Reported / Citable
Background
Michael A., a veteran, applied for disability insurance benefits under Title II of the Social Security Act in September 2023, alleging disability from depression, PTSD, obstructive sleep apnea, fibromyalgia, and spinal osteoarthritis with an alleged onset date of April 4, 2018. His application was denied twice at the administrative level. Following a telephonic hearing, ALJ Jim Fraiser found him not disabled in September 2024, concluding he retained the residual functional capacity (RFC) to perform light work, could follow detailed instructions, and would be off-task only five percent of the workday. The ALJ identified 850,000 housekeeper jobs and 190,000 garment sorter jobs in the national economy that the plaintiff could perform.
In support of his claim, the plaintiff submitted Disability Benefits Questionnaires (DBQs) completed by three VA clinicians — Dr. Mar Grau Escriva, Dr. Mirza M. Vazquez, and Nurse Practitioner Brannon M. Sims — each of whom had examined him and documented specific work-related limitations. The ALJ referenced Dr. Vazquez’s findings but never clearly stated whether he found her opinions persuasive, and he made no mention whatsoever of the opinions of Dr. Escriva or NP Sims. After the Appeals Council denied review, the plaintiff appealed to federal district court.
The Court’s Holding
The magistrate judge first held that the VA clinicians’ DBQ statements constitute “medical opinions” under 20 C.F.R. § 404.1513(a)(2) because they directly address the plaintiff’s ability to perform the physical and mental demands of work — including maintaining concentration and pace, following instructions, adapting to workplace stress, and tolerating prolonged sitting, standing, or lifting. The magistrate rejected the Commissioner’s argument that 20 C.F.R. § 404.1504 — which provides that an ALJ is not bound by another agency’s disability determination — absolved the ALJ of the obligation to evaluate the underlying clinical opinions. The regulation expressly requires the ALJ to consider the supporting medical evidence, and the clinicians’ assessments do not become legal determinations merely because they were prepared in connection with a VA disability claim.
The magistrate further held that the ALJ’s articulation was legally deficient. As to Dr. Escriva and NP Sims, the ALJ’s decision was entirely silent — a boilerplate statement that he “fully considered” all medical opinions cannot cure a complete failure to address specific sources. As to Dr. Vazquez, the ALJ reviewed the underlying evidence but never stated whether he found her opinions persuasive, leaving the court to speculate. Under 20 C.F.R. § 404.1520c(b), an ALJ must at minimum explain how he assessed the supportability and consistency of each medical opinion. The error was not harmless: NP Sims’ opinions identifying difficulty sitting, standing, walking, and lifting would have materially affected the light-work RFC, and the mental health findings by Dr. Escriva and Dr. Vazquez — including deficiencies in most work areas, disturbances of motivation, and mild memory loss — were potentially at odds with the ALJ’s finding that the plaintiff could remember and carry out detailed instructions and be off-task only five percent of the day. Remand is accordingly recommended. On the separate question whether the ALJ was required to make an independent finding on the plaintiff’s ability to maintain employment, the magistrate found no error: the plaintiff’s evidence of “intermittent” incapacity fell short of demonstrating that his symptoms wax and wane in a manner that precludes sustained employment.
Key Takeaways
- VA Disability Benefits Questionnaires containing clinician assessments of work-related functional limitations qualify as “medical opinions” under Social Security regulations and must be evaluated for persuasiveness — they do not lose that status simply because they were prepared for a VA disability claim.
- The regulatory bar on adopting another agency’s disability determination (20 C.F.R. § 404.1504) does not excuse an ALJ from considering the underlying medical evidence and opinions generated in connection with that determination.
- An ALJ’s complete silence on a medical source’s opinions, or a failure to state an ultimate persuasiveness finding after reviewing the underlying evidence, violates the articulation requirement of 20 C.F.R. § 404.1520c(b) and warrants remand as harmful error when the omitted opinions could have altered the RFC.
- A separate “ability to maintain employment” finding is required only when the claimant demonstrates that symptoms wax and wane in a manner that actually precludes sustained work — evidence of merely intermittent bad periods does not cross that threshold.
Why It Matters
This decision reinforces a recurring issue in Social Security disability litigation: ALJs must do more than note the existence of VA medical records or invoke generic boilerplate about having “fully considered” all opinions. Where a veteran submits detailed clinical questionnaires documenting functional limitations, the ALJ is required to engage with each clinician’s findings, explain whether the opinions are supported by objective evidence, assess their consistency with the broader record, and state a persuasiveness conclusion. Silence or formulaic language on any of those steps will not survive judicial review.
The ruling also clarifies the interplay between the VA’s disability determination and the SSA’s separate adjudication. Attorneys representing veterans in Social Security proceedings should ensure that DBQ opinions are formally presented as medical opinions — not merely as attachments to the VA rating decision — and should press for remand whenever an ALJ conflates the non-binding nature of the VA’s ultimate determination with the obligation to consider the clinical evidence underlying it.