Leach v. Colvin
| Decision Date | 20 June 2016 |
| Docket Number | CASE NO. 1:15-cv-01230-YK-GBC |
| Parties | CHRISTOPHER LEACH, Plaintiff, v. CAROLYN W. COLVIN, COMMISSIONER OF SOCIAL SECURITY, Defendant. |
| Court | U.S. District Court — Middle District of Pennsylvania |
(JUDGE KANE)
(MAGISTRATE JUDGE COHN)
REPORT AND RECOMMENDATION TO VACATE THE DECISION OF THE COMMISSIONER AND REMAND FOR FURTHER PROCEEDINGS
The above-captioned action is one seeking review of a decision of the Commissioner of Social Security ("Defendant") denying the application of Christopher Leach ("Plaintiff") for disability insurance benefits ("DIB") under the Social Security Act, 42 U.S.C. §§401-433, 1382-1383 (the "Act") and Social Security Regulations, 20 C.F.R. §§404.1501 et seq. (the "Regulations").
Plaintiff submitted a treating source opinion supported by objective medical findings. Doc. 10. The only evidence inconsistent with this opinion, aside from the ALJ's lay reinterpretation of medical evidence, was a single non-treating, non-examining medical opinion from a source who did not review a complete record. Doc. 10. An examining opinion corroborates the treating source opinion. Doc. 10.
Defendant identifies no precedential Third Circuit decision affirming an ALJ who credited a non-treating, non-examining source over a treating source medical opinion. In Morales v. Apfel, 225 F.3d 310 (3d Cir. 2000) and Brownawell v. Comm'r Of Soc. Sec., 554 F.3d 352 (3d Cir. 2008), the Third Circuit held that the ALJ erred by failing to adopt a treating source medical opinion when only a non-treating, non-examining opinion contradicted the treating source medical opinion. See Brownawell, 554 F.3d at 352; Morales, 225 F.3d at 317. Morales emphasized that the non-treating, non-examining source reviewed an incomplete case record. See Morales, 225 F.3d at 314 (). In Brownawell, like here, an examining opinion corroborated the treating source opinion. See Brownawell, 554 F.3d at 352. In contrast, in Brown v. Astrue, 649 F.3d 193 (3d Cir. 2011), the Third Circuit affirmed where there were two non-treating opinions, one from a source who reviewed the entire record. Id.
Brown, Morales, and Brownawell correspond with SSR 96-6p, which provides that an ALJ may only assign less weight to a treating source opinion based on a non-treating, non-examining medical opinion in "appropriate circumstances." SSR 96-6p; see also 20 C.F.R. §404.1527(c)(1) (). SSR 96-6p does not define "appropriate circumstances," butprovides an example: when the non-treating, non-examining source was able to review a "complete case record...which provides more detailed and comprehensive information than what was available to the individual's treating source." Id. This example does not constitute the only possible appropriate circumstance to assigning greater weight than a treating medical opinion, but the phrase "appropriate circumstances" should be construed as requiring a similarly compelling reason. See Ali v. Fed. Bureau of Prisons, 552 U.S. 214, 223, 128 S. Ct. 831, 838, 169 L. Ed. 2d 680 (2008) ().
SSR 96-6p also corresponds with Frankenfield v. Bowen, 861 F.2d 405 (3d Cir. 1988); Doak v. Heckler, 790 F.2d 26 (3d Cir. 1986); Ferguson v. Schweiker, 765 F.2d 31 (3d Cir. 1985); Kent v. Schweiker, 710 F.2d 110 (3d Cir. 1983); Van Horn v. Schweiker, 717 F.2d 871 (3d Cir. 1983); Kelly v. R.R. Ret. Bd., 625 F.2d 486 (3d Cir. 1980); Rossi v. Califano, 602 F.2d 55 (3d Cir. 1979); Fowler v. Califano, 596 F.2d 600 (3d Cir. 1979); and Gober v. Matthews, 574 F.2d 772 (3d Cir. 1978)). These cases hold that lay reinterpretation of medical evidence does not provide substantial inconsistent evidence to assign less than controlling weight to a treating source medical opinion. Id. If the non-treating, non-examining source failsto review the complete record, the ALJ may be required to undertake lay reinterpretation of medical evidence to reject the treating opinion.
