Wright v. Colvin
| Decision Date | 14 January 2016 |
| Docket Number | CASE NO. 1:14-cv-02350-SHR-GBC |
| Parties | JIMMY IRVIN WRIGHT, Plaintiff, v. CAROLYN W. COLVIN, COMMISSIONER OF SOCIAL SECURITY, Defendant. |
| Court | U.S. District Court — Middle District of Pennsylvania |
(JUDGE RAMBO)
(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 Jimmy Irvin Wright ("Plaintiff") for disability insurance benefits ("DIB") under the Social Security Act, 42 U.S.C. §§401-433 (the "Act") and Social Security Regulations, 20 C.F.R. §§404.1501 et seq. (the "Regulations").
An older claimant is presumed to be less able to transition to new work than a younger claimant. See 20 C.F.R. § Pt. 404, Subpt. P, App. 2, §200.00(a) et seq.. Consequently, claimants who are capable of performing unskilled light work generally may not be considered disabled at age fifty, while claimants who are capable of performing only unskilled sedentary work generally will be considered disabled at age fifty. Id. A claimant who is capable of performing only unskilled light work will be generally be considered disabled at age fifty-five. Id. Here, Plaintiff was over the age of fifty throughout the relevant period. Infra. Every medical opinion authored during the relevant period indicated that Plaintiff could perform only sedentary work. Infra.
An administrative law judge ("ALJ") found that Plaintiff could perform light work throughout the relevant period. Infra. Consequently, the ALJ concluded that he was disabled under the Act as of December 27, 2011, when he turned fifty-five years old. Infra. As an initial matter, this was an error, because an ALJ must not apply age categories mechanically, and must consider a claimant's capacity during a "borderline age" period. See 20 CFR § 404.1563(b).
Moreover, the ALJ erred in finding that Plaintiff could perform light work. After the ALJ initially found that Plaintiff was not disabled from November 8, 2008 to December 26, 2011, Plaintiff appealed to the Appeals Council. The Appeals Council granted Plaintiff's appeal. The Appeals Council noted that two medical opinions in the record indicated that Plaintiff could perform sedentary work, at most, which would render him entitled to benefits throughout the relevant period. The Appeals Council ordered the ALJ to obtain medical expert testimony to rebut these two medical opinions and support the ALJ's determination thatPlaintiff could perform light work. The Appeals Council prohibited the ALJ from relying on a state agency opinion from November of 2008 to reject these opinions. However, at the supplemental hearing, the new medical expert also testified that Plaintiff could only perform sedentary work.
The ALJ disagreed with the Appeals Council's assessment of the applicable law, and refused to follow the Appeals Council's order. However, the Appeals Council correctly applied the relevant law. An ALJ may not supplant the opinion of a competent professional with lay interpretation of medical evidence as long as the opinion is supported by medically acceptable findings. As the Social Security Administration has explained, an opinion does not need to be fully supported, because that would be an impracticably high standard. The ALJ is bound not only by the Regulations, but also Third Circuit precedent. Third Circuit precedent prohibits an ALJ from reinterpreting medical evidence to reject a treating source medical opinion. 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 hold that, even under thedeferential substantial evidence standard of review, no reasonable person would find lay reinterpretation of medical evidence to be adequate to find a claimant was not disabled. Id. Subsequent regulatory amendments retain this common law. See 20 C.F.R. §404.1527(c). Consequently, the Court recommends granting Plaintiff's appeal, vacating the decision of the Commissioner, and remanding for further proceedings.
On February 16, 2011, Plaintiff applied for DIB under the Act. (Tr. 240-53). On May 9, 2011, the Bureau of Disability Determination denied Plaintiff's application (Tr. 143-57), and Plaintiff requested a hearing. (Tr. 212-13). On June 6, 2012, an ALJ held a hearing at which Plaintiff—who was represented by an attorney—and a vocational expert ("VE") appeared and testified. (Tr. 99-124). On August 27, 2012, the ALJ found that Plaintiff was not disabled and not entitled to benefits prior to December 27, 2011. (Tr. 158-82). Plaintiff requested review by the Appeals Council, which the Appeals Council granted on October 18, 2013, vacating the ALJ's denial of benefits prior to December 27, 2011 and remanding for further proceedings. (Tr. 184-88). On March 13, 2014, the ALJ held a hearing at which a medical expert testified. (Tr. 125-40). On May 12, 2014, the ALJ issued a decision denying all benefits for Plaintiff, including the benefits he was receiving for disability after December 27, 2011. (Tr. 35-66). On September 24, 2014, theALJ issued an amended decision reinstating benefits for the period after December 27, 2011 and denying benefits for the period before December 27, 2011. (Tr. 7-32). Plaintiff requested review with the Appeals Council (Tr. 34), which the Appeals Council denied on November 5, 2014, 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 December 11, 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 5, 2015, the Commissioner filed an answer and administrative transcript of proceedings. (Docs. 7, 8). On March 30, 2015, Plaintiff filed a brief in support of the appeal ("Pl. Brief"). (Doc. 11). On May 1, 2015, Defendant filed a brief in response ("Def. Brief"). (Doc. 12). 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.
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 (1988) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (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 (1971)).
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 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 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 alsoPlummer 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 also determine 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...
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