplicably concluded the claimant's depression and anxiety only had a minimal effect on these very criteria. 48 The record contains numerous references to the claimant's depression and anxiety. To review, the evidence in this instance includes several diagnoses of depression and generalized anxiety disorder. On November 26, 1991, she was diagnosed with generalized anxiety disorder. It was reported that she experiences heart palpitations, sweating, hand tremors, shakiness, has depressive bouts in which she feels lonely and removed. On December 18, 1991, she was diagnosed with depression, anxiety and panic attacks. On March 19, 1992, she was diagnosed with anxiety/panic disorder. On May 11, 1992, it was noted in her medical file that she has a psychiatric anxiety disorder. Finally, on July 13, 1994, she was prescribed Pamelor and Nortriptyline, both anti-depressants. 49 Given the evidence in the record, we cannot conclude substantial evidence supports the ALJ's decision regarding the extent of the claimant's mental impairment. While the mere presence of a mental disturbance does not automatically indicate a severe disability, it cannot be ignored by the ALJ. Bernal v. Bowen, 851 F.2d 297, 301 (10th Cir. 1988). It is noteworthy that none of the doctors who diagnosed Plummer with mental impairments evaluated its effects on her ability to work. The ALJ has a duty to develop the record when there is a suggestion of mental impairment by inquiring into the present status of impairment and its possible effects on the claimant's ability to work. See, e.g., Stambaugh on Behalf of Stambaugh v. Sullivan, 929 F.2d 292, 295 (7th Cir. 1991); Hill v. Sullivan, 924 F.2d 972, 974 (10th Cir. 1991) (requiring psychiatric analysis because of a psychiatrist's diagnosis of [c]hronic fatigue and lack of energy; this possibly could be more likely to be chronic mental depression in this patient in the record). In fact, one of the essential purposes of S 404.1520a is to determine whether or not a mental impairment(s) exists. S 404.1520a(b)(1). 50 The ALJ was obligated to investigate the claimant's mental impairments. This could have been accomplished either by remanding the case for further development, by seeking medical assistance, or perhaps by soliciting testimony directly from the claimant. This obligation is heightened when the Commissioner fails, as he did here, to satisfy his obligation under 42 U.S.C. S 421(h) and 20 C.F.R. S 404.1520a to have a qualified psychiatrist or psychologist evaluate Plummer's claim during the initial or reconsideration stage. Thus, it was particularly unjust for the ALJ to prohibit Plummer from developing her mental impairment claim and then to issue a factual finding that could preclude Plummer from raising the issue in a subsequent application. 9 Under these circumstances, additional development of the psychiatric issue is warranted, and the claimant's disability claim will be remanded for further proceedings in accordance with the procedures outlined in 20 C.F.R. S 404.983. The ALJ's Psychiatric Review Technique Form will be disregarded. 51 This Court has noted in the past our frustration with the delays in disability determinations by the Social Security Administration. See, e.g., Woody v. Secretary of Health and Human Services, 859 F.2d 1156 (3d Cir. 1988) (directing disability benefits be paid after eight years of administrative and judicial proceedings). Evelyn Plummer first applied for disability benefits more than six years ago. She suffered through eighteen months of delay before receiving a hearing before an ALJ. Given the inexcusable passage of time, the Commissioner shall consider and evaluate with all due speed updated evidence of Plummer's physical and mental disabilities. 42 U.S.C. S 405(g); 20 C.F.R.S 404.983. In addition, the Commissioner shall consider the combined effect of all of Plummer's impairments, physical and mental, in determining whether the claimant is entitled to disability benefits. 42 U.S.C. S 423(d)(2)(B).