After Frankenfield, Doak, Ferguson, Kent, Van Horn, Kelly, Rossi, and Fowler were decided, the Social Security Administration promulgated regulations addressing medical opinions for the first time. See Standards, 56 FR 36932-01 at 36936. The Social Security Administration retained, rather than abrogated, this common-law when it promulgated 20 C.F.R. §404.1527(c). See Burns v. Colvin, No. 1:14-CV-1925, 2016 WL 147269 (M.D. Pa. Jan. 13, 2016). Regulatory enactments are presumed to retain, rather than abrogate, pre-existing common law unless the enactments are incompatible with existing common-law or there is evidence of a clear intent to abrogate. See Burns v. Colvin, No. 1:14-CV-1925, 2016 WL 147269 (M.D. Pa. Jan. 13, 2016) (citing United States v. Texas, 507 U.S. 529, 534, 113 S.Ct. 1631, 123 L.Ed.2d 245 (1993); Sebelius v. Cloer, —U.S. —, 133 S.Ct. 1886, 1896, 185 L.Ed.2d 1003 (2013); Connecticut Nat. Bank v. Germain, 503 U.S. 249, 253-254, 112 S.Ct. 1146, 117 L.Ed.2d 391 (1992); BFP v. Resolution Trust Corp., 511 U.S. 531, 543, 114 S.Ct. 1757, 128 L.Ed.2d 556 (1994)). The party asserting that the enactment abrogates common law bears the burden of overcoming this presumption. See Green v. Bock Laundry Mach. Co., 490 U.S. 504, 521, 109 S.Ct. 1981, 104 L.Ed.2d 557 (1989). The controlling weight provision is compatible with Frankenfield, Doak, Ferguson, Kent, VanHorn, Kelly, Rossi, and Fowler, and the Supreme Court, Congress, and the Social Security Administration have acknowledged that the intent of 20 C.F.R. §404.1527 was to codify, rather than supersede, the common-law treating source rule. See Burns v. Colvin, No. 1:14-CV-1925, 2016 WL 147269 (M.D. Pa. Jan. 13, 2016). Here, Defendant does not allege that the presumption is overcome. (Def. Brief). Consequently, Defendant fails to overcome the presumption that 20 C.F.R. §404.1527 did not supersede existing common law.1
The ALJ is bound by SSR 96-6p, and the Court should afford SSR 96-6p deference as an interpretation of 20 C.F.R. §404.1527. See 20 C.F.R. § 402.35(b)(1) (); Auer v. Robbins, 519 U.S. 452, 117 S. Ct. 905, 137 L. Ed. 2d 79 (1997). The Court and the ALJ are bound by precedential Third Circuit decisions.2 See Bd. of Trustees of Bricklayers & Allied Craftsmen Local 6 of NewJersey Welfare Fund v. Wettlin Associates, Inc., 237 F.3d 270, 275 (3d Cir.2001) (); 20 C.F.R. § 404.985(a)(The ALJ "will apply a holding in a United States Court of Appeals decision that we determine conflicts with our interpretation of a provision of the Social Security Act or regulations unless the Government seeks further judicial review of that decision or we relitigate the issue presented in the decision").
The Court finds that the ALJ failed to provide a sufficient reason to reject the treating source opinion. "Despite the deference due to administrative decisions in disability benefit cases, '[Courts] retain a responsibility to scrutinize the entire record and to reverse or remand if the [Commissioner]'s decision is not supported by substantial evidence.'" Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000) (quoting Smith v. Califano, 637 F.2d 968, 970 (3d Cir.1981)). The Court recommends that Plaintiff's appeal be granted, the decision of the Commissioner be vacated, and the matter be remanded for further proceedings and proper evaluation of the medical opinions.
On October 15, 2012, Plaintiff applied for DIB. (Tr. 191-92). On February 8, 2013, the Bureau of Disability Determination ("state agency") denied Plaintiff's application (Tr. 70-96), and Plaintiff requested a hearing. (Tr. 111). On January 14,2014, an ALJ held a hearing at which Plaintiff—who was represented by an attorney—and a vocational expert ("VE") appeared and testified. (Tr. 34-69). On January 24, 2014, the ALJ found that Plaintiff was not entitled to benefits. (Tr. 16-33). Plaintiff requested review with the Appeals Council (Tr. 14-15), which the Appeals Council denied on April 21, 2015, affirming the decision of the ALJ as the "final decision" of the Commissioner. (Tr. 1-6). See Sims v. Apfel, 530 U.S. 103, 107 (2000).
On June 22, 2015, Plaintiff filed the above-captioned action pursuant to 42 U.S.C. § 405(g) to appeal the decision of the Commissioner. (Doc. 1). On October 2, 2015, the Commissioner filed an answer and administrative transcript of proceedings. (Docs. 9, 10). On December 21, 2015, Plaintiff filed a brief in support of the appeal ("Pl. Brief"). (Doc. 13). On February 26, 2016, Defendant filed a brief in response ("Def. Brief"). (Doc. 16). On March 15, 2016, Plaintiff filed a brief in reply ("Pl. Reply"). (Doc. 17). On January 12, 2016, the Court referred this case to the undersigned Magistrate Judge. The matter is now ripe for review.
To receive benefits under the Act, a claimant must establish 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 continuous period of not less than 12months." 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 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...
To continue reading
Request your trial