Tilton v. Colvin

• Decision Date: 19 April 2016
• Docket Number: CIVIL ACTION NO. 1:14-cv-2219
• Citation: 184 F.Supp.3d 135
• Parties: Michelle L. Tilton, Plaintiff v. Carolyn W. Colvin, Commissioner of Social Security, Defendant.
• Court: U.S. District Court — Middle District of Pennsylvania

184 F.Supp.3d 135

Michelle L. Tilton, Plaintiff

v.Carolyn W. Colvin, Commissioner of Social Security, Defendant.

CIVIL ACTION NO. 1:14-cv-2219

United States District Court, M.D. Pennsylvania.

Signed April 19, 2016

Samantha Xander, Law Offices of Harry J. Binder and Charles E. Binder, P.C., New York, NY, Stuart I. Seiden, Duane Morris LLP, Philadelphia, PA, for Plaintiff.

Timothy S. Judge, Scranton, PA, for Defendant.

ORDER

Yvette Kane, District Judge, United States District Court

Before the Court in the above captioned action is a March 31, 2016 Report and Recommendation of the Magistrate Judge. The Defendant waived the opportunity to file objections (Doc. No. 16). ACCORDINGLY , this 19th day of April 2016, upon review of the record and the applicable law, IT IS HEREBY ORDERED THAT:

1) The Court adopts the Report and Recommendation (Doc. No. 15) of Magistrate Judge Cohn.

2) The decision of the Commissioner of Social Security denying Plaintiff's benefits under the Act is VACATED and the case is REMANDED to the Commissioner of Social Security to develop the record fully, conduct a new administrative hearing and appropriately evaluate the evidence.

3) The Clerk of Court shall CLOSE the case.

REPORT AND RECOMMENDATION TO VACATE THE DECISION OF THE COMMISSIONER AND REMAND FOR FURTHER PROCEEDINGS

GERALD B. COHN, UNITED STATES MAGISTRATE JUDGE

I. Introduction

The above-captioned action is one seeking review of a decision of the Commissioner of Social Security ("Defendant") denying the application of Michelle L. Tilton ("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. , § 416.901 et. seq. (the "Regulations").

One of Plaintiff's treating providers opined that Plaintiff was disabled. Doc. 5. No medical opinion contradicts the treating source opinion. Doc. 5. The Third Circuit has repeatedly held that an ALJ may not reject an uncontradicted treating source opinion 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). Defendant identifies no subsequent precedential Third Circuit case addressing uncontradicted treating source opinions. (Def. Brief). Subsequent regulations codifying the treating source rule retain, rather than abrogate, this precedent. See Burns v. Colvin, 156 F.Supp.3d 579 (M.D. Pa. 2016) (internal citations omitted). Consequently, Frankenfield, Doak, Ferguson, Kent, Van Horn, Kelly, Rossi, Fowler, and Gober remain binding law. Id.

The ALJ may reject an uncontradicted treating source opinion with non-medical evidence. See Standards for Consultative Examinations and Existing Medical Evidence, 56 FR 36932–01 at 36936. Unlike medical evidence, interpreting non-medical evidence does not require specialized medical expertise. See Fed.R.Evid. 702,¹ 1972 Advisory Committee Notes ("An intelligent evaluation of facts is often difficult or impossible without the application of some scientific, technical, or other specialized knowledge ...‘There is no more certain test for determining when experts may be used than the common sense inquiry whether the untrained layman would be qualified to determine intelligently and to the best possible degree the particular issue without enlightenment from those having a specialized understanding of the subject involved in the dispute’ ") (quoting Ladd, Expert Testimony, 5 Vand.L.Rev. 414, 418 (1952)). However, the non-medical evidence must contradict the treating source opinion. See Standards, 56 FR 36932–01 at 36936. Here, Plaintiff reported activities of daily living that included significant assistance from her husband and she stated she was unable to sit or stand for much of the day. Doc. 5. The ALJ improperly found that Plaintiff's ability to bear children contradicted the treating source opinion. Doc. 5. Consequently, the ALJ failed to cite any non-medical evidence that was inconsistent with the treating source opinion.

The only remaining rationale provided by the ALJ was lay reinterpretation of medical evidence. This is impermissible. See Frankenfield, 861 F.2d 405 at 408 ; Doak, 790 F.2d at 29–30 ; Ferguson, 765 F.2d at 37 ; Kent, 710 F.2d at 115 ; Van Horn, 717 F.2d at 874 ; Kelly, 625 F.2d at 494 ; Rossi, 602 F.2d at 58–59 ; Fowler, 596 F.2d at 603 ; Gober, 574 F.2d at 777. "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.

II. Procedural Background

On December 15, 2010, Plaintiff applied for DIB. (Tr. 243). On February 9, 2011, the Bureau of Disability Determination ("state agency") denied Plaintiff's application (Tr. 189–211), and Plaintiff requested a hearing. (Tr. 212–13). On March 7, 2013, an ALJ held a hearing at which Plaintiff–who was represented by an attorney–and a vocational expert ("VE") appeared and testified. (Tr. 150–88). On May 6, 2013, the ALJ found that Plaintiff was not entitled to benefits. (Tr. 13–35). Plaintiff requested review with the Appeals Council (Tr. 12), which the Appeals Council denied on September 22, 2014, affirming the decision of the ALJ as the "final decision" of the Commissioner. (Tr. 1–5). See Sims v. Apfel, 530 U.S. 103, 107, 120 S.Ct. 2080, 147 L.Ed.2d 80 (2000).

On November 20, 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 February 3, 2015, the Commissioner filed an answer and administrative transcript of proceedings. (Docs. 4, 5). On March 20, 2015, Plaintiff filed a brief in support of the appeal ("Pl. Brief"). (Doc. 10). On April 23, 2015, Defendant filed a brief in response ("Def. Brief"). (Doc. 11). On May 5, 2015, Plaintiff filed a brief in reply ("Pl. Reply"). (Doc. 12). On December 17, 2015, the Court referred this case to the undersigned Magistrate Judge. The matter is now ripe for review.

III. Standard of Review and Sequential Evaluation Process

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 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 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 ALJ uses a five-step evaluation process to determine if a person is eligible for disability benefits. See 20 C.F.R. § 404.1520. The ALJ 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. Before step four in this process, the ALJ must also determine Plaintiff's residual functional capacity ("RFC"). 20 C.F.R. § 404.1520(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 the claimant can perform. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993). The ultimate burden of proving disability under the Act lies with the claimant. See 42 U.S.C. § 423(d)(5)(A) ; 20 C.F.R. § 416.912(a).

When reviewing the denial of disability benefits, the Court must determine whether substantial evidence supports the denial. Johnson v. Commissioner of Social Sec., 529 F.3d 198, 200 (3d Cir. 2008).

Substantial evidence is a deferential standard of review. See Jones v. Barnhart, 364 F.3d 501, 503 (3d Cir. 2004). Substantial evidence "does not mean a large or considerable amount of evidence, but rather ‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.’ " Pierce v. Underwood, 487 U.S. 552, 565, 108 S.Ct. 2541, 101 L.Ed.2d 490 (1988) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938) ). Substantial evidence is "less than a preponderance" and "more than a mere scintilla." Jesurum v. Sec'y of U.S. Dep't of Health & Human Servs., 48 F.3d 114, 117 (3d Cir. 1995) (citing Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971) ).

IV. Relevant Facts in the Record

Pla...