No Substantial Evidence: Tenth Circuit Reverses ALJ's Ruling

Thanks to Astrue v. Capato -- and most federal benefits cases we’ve come across in the last year -- we're stuck with this idea that the courts are constantly denying Social Security requests. The Tenth Circuit Court of Appeals, however, tried to help us overcome our Social Security cynicism this week by reversing a blanket denial and giving an Oklahoma woman another shot at her disability claim.

(Don’t get too excited; this is an unpublished Tenth Circuit opinion.)

Back when Newt Gingrich was Speaker of the House, Congress amended the Social Security Act through the Contract with America. The Contract provided that a claimant could not be considered disabled if alcohol or drug addiction was "a contributing factor" to her disability. The contributing material factor inquiry involves a five-step evaluation:

1. Claimant must establish she is not engaged in "substantial gainful activity."
2. Claimant must establish that she has a "medically severe impairment or combination of impairments."
3. The fact-finder must determine whether any "medically severe impairment, alone or in combination with other impairments, is equivalent to any of a number of listed impairments so severe as to preclude "substantial gainful employment."
4. If listed, the impairment is conclusively presumed disabling.
5. If unlisted, the claimant must establish that her impairment prevents her from performing work she has previously performed.

If the claimant is not considered disabled at step three, but has satisfied her burden of establishing a prima facie case of disability under steps one, two, and four, the burden shifts to the Social Security Commissioner to show the claimant has the residual functional capacity to perform other work.

After the Social Security Administration (SSA) denied her application for disability benefits, the applicant in this case -- who had a history of substance abuse -- sought review by an Administrative Law Judge (ALJ) and the district court. The ALJ denied her request for benefits, finding that she would be able to return to work if she stopped her substance abuse. The district court affirmed that ruling.

On appeal, the Tenth Circuit Court of Appeals concluded that the ALJ's conclusion was not supported by substantial evidence, and agreed with the applicant that the ALJ erroneously rejected the applicant's doctor's opinion. According to the federal regulations, a treating physician's opinion is owed controlling weight as long as it is "well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with other substantial evidence."

The ALJ must "give good reasons ... for the weight he ultimately assigns the opinion." Here, the lower judges didn't offer good reasons. The appellate court reversed and remanded the case.

Does that mean the applicant will receive disability benefits? No. But it at least means that the Tenth Circuit Court of Appeals will enforce the review process.

Related Resources:

• Zemp-Bacher v. Astrue (Tenth Circuit Court of Appeals)
• Will SCOTUS Favor Administrative Deference in Astrue v. Capato? (FindLaw's Supreme Court Blog)
• Artificial Insemination Child Denied Social Security Benefits (FindLaw's Eighth Circuit Blog)