Credibility Determinations for Social Security Benefits

Facts of the Case

On July 19, 2006, Mr. Brown is alleged to have sustained numerous physical injuries while using a hammer drill at work that resulted in chronic pain and associated problems with his mental health and emotional functioning. Specifically, after the accident, he reportedly had “chronic pain in his back, left shoulder and arm, and right hip and leg; occasional pain in his left hip; and depression and anxiety” (Brown, p 258). Mr. Brown also reported “muscle spasms” that interrupted his sleep and arthritis in his hands. In his claim for disability insurance benefits, Mr. Brown submitted evidence from three physicians and one psychologist that indicated that he had received diagnoses of dysthymia, major depressive disorder, anxiety, and somatoform disorder after the accident. During their determination of Mr. Brown's eligibility for insurance benefits, the ALJ found that his deficiencies were not included within the regulations delineating impairments that would limit an individual's capacity for gainful employment. Further, Mr. Brown underwent a residual functional capacity assessment (FCA) through the ALJ to determine “the most [he could] still do despite [his physical and mental] limitations” (20 C.F.R. § 416.945[a][1](2003)). This FCA determined that Mr. Brown “could lift or carry ten pounds, stand two of eight hours, walk two of eight hours, sit six of eight hours, and frequently handle, finger, and reach overhead” (Brown, p 257). The ALJ rejected evidence indicating that Mr. Brown was not capable of performing sedentary tasks because of his impairments and so ruled that, to accommodate deficiencies in his “concentration, persistence, and pace,” his tasks should be limited to one to two steps at most (Second ALJ Decision 7).

In their deliberations, the ALJ accorded “little,” “limited” and “less than significant” weight to the testimony of Mr. Brown's treating and examining physicians and psychologist (Brown, p 266). In contrast, the ALJ favored the opinion of the nontreating expert who had reviewed the medical records, but who had not directly examined Mr. Brown. The nontreating physician disagreed with a diagnosis of somatoform disorder, despite the ALJ's ruling that Mr. Brown, in fact, suffered the effects of this condition. The ALJ nevertheless accepted the nontreating physician's testimony. The nontreating physician also broadly testified that the physical injuries sustained and the resulting conditions were not as severe as Mr. Brown had claimed and cited a few sporadic statements from Mr. Brown's medical records. Of note, the information cited was described as contextual and not reflective of the larger record submitted by Mr. Brown's providers, which indicated rather substantial impairment in his activities of daily living as a result of his workplace injury. The nontreating physician also testified that, absent the physical injuries, the psychological injuries could not credibly be present.

The ALJ determined that Mr. Brown was unable to return to work in his previous position as a millwright and maintenance worker; however, he was not deemed unable to work altogether. Indeed, the judge stated that he could engage in “unskilled sedentary work, such as a packer, assembler, inspector, or surveillance monitor” (Brown, p 257). The ALJ reasoned that his purported symptoms were in contrast with his activities of daily living, as recounted in Mr. Brown's testimony and in the testimony and records of his providers (i.e., that Mr. Brown was “cooking, driving, doing laundry, collecting coins, attending church and shopping” as well as “work[ing] around his house,” repairing his automobile and “exercising” (Brown, p 263, citing Second ALJ Decision 10-11)).

Ruling and Reasoning

The Fourth Circuit Court of Appeals held that the ALJ gave greater weight to the nontreating physician's opinion in the absence of: 1) a “high-quality explanation for the opinion and a significant amount of substantiating evidence, particularly medical signs and laboratory findings” (Brown, p 268); 2) consistent evidence across expert opinions and available records; and 3) specific expertise of the nontreating physician in the field supporting his opinion. The Fourth Circuit also found that the ALJ ignored the limits and quality of Mr. Brown's functional activities and appeared to focus on their mere presence as indicators of functional daily living. Further, the ALJ failed to establish a clear nexus between the presence of these functional activities and his ability to sustain full-time gainful employment. Regarding the ALJ's assertion that Mr. Brown's symptoms and testimony were inconsistent with available evidence, the Fourth Circuit found no “accurate and logical bridge” (Brown, p 270) supporting this position and held that Mr. Brown's testimony was, in fact, supported by the records submitted to this court. Finally, the Fourth Circuit Court of Appeals found that the ALJ erred in his reliance on his own “lay opinions” regarding the relevance of Mr. Brown's functioning in certain areas (e.g., sitting for extended periods of time during the hearing) to his work-related abilities in place of the expertise of medical professionals (Brown, p 271). In light of these opinions, the Fourth Circuit Court of Appeals reversed and remanded the case.