In a decision that highlights the complex intersection of severe mental trauma and disability law, the U.S. District Court for the District of New Jersey recently affirmed the denial of Social Security disability benefits to a former police officer suffering from post-traumatic stress disorder after someone put a contract on his life.

Jon L. Gelman

Key takeaways

• Administrative law judges are not required to discuss every piece of evidence. The court held that, though an ALJ must consider all evidence, there is no requirement to explicitly discuss every treatment note or piece of evidence in the written decision.
• Medical opinions on ultimate disability are not persuasive. Opinions stating that a claimant cannot perform past work (an issue reserved to the commissioner) are "inherently neither valuable nor persuasive."
• The harmless error doctrine applies. Even if an ALJ errs in certain aspects of analysis, remand is not required if the errors don't affect the outcome.
• Treatment compliance matters. The ALJ considered adequately that the man's undertreated status and reluctance to engage in recommended therapy undermined claims of total disability.
• GAF scores alone don't establish disability. While his therapist assigned a global assessment of functioning score of 50 (indicating serious symptoms), the ALJ correctly noted this was inconsistent with other evidence showing he could perform daily activities.

The court's analysis

The case involves Cecil Z., a former police detective who developed severe PTSD after arresting Joseph D'Amico. While in prison, D'Amico contacted the Aryan Brotherhood and attempted to hire a hit man to kill Cecil. Law enforcement thwarted the plot, but the psychological damage was done.

Cecil reported experiencing flashbacks and intrusive thoughts, nightmares causing him to wake in cold sweats and vomit twice weekly, dissociative episodes requiring family members to yell his name multiple times, hypervigilance and paranoia, and social isolation lasting days after episodes.

The court systematically addressed Cecil's three challenges to the ALJ's decision:

• The Brolin evidence issue. Cecil argued that the ALJ failed to meaningfully consider treatment notes from his therapist, Pamela Brolin. The court disagreed, finding:
  • Under 20 C.F.R. § 404.1520c, Brolin's notes constituted "other medical evidence" rather than "medical opinions" because they didn't specifically address work-related functional limitations.
  • The ALJ wasn't required to discuss Brolin's GAF score of 50 under the regulations.
  • Any error was harmless because the ALJ acknowledged Cecil's diagnoses of PTSD, panic disorder and major depressive disorder as severe impairments.
  • The ALJ considered Cecil's symptoms that Brolin documented (nightmares, anxiety, flashbacks, etc.) when crafting the residual functional capacity.
•  The Drs. Glass and Schlosser opinions. Cecil challenged the ALJ's treatment of two doctors who evaluated him in 2018 and found him unfit for police work. The court held that this was not inconsistent because:
  • Opinions on whether someone can perform "past work" are reserved for the commissioner and are "inherently not persuasive."
  • However, the ALJ could still consider the medical findings from those examinations.
  • The ALJ actually agreed with these doctors that Cecil couldn't return to police work.
  • But fitness for one specific job doesn't determine disability for all work.
• The vocational expert objection. After the hearing, Cecil objected to the VE's testimony regarding "reasoning codes." The ALJ never addressed this objection. The court found any error harmless because:
  • Even removing the disputed "mail clerk" job (reasoning level 3), there remained 286,421 jobs nationally that Cecil could perform.
  • The 3rd Circuit has found far fewer jobs sufficient (even 18,000-20,000 jobs).
  • The marker and routing clerk positions (reasoning level 2) were properly supported.
  • Working at reasoning level 2 is consistent with an RFC for "simple, routine tasks."

The most important sentence

An ALJ may consider the entire record without discussing each piece of evidence contained therein. (Phillips v. Barnhart.)

This sentence encapsulates a crucial principle in Social Security disability law. While ALJs must consider all evidence, they need not write an encyclopedia. This standard allows for efficient adjudication while still requiring substantial evidence and reasoned decisionmaking. It protects against the unrealistic burden of discussing every page in what can be a thousand-page record, while still requiring meaningful analysis of significant evidence.

Why this case matters

• Clarifies post-2017 regulations on medical evidence. This case provides important guidance on how courts interpret the Social Security Administration's revised regulations for claims filed after March 27, 2017. The distinction between "medical opinions" (which must be discussed) and "other medical evidence" (which need not be explicitly addressed) is critical for practitioners.
• Addresses the treatment of VA evidence. While not the focus, the case touches on how ALJs should handle Department of Veterans Affairs disability determinations, which is increasingly important, given the number of veterans seeking Social Security disability benefits.
• Highlights the "undertreated" status issue. The ALJ's finding that Cecil was "undertreated" — specifically, that he refused therapy and medication changes partly due to fear of losing his VA benefits — raises important questions about:
  • How mental illness itself can impair treatment compliance.
  • Whether fear of losing benefits should be considered a mental health symptom.
  • The tension between requiring treatment compliance and recognizing that severe mental illness often prevents it.
• Demonstrates the limits of subjective complaints. Despite horrific trauma and genuine mental health conditions, Cecil's claim failed partly because:
  • He could perform various daily activities (shopping, going to the gym, fishing, riding motorcycles).
  • Mental status exams often showed intact cognition.
  • He made progress when he engaged in treatment (anger management after the relevant period).
  • This illustrates the high bar for disability benefits even with legitimate, severe impairments.
• Harmless error doctrine application. The case demonstrates how courts apply harmless error analysis in Social Security cases, showing that procedural missteps don't automatically require remand if they don't affect the outcome.

Conclusion

Cecil Z.'s case illustrates the challenging reality that even severe, documented mental health conditions arising from traumatic circumstances may not meet the stringent requirements for Social Security disability benefits. The case reinforces that:

• Functional capacity matters more than diagnosis. Having PTSD, depression and anxiety wasn't enough; the key was whether these conditions prevented all work.
• Treatment compliance is scrutinized. Refusing recommended treatment undermined Cecil's credibility.
• Daily activities count. Being able to shop, exercise and ride motorcycles suggested work capacity.
• The bar for disability is high. The system requires that claimants be unable to perform any work in the national economy, not just their past work.

For practitioners, this case serves as a reminder to thoroughly document not just diagnoses and symptoms, but specific functional limitations and how they prevent sustained work activity. For claimants, it underscores the importance of following treatment recommendations and documenting why any noncompliance is itself a symptom of the disabling condition.

Claimants' attorney Jon L. Gelman is the author of "New Jersey Workers’ Compensation Law" and co-author of the national treatise "Modern Workers’ Compensation Law." He is based in Wayne, New Jersey. This blog post is republished with permission.