Nurse Practitioner's Opinion on Disability Should Not be Ignored, Federal Judge Rules

This article discusses an actual Social Security disability claim that was denied and appealed to federal court. I'll explain the background of the case and the judge's 2016 decision.

Facts of the Disability Claim

In 2009, the 24-year-old claimant, Sarah Dale, filed a claim for Supplemental Security Income (SSI) disability based on a combination of psychological and physical problems, including PTSD, anxiety, panic disorder, dyslexia, and degenerative disc disease. The claimant had a difficult childhood and adolescence in which she experienced physical and sexual abuse and substance dependency, and she had performed only a minimal amount of work until applying for disability benefits.

The claimant's treating nurse practitioner had provided an opinion regarding both the claimant's mental and physical limitations. The nurse practitioner, who had been treating the claimant for three years, stated that the claimant's social functioning was "markedly limited" due to agoraphobia, that the claimant suffered from poor attention and concentration, and that she would miss at least two days of work per month due to her mental issues.

From a physical standpoint, the nurse practitioner found that the claimant could lift no more than 10 pounds on an occasional basis; could stand or walk for two hours a day and 15 minutes at a time; and had limitations in both her arms and legs, especially with pushing and pulling and gross manipulation.

After her application for benefits was initially denied by Social Security, the claimant requested an appeal hearing. The administrative law judge (ALJ) who heard her appeal again rejected her claim, giving only "limited weight" to the opinions of the treating nurse practitioner. Instead, the ALJ relied on the opinions of a psychologist who had reviewed the claimant's mental health records but never examined her.

The ALJ discounted the nurse practitioner's opinions as to the claimant's exertional (strength-related) and postural limitations because they were not reflected in her treatment notes. The ALJ also stated that "the residual functional capacity ... includes manipulative and mental limitations that are generally consistent with [the nurse practitioner's] assessment." [Emphasis added.]

The claimant again appealed and the case ended up in the the U.S. Court of Appeals for the Ninth Circuit.

The Judge's Decision

The federal judge writing for the Ninth Circuit pointed out:

The federal court found that the ALJ made a mistake in ignoring the nurse practitioner's opinions regarding manipulative and mental limitations simply because her testimony about the claimant's strength and postural limitations were not supported by the record. Furthermore, because the vocational expert had testified at the hearing that a person with the mental limitations cited by the nurse practitioner could not perform even simple work, the ALJ's mistake was not "harmless error." As a result, the case was sent back to Social Security for further proceedings.

Impact of the Decision

As any disability attorney will tell you, administrative law judges routinely discount the opinions of treating providers, from physicians to psychologists to nurse practitioners, because of apparent inconsistencies between the providers' treatment notes and their opinions. In this case, the Ninth Circuit warned ALJs not to throw the baby out with the bathwater. In other words, if a particular portion of a medical source statement is not supported by the record, the ALJ need not give it credence—but at the same time, an inconsistency in one part of a medical opinion (say, as to strength limitations) does not allow the ALJ to ignore unrelated opinions, such as those relating to mental health.

This case underscores the importance of obtaining a medical source statement from your treating provider, ideally a statement that is fully consistent with the your treatment notes. Of course, inconsistencies are virtually inevitable, as not all medical providers are as meticulous with their treatment notes as they could be. For disability claimants, this decision provides hope that ALJs will not overlook an entire medical source statement simply because some portion of it is not fully supported by your medical records.

Read the full text of Dale v. Colvin, 823 F.3d 941 (9th Cir. 2016).