Disability pension: refusal in case of mental illness and alcohol dependence without incapacity for work; no structured evidence procedure required

Facts

Parties and proceedings: The appellant (insured person, born 1957) is represented by a lawyer. The respondent is the IV office of the Canton of Zurich. The contested decision is that of the Social Insurance Court of the Canton of Zurich of 6 March 2019 (IV.2018.00309). The subject matter is a claim to a disability pension under the disability insurance scheme.

Background: An earlier benefits refusal of 20 June 2011 (occupational measures and pension) and a non-entry decision of 6 March 2012 existed. On 14 January 2013 the insured person registered again, citing post-traumatic stress disorder, depression, nightmares and anxiety. The IV office denied an entitlement by decision of 11 February 2016 based on a psychiatric-psychological expert report of 19 October 2015. The cantonal court set aside this decision on 26 August 2016 and remitted the matter for a further expert report taking into account ophthalmological complaints.

Further proceedings: The IV office obtained a psychiatric expert report from Dr. med. [D.] of 13 June 2017 (supplemented on 17 January 2018) and an ophthalmological report of 5 April 2016. By decision of 1 March 2018 it maintained the benefits refusal. The cantonal court dismissed the appeal by decision of 6 March 2019.

Requests before the Federal Supreme Court: The appellant initially requested remittal for a further psychiatric expert report; after a change in case law (judgment 9C_724/2018) he requested, in the alternative, a full pension from 1 August 2013. The IV office requested dismissal. The FSCA (INO) waived a response.

Medical findings: Somatically and ophthalmologically, there is undisputedly no relevant impairment. According to the expert report, psychologically there is a 100% capacity for work in the previous activity and in an adapted activity; a temporary incapacity for work of at most 50% during moderately severe depressive phases and 100% during inpatient treatment was assumed only at times. The diagnoses were a recurrent depressive disorder (currently mild episode) and alcohol dependence syndrome without active addiction, without effect on capacity for work.

Issue in dispute: Whether the cantonal court violated federal law by upholding the benefits refusal, in particular whether Dr. [D.] 's report had probative value and whether the alcohol dependence, as a primary addiction, had to be subjected to a structured evidence procedure under BGE 141 V 281 in light of the new case law.

Considerations

Scope of review: The Federal Supreme Court applies the law of its own motion (Art. 106 para. 1 FSCA), but in principle only examines the complaints raised (Art. 42 paras. 1 and 2 FSCA). It is bound by the facts established by the lower court and corrects them only where they are manifestly incorrect or established in violation of law (Art. 105 para. 2 FSCA). Assessment of evidence is reviewed only for arbitrariness (Art. 97 para. 1 FSCA, complaint principle under Art. 106 para. 2 FSCA). Observance of the investigation principle and the rules on assessing evidence, by contrast, are questions of law reviewed freely.

Legal bases and lower court: The relevant provisions are Art. 28 para. 1 InvIA, Art. 7 and Art. 8 para. 1 GSSLA, and Art. 4 para. 1 InvIA. The lower court correctly set out the case law on disability in cases of mental illness (BGE 141 V 281, 143 V 409 and 418) and on the probative value of medical reports. The practice reflected by the lower court, under which alcoholism in principle does not give rise to disability, has in the meantime been superseded.

Probative value of the report: The report of Dr. med. [D.] , together with its supplement, meets the requirements of case law: it is based on its own examinations and a detailed anamnesis, and engages with other reports. Where an expert report was obtained in proceedings under Art. 44 GSSLA, reliance on it is appropriate unless there are concrete indications against its reliability (BGE 137 V 210). Guidelines (SGPP, SVNP) are merely an aid to orientation; a report does not automatically lose its probative value because it departs from them. Psychological test findings have only a supplementary function; the clinical examination is decisive. The absence of a diagnosis of post-traumatic stress disorder is not objectionable in view of the circumstances of life, the level of performance and the six-month latency period required under ICD-10. The cantonal court was entitled, without…