The Weight of Treatment Team Opinion Regarding Mental Illness in Social Security Disability Claims

Facts of the Case

In April 2007, Todd Bernard, a 44-year-old laborer with a high school diploma claimed he could not work due to anxiety, cramping in his feet, and difficulty breathing. The record showed that he had worked a temporary job until April 2007 and that it had ended after completion of the project. Mr. Bernard sought mental health treatment in December of 2007 from a social worker for therapy and from a psychiatrist for psychopharmacology. During the next two years, multiple medical professionals treated Mr. Bernard for a variety of conditions, including major depressive disorder, alcohol dependence, generalized anxiety disorder, and emphysema until his death in July 2009 in the midst of the appeals process. There is no information in the opinion as to how he died.

An administrative law judge (ALJ) reviewed Mr. Bernard's claim and heard testimony from his father, medical professionals, a neighbor, and vocational experts. The ALJ determined that Mr. Bernard was still able to engage in light work, as he did when he was a laborer; that he was not disabled,; and that he was not actively looking for gainful employment. Thus, in light of the finding, the ALJ determined that Mr. Bernard was not eligible for benefits.

The district court agreed with the ALJ's decision. They noted that, although the ALJ inappropriately weighed the medical professionals' opinions, it was a moot error because substantial evidence in Mr. Bernard's whole record indicated that his illnesses did not hinder his ability to work if he stopped using alcohol. After Mr Bernard died, Ronald L. Bernard, his brother, filed an appeal.

Ruling and Reasoning

The Eight Circuit Court of Appeals agreed with the U.S. District Court's decision to deny benefits after reviewing the case using the de novo standard (i.e., the court reviewed the evidence as if the ALJ had not already made a finding of fact, essentially taking a fresh look at the case). The court wrote that it “must affirm the Commissioner's decision if it is supported by substantial evidence on the record as a whole” (quoting Pelkey v. Barnhart, 433 F.3d 575 (8th Cir. 2006), p 577). The court stated that for individuals to receive Social Security benefits, they must be disabled. Disability is defined as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than 12 months (Halverson v. Astrue, 600 F.3d 922 (8th Cir. 2010) p 929).

Disability, in the court of law, is determined by five considerations: the claimant was employed; he is severely impaired; his impairment is, or is comparable with, a listed impairment; he cannot perform past relevant work; and he cannot perform any other work.

Ronald Bernard contended that because the ALJ did not give appropriate weight to the opinions of the medical professionals, particularly his brother's psychiatrist and social worker who had treated him for an extended time, the ALJ's decision was not supported by substantial evidence in the record as a whole. From December 2007 through July 2009, Mr. Bernard had met with his social worker eight times and his psychiatrist four times. His treatment team had explained that he had “an anxiety related disorder and complete inability to function independently outside the area of [his] home” (Bernard, p 486). Regarding his alcohol use, they indicated that it was “impossible to separate out what attributes contribute to [Mr. Bernard's] dysfunction while he was drinking. He was equally disabled, however, when not drinking” (Bernard, p 486). Ronald Bernard also argued that the ALJ should have given greater weight to the doctor who evaluated his brother's hand tremors and had opined that his tremors were not derived from alcohol withdrawal and would prevent him from being effective at work.

The court determined that because the ALJ was tasked with evaluating the record as a whole, the treatment team's opinions did not automatically control the decision. The court cited the case of Goff v. Barnhhart, 421 F.3d 785 (8th Cir. 2005): “An ALJ may discount or even disregard the opinion of a treating physician where other medical assessments are supported by better or more thorough medical evidence, or where a treating physician renders inconsistent opinions that undermine the credibility of such opinions” (Goff, p 790). The court determined that the evidence in the record was inconsistent with the opinions of the treatment team, because Mr. Bernard failed to follow the treatment recommendations of the psychiatrist and social worker. As one example, Mr. Bernard did not see his psychiatrist for 15 months during his 2-year treatment because of his drinking. The court felt it was unjustified to give controlling weight to the opinions of the psychiatrist and social worker because of Mr. Bernard's gaps in appointments and because he was not seen during critical periods (including when he was drinking) or taking his medications regularly.

The court also agreed with the ALJ that Mr. Bernard seemed to stabilize when he was compliant with his medications and that he slept better, had less depressive symptoms, and experienced reduced tremors. In addition, the court opined that his participation in activities such as riding his bike to the library, playing games, handling finances, and performing maintenance work at his apartment building, was inconsistent with his subjective complaints, bringing his credibility into question. Because the treatment team relied only on Mr. Bernard's interpretation of his experience, they were likely relying on noncredible information.

The ALJ had also found that Mr. Bernard had a sparse work history and made no significant attempt to return to work. His making no effort to take vocational or rehabilitative training indicated his lack of motivation to return to work. Considering the lack of medical evidence indicating disability and Mr. Bernard's high activity level, sparse work history, and lack of motivation, the court found that the ALJ had properly denied giving controlling weight to the opinions of his doctors and social worker. The court also found the ALJ had substantial evidence to support denying benefits to Mr. Bernard.