When Checkbox Forms Fall Short

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:

1. Supportability – Is the opinion backed by objective evidence and explained?

2. 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.

Got any questions? Schedule a consultation with us. I’m here to help. It’s a lot to take in, but we’ll get through it together. After all, navigating these waters is always easier when you’ve got someone to chat with.