Burns v. Colvin

Decision Date30 December 2015
Docket NumberCASE NO. 1:14-cv-01925-YK-GBC
CourtU.S. District Court — Middle District of Pennsylvania




Docs. 1, 8, 9, 11, 14
I. Introduction

The above-captioned action is one seeking review of a decision of the Commissioner of Social Security ("Commissioner") denying the application of Plaintiff Howard Burns for supplemental security income ("SSI") under the Social Security Act, 42 U.S.C. §§401-433, 1382-1383 (the "Act"). Plaintiff injured his spine in 1987 and underwent surgery. He returned to the workforce for almost twenty-five years. He stopped working in 2011 and exhibited worsening degenerative disc disease, dextroscoliosis, and other impairments. Both medical opinions in the record, one from a treating source and one from the state agency, indicated that Plaintiff was unable to sit or stand sufficiently to perform work in the national economy. No medical opinion supported the ALJ's determination that Plaintiff was able to perform work in the national economy.

Courts review denial of benefits under the Act using the deferential substantial evidence standard. See Johnson v. Commissioner of Social Sec., 529 F.3d 198, 200 (3d Cir. 2008). The Court must affirm the ALJ's denial if "a reasonable mind might accept [the relevant evidence] as adequate to support a conclusion.'" Pierce v. Underwood, 487 U.S. 552, 565 (1988) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)).

In a slew of decisions, the Third Circuit holds that no reasonable mind would find the ALJ's evidence to be adequate when the ALJ rejects every medical opinion in the record with only lay reinterpretation of medical evidence. See Frankenfield v. Bowen, 861 F.2d 405, 408 (3d Cir. 1988); Doak v. Heckler, 790 F.2d 26, 29-30 (3d Cir. 1986); Ferguson v. Schweiker, 765 F.2d 31, 37, 36-37 (3d Cir. 1985); Kent v. Schweiker, 710 F.2d 110, 115 (3d Cir. 1983); Van Horn v. Schweiker, 717 F.2d 871, 874 (3d Cir.1983); Kelly v. R.R. Ret. Bd., 625 F.2d 486, 494 (3d Cir. 1980); Rossi v. Califano, 602 F.2d 55, 58-59, (3d Cir. 1979); Fowler v. Califano, 596 F.2d 600, 603 (3d Cir. 1979); Gober v. Matthews, 574 F.2d 772, 777 (3d Cir. 1978). These cases also recognize the special deference owed to medical opinions from treating sources ("treating source rule"). Id. No subsequentbinding precedential Third Circuit decision or enactment overrules these cases. These cases remain binding precedent.

In Jones v. Sullivan, 954 F.2d 125, 129 (3d Cir. 1991); Plummer v. Apfel, 186 F.3d 422, 430 (3d Cir. 1999); and Brown v. Astrue, 649 F.3d 193, 194 (3d Cir. 2011), the Third Circuit affirmed an ALJ who rejected a treating source medical opinion when two or more medical opinions supported the ALJ's determination that the claimant was not disabled. Id. Consequently, these cases do not address whether an ALJ's lay reinterpretation of medical evidence, alone, supplies substantial evidence to find that a claimant is not disabled when all of the medical opinions indicate that the claimant is disabled. Id. In Chandler v. Comm'r of Soc. Sec., 667 F.3d 356 (3d Cir. 2011), the Third Circuit affirmed an ALJ who relied on an uncontradicted state agency opinion that the claimant was not disabled. Id. at 361-63. The only precedential holding in Chandler is the unremarkable finding that an ALJ may rely on a state agency medical opinion that the claimant is not disabled when there are no medical opinions from treating sources that the claimant is disabled. Id. Consequently, Chandler addresses neither the treating source rule nor the standard an ALJ must use to reject, rather than accept, medical opinions. Id.

When binding precedent squarely addresses an issue, the District Court may not deviate from that precedent based on dicta. See Bd. of Trustees of Bricklayers& Allied Craftsmen Local 6 of New Jersey Welfare Fund v. Wettlin Associates, Inc., 237 F.3d 270, 275 (3d Cir. 2001) ("To the extent it applied dicta...the District Court erred"). Here, Frankenfield, Doak, Ferguson, Kent, Van Horn, Kelly, Rossi, Fowler and Gober squarely address whether an ALJ's lay reinterpretation of medical evidence, alone, constitutes substantial evidence to reject a treating source medical opinion. Jones, Plummer, Brown, and Chandler do not address this issue. Consequently, the District Court must follow Frankenfield, Doak, Ferguson, Kent, Van Horn, Kelly, Rossi, Fowler and Gober regardless of dicta statements in Jones, Plummer, Brown and Chandler.

