454 F.3d 627
United States Court of Appeals,
Tina KANGAIL, Plaintiff–Appellant,
Jo Anne B. BARNHART, Commissioner of Social Security, Defendant–Appellee.
Argued June 13, 2006.Decided July 14, 2006.
Unrelated to LPS Conservatorship or dependency law, the case of Kangail v Barnhart addresses an issue of mental within the purview of the courts considering mental illness in its entirety versus nit picking a single aspect of the illness in rendering a judgement. Like the laws that mandate that the legislature should be interpreted within the context that they were written and the statute as a whole rather than parts in a vaccum, this case reflects that the court should render a judgment in the same way when addressing mental illness. This case originating out of Illinois addresses the issue of whether a SSI claimant was properly denied benefits based on her substance use originating from her bipolar disorder. The district court denied her benefits based on the judgement that the substance usage aggravated the mental illness and claimant was not disabled when sober. In addition, the SSA failed to assess the claimant’s bipolar and substance use as interlinked and viewed substance use as the disqualifying factor within the SSA guidelines. The court of appeals held that the district court and SSA failed to properly interpret the SSA guidelines when it did not consider the claimant’s mental illness and substance use in its entirety and ordered that the SSA’s decision be vacated and remanded.
The claimant filed request for SSA benefits having been diagnosed with manic depression or bipolar for the last for more than a decade. She claims to have applied and held a position at a least ten jobs but lost her positions soon after due to her symptoms. Claimant also had a positive history for drug use, cocaine. During well periods claimant was able to hold down her job, perform the necessary duties expected of her, and behave in a manner consistent with that of her coworkers. However, when she relapsed into an episode, she displayed impairing manic symptoms consistent with a bipolar disorder diagnosis. She would start by “blowing up,” [having] racing thoughts, confrontations with customers and supervisors, or other manic activity; or because of insomnia, inability to concentrate, feeling overwhelmed, or other symptoms of depression; or because of “disappearing,” confusion”. These all impacted her ability to work and keep her job in the long term despite temporary competence. The SSA also noted that claimant presented as well spoken and cohesive during her initial interviews thus rendering the impression that her bipolar disorder was not that grave. It should also be noted that the administrative law judge thought the claimant’s inability to hold a job was not of material substance because she could work when she took her medicine.
In rendering its decision, the SSA claimed that denial of benefits may be appropriate if substance use may have led to disability (in re 42 U.S.C. § 423(d)(2)(C); Vester v. Barnhart, 416 F.3d 886, 888 (8th Cir.2005). The SSA averred that claimant had periods of remission when not using substances in which she was able to hold a position at her place of employment. The SSA affirms the rule that if the applicant “is a substance abuser, the issue for the administrative law judge is whether, were the applicant not a substance abuser, she would still be disabled…”. The SSA believed that claimant was not completely impaired by her substance use and that such use existed largely independent of her bipolar disorder thus rendering the bipolar disorder not a disabling condition. In addition, SSA asserts that bipolar disorder can be managed with medication treatment and failure to take medications was an issue entirely separate of the disorder thus rendering claimant ineligible should she be noncompliant. Having taken all these factors, the SSA and the district appellate court upheld the judgement denying benefits. Claimant filed a timely appeal. Upon submission of the previous court records, the US court of appeals dissented in its opinion. The US court of appeals overturned the judgement citing that the two previous courts failed to consider mental illness and the side effects in their entirety and improperly denied claimant of her benefits. It provided two bases for its reasoning: the SSA failed to view mental illness as a complex condition with many variables and the SSA’s over-reliance on drug abuse as a sole basis for denial.
The first assertion comes from the basis that bipolar disorder is an illness with many facets. Bipolar disorder affects many aspects of life outside of simple mood swings. The two primary sides of bipolar comprise the manic and depressive episodes. During manic episodes the patient can experience grandiose beliefs, irritability, impulsive decisions making, less need for sleep, mood lability, distractibility, and anosognosia. During the depressive end of the spectrum, the patient can suffer from apathy, decreased appetite, lack of energy, suicidal thoughts, distractibility, and feelings of worthlessness. Bipolar is an episodic illness meaning that there are periods of remission between episodes in which the person may feel fine and lack any disabling symptoms. However, that does not mean the illness is gone. Frequently the person may suffer a relapse of either mania or depression and become disabled. Claimant during her periods of remission was able to hold down her job to varying degrees of success. However, due to the cyclic nature of the illness did not maintain her positions long enough to meet the criteria for “substantial gainful employment”. The appellate court upheld this assertion citing her pay over several periods of time where it was subpar due to her relapses. The appellate court state that it believed that the SSA “attached too much weight to the plaintiff's job experiences after March 2000, when she stopped abusing drugs and alcohol and had a remission of symptoms. The appellate court also noted medication compliance as a factor in disability when viewed in the scope of bipolar illness. Because anosognosia, a lack of insight into the illness, is very common during mania the patient may discontinue their medications not out of spite but simply an inability to see themselves as ill. This phenomenon is very common among bipolar patients (50%) and contributes to an increase in symptoms. The SSA when rendering their judgement failed to consider the remitting nature of bipolar, inability to take medication, and the resulting work inconsistencies resulting from the previous two factors. Because of their failure to understand the link, the SSA decision was flawed.
The second assertion that the claimant’s substance use precluded them from services as substance use can be a disqualifying factor should the claimant demonstrate an ability to sustain work temporarily when not using substances and taking her medication. Bipolar suffers frequently self medicate due to either anosognosia or as a preference over medication. Alcohol and street drugs are very common substances of abuse. Substance abuse is one of the criteria for a manic episode. As expected the claimant was able to gain employment when she was not using substances and taking her medication, but the SSA failed to appreciate the fact that bipolar disorder can distort the person’s insight into their own treatment and lead to the person quitting their medication and self medicating instead. Even if the person was stable when not using street drugs, this stability can relapse into another episode even if street drugs are not used in the future. Simply put the street drugs were one of the many ways bipolar can manifest.
Although not a primary issue in this case the SSA relied on singular instances of the appellant’s employment history where she was able to maintain gainful employment. The appellate court rejected the SSA’s evidence citing that the SSA did not consider many of the time periods where the applicant was disabled and worked for briefer time periods gaining subpar income. The appellate court reminded the SSA that it needs to consider the employment history as a whole rather than “cherry picking” certain facts to create a favourable case for itself.
Based on these two primary points, the appellate court found that SSA failed to proffer substantial evidence that the claimant was not disabled independent of her substance abuse and medication noncompliance as a result of her bipolar disorder. The appellate court vacated the decision and remanded to SSA ordering that it render a new judgement consistent with the appellate court’s findings.
Background: Claimant diagnosed with bipolar disorder sought judicial review of the denial by the Social Security Administration of her application for social security disability benefits. The United States District Court for the Northern District of Illinois, Charles R. Norgle, Sr., J., affirmed the denial of benefits. Claimant appealed.
Holding: The Court of Appeals, Posner, Circuit Judge, held that substantial evidence did not support determination by ALJ that social security disability claimant was not disabled independent of her substance abuse as a result of her bipolar disorder.
Vacated and remanded.
Juvenile Dependency and