Mathis v. Comm'r of Soc. Sec. Admin.

• Docket Number: Civil Action 8:20-cv-03363-BHH-JDA
• Decision Date: 28 September 2021
• Parties: Tara Mathis, Plaintiff, v. Commissioner Social Security Administration, Defendant.
• Court: U.S. District Court — District of South Carolina

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Tara Mathis, Plaintiff, v. Commissioner Social Security Administration, Defendant.

Civil Action No. 8:20-cv-03363-BHH-JDA

United States District Court, D. South Carolina, Anderson/Greenwood Division

September 28, 2021

REPORT AND RECOMMENDATION OF MAGISTRATE JUDGE

Jacquelyn D. Austin United States Magistrate Judge

This matter is before the Court for a Report and Recommendation pursuant to Local Civil Rule 73.02(B)(2)(a), D.S.C., and 28 U.S.C. § 636(b)(1)(B).^[1] Plaintiff brought this action pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3) to obtain judicial review of a final decision of the Commissioner of Social Security (“the Commissioner”), denying Plaintiff's claims for disability insurance benefits (“DIB”) and supplemental security income (“SSI”).^[2]For the reasons set forth below, it is recommended that the decision of the Commissioner be reversed and remanded for administrative action consistent with this recommendation, pursuant to sentence four of 42 U.S.C. § 405(g).

PROCEDURAL HISTORY

Plaintiff filed applications for DIB and SSI in 2016. [R. 207-13; see R. 19.]^[3] The DIB application alleged an onset-of-disability date of January 1, 2016 [R. 207], and after an amendment, the SSI application alleged the same onset-of-disability date [R. 47, 193]. The claims were denied initially and on reconsideration by the Social Security Administration (“the Administration”). [R 85-129.] Plaintiff requested a hearing before an administrative law judge (“ALJ”) and on November 8, 2018, ALJ Gregory M. Wilson conducted a de novo hearing on Plaintiff's claims. [R. 43-84.]

The ALJ issued a decision on July 12, 2019, finding Plaintiff not disabled under the Social Security Act (the “Act”). [R. 16-41.] At Step 1, ^[4] the ALJ found Plaintiff met the insured status requirements of the Act through March 31, 2021, and had not engaged in substantial gainful activity since January 1, 2016, the alleged onset date. [R. 21, Findings 1 & 2.] At Step 2, the ALJ found Plaintiff had the following severe impairments: obesity lumbar spine degenerative disc disease, left hip osteoarthritis, and left knee degenerative joint disease. [R 21, Finding 3.] The ALJ also found Plaintiff had non-severe impairments of nonsevere hypertension, anxiety, and depression. [R. 22.] At Step 3, the ALJ found that Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. [R. 24, Finding 4.]

Before addressing Step 4, Plaintiff's ability to perform her past relevant work, the ALJ found Plaintiff retained the following residual functional capacity (“RFC”):

I find that the claimant has the [RFC] to perform light work (lift, carry, push, or pull 20 pounds occasionally and 10 pounds frequently; and sit 6 hours in an 8-hour workday), as defined in 20 CFR 404.1567(b) and 416.967(b) except with the following limitations: she can stand/walk for 4 hours in an 8-hour workday. She can never climb ladder/rope/scaffolds. She can occasionally climb ramp/stairs, stoop, kneel, crouch, and crawl. She can frequently balance. She should avoid concentrated exposure to hazards.

[R. 24, Finding 5.] Based on this RFC finding, the ALJ determined at Step 4 that Plaintiff was unable to perform her past relevant work. [R. 34, Finding 6]. However, considering Plaintiff's age, education, work experience, RFC, and the testimony of a vocational expert (“VE”), the ALJ found that there were jobs that existed in significant numbers in the national economy that Plaintiff could perform. [R. 35, Finding 10.] Thus, the ALJ found that Plaintiff had not been under a disability as defined by the Act from January 1, 2016, through the date of the decision. [R. 36, Finding 11.]

Plaintiff requested Appeals Council review of the ALJ's decision but the Appeals Council declined review. [R. 1-7.] Plaintiff filed the instant request for review in this Court on September 23, 2020. [Doc. 1.]

THE PARTIES' POSITIONS

Plaintiff contends the ALJ's decision is not supported by substantial evidence and should be reversed and remanded. [Docs. 14 at 16-28; 16.] Specifically, Plaintiff contends the ALJ erred by improperly evaluating opinion evidence [Docs. 14 at 16-23; 16 at 1-8] and inferring a lack of seriousness of her limitations from her failure to obtain further treatment [Docs. 14 at 24-25; 16 at 8-10]. Plaintiff also argues that the Appeals Council erred in refusing to grant review based on additional evidence. [Docs. 14 at 25-28; 16 at 10-14]. The Commissioner, on the other hand, contends the ALJ's decision should be affirmed because the record contains substantial evidence supporting the decision. [Doc. 15 at 7-21.]