The ALJ rejected two medical opinions, one from the state agency and one from a treating source, based only on lay interpretation of medical evidence. Each medical opinion indicated disabling limitations. No medical opinion supported the ALJ's assessment. The ALJ lacked substantial evidence to reject these opinions and deny benefits under the Act. The Court recommends that Plaintiff's appeal be granted, the decision of the Commissioner be vacated, and the matter be remanded for further proceedings.

II. Procedural Background

On December 7, 2011, Plaintiff filed an application for SSI under the Act. (Tr. 143-48). On February 3, 2012, the Bureau of Disability Determination denied Plaintiff's application (Tr. 61-70), and Plaintiff filed a request for a hearing onMarch 9, 2012. (Tr. 79-81). On March 7, 2013, an ALJ held a hearing at which Plaintiff—who was represented by an attorney—appeared and testified. (Tr. 36-60). On May 6, 2013, the ALJ found that Plaintiff was not disabled and not entitled to benefits. (Tr. 16-33). On May 20, 2013, Plaintiff filed a request for review with the Appeals Council (Tr. 13-15), which the Appeals Council denied on August 7, 2014, thereby affirming the decision of the ALJ as the "final decision" of the Commissioner. (Tr. 1-5).

On October 3, 2014, Plaintiff filed the above-captioned action pursuant to 42 U.S.C. § 405(g) to appeal the decision of the Commissioner. (Doc. 1). On December 9, 2014, the Commissioner filed an answer and administrative transcript of proceedings. (Docs. 8, 9). On January 26, 2015, Plaintiff filed a brief in support of his appeal ("Pl. Brief"). (Doc. 11). On March 30, 2015, Defendant filed a brief in response ("Def. Brief"). (Doc. 14). Plaintiff did not file a brief in reply. On June 29, 2015, the Court referred this case to the undersigned Magistrate Judge. The matter is now ripe for review.

III. Legal Standards and Review of ALJ Decision

To receive disability or supplemental security benefits, a claimant must demonstrate an "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuousperiod of not less than 12 months." 42 U.S.C. § 423(d)(1)(A); 42 U.S.C. § 1382c(a)(3)(A). The Act requires that a claimant for disability benefits show that he has a physical or mental impairment of such a severity that:

He is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work.

42 U.S.C. § 423(d)(2)(A); 42 U.S.C. § 1382c(a)(3)(B).

The Commissioner uses a five-step evaluation process to determine if a person is eligible for disability benefits. See 20 C.F.R. § 404.1520; see also Plummer v. Apfel, 186 F.3d 422, 428 (3d Cir. 1999). If the Commissioner finds that a Plaintiff is disabled or not disabled at any point in the sequence, review does not proceed. See 20 C.F.R. § 404.1520. The Commissioner must sequentially determine: (1) whether the claimant is engaged in substantial gainful activity; (2) whether the claimant has a severe impairment; (3) whether the claimant's impairment meets or equals a listed impairment from 20 C.F.R. Part 404, Subpart P, Appendix 1 ("Listing"); (4) whether the claimant's impairment prevents the claimant from doing past relevant work; and (5) whether the claimant's impairment prevents the claimant from doing any other work. See 20 C.F.R. §§ 404.1520, 416.920. Before moving on to step four in this process, the ALJ must alsodetermine Plaintiff's residual functional capacity ("RFC"). 20 C.F.R. §§ 404.1520(e), 416.920(e).

The disability determination involves shifting burdens of proof. The claimant bears the burden of proof at steps one through four. If the claimant satisfies this burden, then the Commissioner must show at step five that jobs exist in the national economy that a person with the claimant's abilities, age, education, and work experience can perform. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993). The ultimate burden of proving disability within the meaning of the Act lies with the claimant. See 42 U.S.C. § 423(d)(5)(A); 20 C.F.R. § 416.912(a).

IV. Relevant Facts in the Record

Plaintiff was born on April 14, 1967, and was classified by the regulations as a younger individual through the date of the ALJ decision. 20 C.F.R. § 404.1563. (Tr. 28). Plaintiff has at least a high school education. (Tr. 28). In 1987, Plaintiff injured his back and underwent spinal fusion surgery. (Tr. 46). He was able to return to work. (Tr. 46-47). The relevant period begins on November 27, 2011, the application date. (Tr. 21).

On November 4, 2011, Plaintiff presented to the emergency room complaining of chest and epigastric pain. (Tr. 245-61, 339). He was anxious, in mild distress, and "appear[ed] to be in pain." (Tr. 329). Examination indicated abdominal tenderness. (Tr. 339). Abdominal CT scan showed "chronic L1compression," a urinary calculus, ...

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