When Checkbox Forms Fall Short
- juliana9396
- Aug 4
- 3 min read
In Drumgold v. Commissioner of Social Security (4th Cir. 2025), the court affirmed the ALJ’s denial of disability benefits, offering a sharp reminder of the post-2017 SSA rules on evaluating medical opinions—especially in claims involving mental health.
The Factual Background
Drumgold, a former SSA employee, had a history of mental health struggles including depression, bipolar disorder, and PTSD. She left work in 2015 after what she described as a “snap” due to frustration and anger. She first applied for benefits in 2015, was denied in 2019, and re-applied in 2020.
The second application included:
🩺 Her primary care doctor’s notes, which mostly showed depression in remission and minimal complaints.
🧑⚕️ Two brief letters and checkbox forms from her mental health counselor, Shideh Sarmadi, stating that Drumgold had marked impairments and could not attend work more than three times a month.
👩⚕️ An SSA-ordered exam by Dr. McCleary, who found marked limitations in workplace functioning, but whose findings weren’t fully supported by her own clinical observations.
📋 Two SSA consultants, Drs. Montgomery and McClain, who reviewed the records and concluded the impairments were only moderate and that Drumgold could still work.
⚖️ What the ALJ Did
The ALJ reviewed all the evidence and applied the post-2017 regulations under 20 C.F.R. § 404.1520c, which require that medical opinions be evaluated for:
Supportability – Is the opinion backed by objective evidence and explained?
Consistency – Does it align with the rest of the record?
The ALJ found:
Sarmadi’s opinions lacked supportability: no treatment notes, only vague letters and forms with checked boxes and no explanations.
The opinions were not consistent with the overall record: most notably the conservative course of treatment, Drumgold’s ability to perform daily activities, and the conclusions of the SSA consultants.
Dr. McCleary’s assessment was also given limited weight due to inconsistencies within her own report.
Greater weight was given to Drs. Montgomery and McClain, who explained their opinions and were aligned with the record as a whole.
Ultimately, the ALJ found Drumgold had moderate limitations but retained residual functional capacity for some work.
🏛️ What the Court Said
The Fourth Circuit affirmed the decision, emphasizing:
ALJs no longer give controlling weight to treating providers under the 2017 rule.
The ALJ properly explained how supportability and consistency factored into weighing each opinion.
It’s not enough to label a submission a “special report” if it lacks substantive detail.
The use of daily activities was not improper here—the ALJ did not extrapolate capacity solely from daily tasks but weighed them in the context of a broader, well-supported record.
⚖️ Judge Gregory Dissents
In a sharply worded dissent, Judge Gregory argued:
Sarmadi’s letters did meet SSA’s definition of a “special report,” as they described longitudinal treatment and functional limitations.
The ALJ’s expectations were unreasonably high and risked penalizing claimants for preserving psychotherapy privacy.
The ALJ failed to build a “logical bridge” between Drumgold’s ability to perform some daily activities and the denial of full-time work capacity.
💡 Key Takeaways for Practitioners
✅ Supportability and consistency are king under the 2017 SSA regs.❌ Checkbox forms without narrative detail carry little weight.📝 Even treating sources must substantiate opinions with clinical detail—letters alone won’t cut it.🧾 Consider helping providers craft reports that summarize treatment and function clearly and thoroughly, especially in mental health cases.
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