Opinion ID: 4421217
Heading Depth: 2
Heading Rank: 1

Heading: The Social Security Disability Determination

Text: Methodology Social security cases can be complex, in part because of the labyrinthine regulatory structure that governs them. The matter before us involves the part of that structure controlling disability determinations. The Social Security Administration, working through ALJs, decides whether a claimant is disabled by following a now familiar five-step analysis. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4) (2016).1 The burden of proof is on the claimant at all steps except step five, where the burden is on the Commissioner of Social Security. Smith v. Comm’r of Soc. Sec., 631 F.3d 632, 634 (3d Cir. 2010). The analysis proceeds as follows: 1 In this opinion, we cite to the edition of the Code of Federal Regulations in force at the time of the ALJ’s decision in this case. There have been changes to social security regulations since that time, but those changes do not affect our analysis, and neither party contends that they should. 4 At step one, the ALJ determines whether the claimant is performing “substantial gainful activity[.]” 20 C.F.R. §§ 404.1520(a)(4)(i), 416.920(a)(4)(i). If he is, he is not disabled. Id. Otherwise, the ALJ moves on to step two. At step two, the ALJ considers whether the claimant has any “severe medically determinable physical or mental impairment” that meets certain regulatory requirements. Id. §§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii). A “severe impairment” is one that “significantly limits [the claimant’s] physical or mental ability to do basic work activities[.]” Id. §§ 404.1520(c), 416.920(c). If the claimant lacks such an impairment, he is not disabled. Id. §§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii). If he has such an impairment, the ALJ moves on to step three. At step three, the ALJ decides “whether the claimant’s impairments meet or equal the requirements of an impairment listed in the regulations[.]” Smith, 631 F.3d at 634. If the claimant’s impairments do, he is disabled. 20 C.F.R. §§ 404.1520(a)(4)(iii), 416.920(a)(4)(iii). If they do not, the ALJ moves on to step four. At step four, the ALJ assesses the claimant’s “residual functional capacity” (“RFC”) and whether he can perform his “past relevant work.”2 Id. §§ 404.1520(a)(4)(iv), 2 There is some ambiguity in the case law as to whether RFC is assessed at step four or at the end of step three. Compare Hurd v. Astrue, 621 F.3d 734, 738 (8th Cir. 2010) (“Before moving to step four, the ALJ must determine a claimant’s residual functional capacity[.]”), with Moon v. 5 416.920(a)(4)(iv). A claimant’s “[RFC] is the most [he] can still do despite [his] limitations.” Id. §§ 404.1545(a)(1), 416.945(a)(1). If the claimant can perform his past relevant work despite his limitations, he is not disabled. Id. §§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv). If he cannot, the ALJ moves on to step five. At step five, the ALJ examines whether the claimant “can make an adjustment to other work[,]” considering his “[RFC,] … age, education, and work experience[.]” Id. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v). That examination typically involves “one or more hypothetical questions posed by the ALJ to [a] vocational expert.” Podedworny v. Harris, 745 F.2d 210, 218 (3d Cir. 1984). If the claimant can make an adjustment to other work, he is not disabled. 20 C.F.R. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v). If he cannot, he is disabled. When, as in this instance, mental impairments are at issue, additional inquiries are layered on top of the basic fivestep disability analysis. Id. §§ 404.1520a(a), 416.920a(a). An ALJ assesses mental impairments in the following way. Colvin, 763 F.3d 718, 720 (7th Cir. 2014) (“[T]he ALJ was required to determine [the claimant’s] ‘residual functional capacity’ at step four.”). The ALJ treated it as an intermediate step between steps three and four. (See infra n.5.) We acknowledge that the social security regulations state that, “[b]efore [the ALJ] go[es] from step three to step four, [he] assess[es] [the claimant’s] residual functional capacity.” 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). But, because we find it simpler to consider the RFC assessment with step four, we will treat the RFC assessment as part of step four. 6 As part of step two of the disability analysis, the ALJ decides whether the claimant has any “medically determinable mental impairment(s).” Id. §§ 404.1520a(b)(1), 416.920a(b)(1); see also id. §§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii) (providing that, at step two, the ALJ determines whether the claimant has “a severe medically determinable physical or mental impairment”). Then, as part of that same step and also step three of the disability analysis, the ALJ determines “the degree of functional limitation resulting from the impairment(s)[.]” Id. §§ 404.1520a(b)(2), 416.920a(b)(2); see also id. §§ 404.1520a(d), 416.920a(d), 404.1520(a)(4)(ii)-(iii), 416.920(a)(4)(ii)-(iii) (explaining that the ALJ uses “the degree of functional limitation” in assessing “the severity of [the claimant’s] mental impairment(s)[,]” which is considered at steps two and three). The ALJ does so in “four broad functional areas … : Activities of daily living; social functioning; concentration, persistence, or pace; and episodes of decompensation.” Id. §§ 404.1520a(c)(3), 416.920a(c)(3). The first three of those areas are rated on a “five-point scale: None, mild, moderate, marked, and extreme.” Id. §§ 404.1520a(c)(4), 416.920a(c)(4). The fourth is rated on a scale of: “None, one or two, three, four or more.” Id. The ALJ uses that degree rating in “determin[ing] the severity of [the] mental impairment(s)[,]” which is considered at steps two and three. Id. §§ 404.1520a(d), 416.920a(d); see also id. §§ 404.1520(a)(4)(ii)-(iii), 416.920(a)(4)(ii)-(iii) (stating that, at steps two and three, the ALJ “consider[s] the medical severity of [the claimant’s] impairment(s)”). “If … the degree of [the claimant’s] limitation in the first three functional areas [is] ‘none’ or ‘mild’ and ‘none’ in the fourth 7 area, [the ALJ] will generally conclude that [the claimant’s] impairment(s) is not severe, unless the evidence otherwise indicates that there is more than a minimal limitation in [his] ability to do basic work activities.” Id. §§ 404.1520a(d)(1), 416.920a(d)(1) (citation omitted). At step three, if the ALJ has found that a mental impairment is severe, he “then determine[s] if it meets or is equivalent in severity to a listed mental disorder.” Id. §§ 404.1520a(d)(2), 416.920a(d)(2); see also id. §§ 404.1520(a)(4)(iii), 416.920(a)(4)(iii) (explaining that, at step three, the ALJ determines whether the claimant has “an impairment(s) that meets or equals” a listed impairment). That analysis is done “by comparing the medical findings about [the claimant’s] impairment(s) and the rating of the degree of functional limitation to the criteria of the appropriate listed mental disorder.” Id. §§ 404.1520a(d)(2), 416.920a(d)(2). For example, the claimant may have the equivalent of a listed impairment if, inter alia, he has at least two of “1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration[.]” Id. Pt. 404, Subpt. P, App. 1. Finally, to complete steps four and five of the disability analysis, if the ALJ has found that the claimant does not have a listed impairment or its equivalent, the ALJ “will then assess [the claimant’s mental RFC].” Id. §§ 404.1520a(d)(3), 416.920a(d)(3); see also id. §§ 404.1520(a)(4)(iv)-(v), 416.920(a)(4)(iv)-(v) (providing that, at steps four and five, the ALJ considers the claimant’s RFC). 8 With that regulatory framework in mind, we turn to the details of the case before us.