United States District Court, N.D. Indiana, South Bend Division
OPINION AND ORDER
DEGUILIO Judge United States District Court
case, plaintiff Benjamin Caviness, by counsel, appeals the
denial of his claim for Social Security Disability Insurance
Benefits. For the following reasons, the Court remands this
matter to the Commissioner for further proceedings consistent
with this opinion.
sought disability insurance benefits on July 21, 2014,
alleging an onset date of April 1, 2007. (Tr. 253-61).
Caviness indicated that he was unable to work due to back
pain, anxiety, depression, and post-traumatic stress disorder
("PTSD"). (Tr. 269-94). Because Caviness remained
insured through December 31, 2012, he had to establish
disability on or before that date in order to be entitled to
the benefits he sought. But his application was denied
initially and on reconsideration. (Tr. 188, 195). An
Administrative Law Judge ("ALJ") held a hearing on
March 30, 2015, during which Caviness appeared with counsel
and testified, along with a vocational expert
("VE") who testified. (Tr. 129-81). On April 21,
2015, the ALJ decided that even though Caviness suffered from
the severe impairments of degenerative disc disease, obesity,
depression, anxiety, and PTSD, he could still perform light
work that was limited (in relevant part) to simple routine
tasks that were not performed at a production rate pace and
involved no more than occasional changes in the work setting.
(Tr. 111-22). The ALJ did not impose any further mental or
social restrictions, such as limiting the amount of
interaction with coworkers, supervisors, or the public. The
hypotheticals posed to the VE considered the same limitations
(which were ultimately contained in Caviness' assigned
residual functional capacity ("RFC")), and the VE
testified that such a restricted individual could still
perform work as an office helper, mail clerk, house cleaner,
order clerk, charge account clerk, and information clerk.
Thus, the ALJ determined that Caviness was not disabled
through December 31, 2012, since he could perform these other
17, 2015, the Appeals Council denied Caviness' request
for review of the ALJ's decision, stating that "[w]e
found no reason under our rules to review the Administrative
Law Judge's decision." (Tr. 1). The Appeals Council
We also looked at the following materials that you submitted
to us (1) medical records of the VA Hospital dated from
January 2, 2015 to January 15, 2015 (3 pages), (2) a VA
Benefits Decision dated May 12, 2015 adjusting your
disability rating effective May 15, 2014 (7 pages), (3) a VA
Benefits Summary dated May 14, 2015 (3 pages), and (4)
medical records of VAMC Marion dated from February 14, 2015
to May 14, 2015 (79 pages). The Administrative Law Judge
decided your case through December 31, 2012, the date you
were last insured for disability benefits. This new
information is about a later time. Therefore, it does not
affect the decision about whether you were disabled at the
time you were last insured for disability benefits.
(Tr. 2). Caviness filed a timely complaint seeking judicial
review of the Commissioner's decision, and this Court has
jurisdiction pursuant to 42 U.S.C. § 405(g). Caviness
specifically contends that a remand for further proceedings
is necessary because the Commissioner erred as a matter of
law in denying Caviness' claim when the Appeals Council
did not apply its regulation properly in considering
"new" and "material" evidence which
revealed that Caviness was further limited in his mental and
social ability to perform other work. Caviness further
suggests that the Commissioner's decision is ultimately
not based on substantial evidence.
was born on March 6, 1978, and is currently 39 years old.
(Tr. 269). Caviness was enlisted in the Army for four years
as a patient administrative specialist (taking care of the
paperwork for births, deaths, and air evacs), until he
injured his back when a large steel desk fell and trapped him
on the floor. (Tr. 142, 168). Following his service overseas,
he was basically unable to maintain regular employment due to
the physical and mental demands of regular work. But because
Caviness does not challenge the ALJ's assessment of his
physical limitations, the Court turns to his documented
the administrative hearing, the ALJ questioned Caviness about
why he felt he could not work, referring to the period before
December 2012. Caviness responded that his "physical
disabilities aside, " his anxiety caused great
limitations. (Tr. 149-50). Caviness discussed his
hypervigilance and noted that he was "freaked out"
by having to appear at the disability hearing because there
was only one way in and one way out of the building. (Tr.
150). He testified that his constant pain and other physical
ailments caused him to be mean and the thought of dealing
with people gave him anxiety. (Tr. 150-51). After the ALJ
noted the record's supporting diagnoses for anxiety and
depression, with PTSD "definitely [being] mentioned in
the record throughout the years, " the ALJ asked
Caviness to discuss how his mental problems affected him on a
daily basis. (Tr. 158). At that point, Caviness explained how
he conducts perimeter checks of his house and is constantly
on the lookout for threats and exits. (Tr. 158-60).
referenced having nightmares, even with the help of
medication, and noted that his sleep suffered as a result.
Id. Caviness also noted having issues with his
concentration, as well as anxiety attacks on a daily basis
caused by his fear of situational events. (Tr. 161). It was
Caviness' opinion that his anxiety, depression, and PTSD
were all "tied in together." (Tr. 159).
mental health treatment records indicate that in July 2009 he
requested mental health counseling after experiencing dreams
and flashbacks from his military tour. (Tr. 557-59). On
September 23, 2009, Caviness presented to Dr. Sarah Higley
for a psychological consult, specifically for a PTSD
screening and comprehensive psychiatric evaluation. (Tr.
546-56). Caviness relayed high levels of stress and
flashbacks to his tour of duty. Id. On mental exam,
Dr. Higley noted no abnormalities and indicated that although
Caviness was referred for an evaluation due to reported
symptoms of PTSD, when evaluated, Caviness was unable to
provide details about specific military-related incidents
that were distressing and he did not report any symptoms
consistent with PTSD. Id. Dr. Higley diagnosed
unspecified adjustment disorder and cannabis abuse.
Id. Again, in November 2009, January, March, April,
and October 2010, Caviness presented with reports of stress,
but noted that it was mostly attributed to situational
factors. (Tr. 520-44). No new clinical findings or diagnoses
were noted. Id.
after his date last insured, Caviness sought treatment again
in early 2013 with complaints of PTSD. (Tr. 450-53, 458).
During a psychiatric evaluation performed by Dr. Echo Arnett,
Caviness complained of volatile mood and poor sleep.
Id. On exam, Dr. Arnett noted Caviness as having
poor insight and judgment, behavioral control issues,
inability to tolerate criticism, and impulsiveness.
Id. Dr. Arnett diagnosed Caviness with anxiety
disorder NOS, depressive disorder NOS, and personality
disorder NOS with narcissistic/borderline features.
inclusion in Caviness' administrative medical record, the
ALJ did not discuss the following medical records concerning
Caviness' ongoing mental problems:
on August 8, 2013, Caviness presented to Jonathan Graber, NP,
for an updated comprehensive psychiatric exam, including
medication review and supportive therapy. (Tr. 439-41).
Caviness reported being irritable and short tempered, as well
as experiencing feelings of hopelessness and depression,
panic attacks, visual hallucinations of dead babies, poor
motivation, flashbacks, and changing appetite. Id.
It was noted that Caviness was "looking for medications
for anxiety and depression" and that he had "been
hesitant to try to get help in the past." Id.
Mr. Graber diagnosed Caviness with depression NOS, anxiety
NOS, and ...