STANDARD OF REVIEW

The Commissioner's findings of fact are conclusive if supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is more than a scintilla-i.e., the evidence must do more than merely create a suspicion of the existence of a fact and must include such relevant evidence as a reasonable person would accept as adequate to support the conclusion. See Richardson v. Perales, 402 U.S 389, 401 (1971); Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir. 1966).

Where conflicting evidence “allows reasonable minds to differ as to whether a claimant is disabled, the responsibility for that decision falls on the [Commissioner] (or the [Commissioner's] designate, the ALJ), ” not on the reviewing court. Craig v. Chater, 76 F.3d 585, 589 (4th Cir. 1996); see also Edwards v. Sullivan, 937 F.2d 580, 584 n.3 (11th Cir. 1991) (stating that where the Commissioner's decision is supported by substantial evidence, the court will affirm, even if the reviewer would have reached a contrary result as finder of fact and even if the reviewer finds that the evidence preponderates against the Commissioner's decision). Thus, it is not within the province of a reviewing court to determine the weight of the evidence, nor is it the court's function to substitute its judgment for that of the Commissioner so long as the decision is supported by substantial evidence. See Bird v. Comm'r, 699 F.3d 337, 340 (4th Cir. 2012); Laws, 368 F.2d at 642; Snyder v. Ribicoff, 307 F.2d 518, 520 (4th Cir. 1962).

The reviewing court will reverse the Commissioner's decision on plenary review, however, if the decision applies incorrect law or fails to provide the court with sufficient reasoning to determine that the Commissioner properly applied the law. Myers v. Califano, 611 F.2d 980, 982 (4th Cir. 1980); see also Keeton v. Dep't of Health & Human Servs., 21 F.3d 1064, 1066 (11th Cir. 1994). Where the Commissioner's decision “is in clear disregard of the overwhelming weight of the evidence, Congress has empowered the courts to modify or reverse the [Commissioner's] decision ‘with or without remanding the cause for a rehearing.'” Vitek v. Finch, 438 F.2d 1157, 1158 (4th Cir. 1971) (quoting 42 U.S.C. § 405(g)). Remand is unnecessary where “the record does not contain substantial evidence to support a decision denying coverage under the correct legal standard and when reopening the record for more evidence would serve no purpose.” Breeden v. Weinberger, 493 F.2d 1002, 1012 (4th Cir. 1974).

The court may remand a case to the Commissioner for a rehearing under sentence four or sentence six of 42 U.S.C. § 405(g). Sargent v. Sullivan, 941 F.2d 1207 (4th Cir. 1991) (unpublished table decision). To remand under sentence four, the reviewing court must find either that the Commissioner's decision is not supported by substantial evidence or that the Commissioner incorrectly applied the law relevant to the disability claim. See, e.g., Jackson v. Chater, 99 F.3d 1086, 1090-91 (11th Cir. 1996) (holding remand was appropriate where the ALJ failed to develop a full and fair record of the claimant's residual functional capacity); Brenem v. Harris, 621 F.2d 688, 690-91 (5th Cir. 1980) (holding remand was appropriate where record was insufficient to affirm but was also insufficient for court to find the claimant disabled). Where the court cannot discern the basis for the Commissioner's decision, a remand under sentence four is usually the proper course to allow the Commissioner to explain the basis for the decision or for additional investigation. See Radford v. Comm'r, 734 F.3d 288, 295 (4th Cir. 2013); see also Smith v. Heckler, 782 F.2d 1176, 1181-82 (4th Cir. 1986) (remanding case where decision of ALJ contained “a gap in its reasoning” because ALJ did not say he was discounting testimony or why); Gordon v. Schweiker, 725 F.2d 231, 235 (4th Cir. 1984) (remanding case where neither the ALJ nor the Appeals Council indicated the weight given to relevant evidence). On remand under sentence four, the ALJ should review the case on a complete record, including any new material evidence. See Smith, 782 F.2d at 1182 (“The [Commissioner] and the claimant may produce further evidence on remand.”). After a remand under sentence four, the court enters a final and immediately appealable judgment and then loses jurisdiction. Sargent, 941 F.2d 1207.

In contrast, sentence six provides:

The court may . . . at any time order additional evidence to be taken before the Commissioner of Social Security, but only upon a showing that there is new evidence which is material and that there is good cause for the failure to incorporate such evidence into the record in a prior proceeding . . . .

42 U.S.C. § 405(g). A reviewing court may remand a case to the Commissioner on the basis of new evidence only if four prerequisites are met: (1) the evidence is relevant to the determination of disability at the time the application was first filed; (2) the evidence is material to the extent that the Commissioner's decision might reasonably have...