has promulgated regulations which establish a five-step evaluation process to determine whether a claimant is disabled. 20 C.F.R. 404.1520(a). If at any point in the process the ALJ determines that the claimant is or is not disabled, the inquiry must end. Id.
The analysis requires the ALJ to decide: 1) whether the claimant is currently engaged in substantial gainful employment; 2) if not, whether the claimant has a severe impairment; 3) if he does have a severe impairment, whether the impairment meets or equals one of the impairments listed in 20 C.F.R., Pt. 404, Subpt. P, App. 1; 4) if it does not, whether the claimant's impairment prevents him from performing his past relevant work; and 5) if his impairment does prevent him from performing his past job, whether the claimant is able to engage in other forms of substantial gainful activity, considering his age, education, prior work experience and residual functional capacity. The claim is approved if the claimant cannot perform other kinds of work. 20 C.F.R. 404.1520.
The medical vocational guidelines are used to determine whether the claimant is disabled if the ALJ reaches the fifth step in the evaluation process. 20 C.F.R., Pts. 404-416, Subpts. P, I, App. 2. To use the guidelines, the ALJ must make findings of fact regarding the claimant's age, education and work experience. 20 C.F.R. 404.1568, 416.960-68. In addition, the ALJ must assess the claimant's residual functional capacity. 20 C.F.R. 404.1545, 416.945.
However, when a claimant presents evidence of both exertional and nonexertional (mental, sensory or skin) impairments, the guidelines are inapplicable, and the ALJ must make findings of fact regarding the extent to which the nonexertional limitations diminish the claimant's work ability. 20 C.F.R. 404.1545, 416.945. In addition, the ALJ must identify specific jobs that the claimant is capable of performing. 20 C.F.R. 404.1520(f), 416.9210(f). This finding is preferably done with the assistance of vocational expert testimony.
Although the five-step evaluation process applies to both physical and mental impairments, the regulations require the ALJ to follow a special procedure to evaluate the severity of mental impairments. 20 C.F.R. 404.1520(a), 416.910(a). First, the ALJ must review the mental status examinations and psychiatric history of the claimant to determine whether a mental impairment exists. Id. If the ALJ finds the existence of a mental impairment, the second step requires her to determine the severity of the impairment as it affects the claimant's ability to work. Id. The Social Security Administration assesses the severity by the degree to which the impairment imposes functional limitations on the claimant's ability to work. Id.
The regulations identify four areas of function which are considered essential to the ability to work: activities of daily living; social functioning; concentration, persistence and pace; and, deterioration or decompensation in work or work-like settings. 20 C.F.R. Pt. 404, Subpt. P, App. 1. The ALJ must rate the degree of limitation in each of the four functions to determine whether the impairment is severe. 20 C.F.R 404.1520a(c), 416.920a(c). If the mental impairment is severe, the ALJ must then decide whether it meets or equals a listed mental disorder. 20 C.F.R. Pt. 404, Subpt. P, App. 1. The ALJ will determine that the claimant is disabled if the mental impairment is a listed mental disorder and at least two of the functional criteria have been limited. Id. If it does not meet a listed mental disorder, the ALJ must perform a residual functional capacity assessment to determine whether the claimant can perform some jobs notwithstanding his mental impairment. 20 C.F.R. 404.1520a(c)(3), 416.920a(c)(3).
B. Standard of Review
In reviewing the Secretary's decision to deny Mr. Jackman benefits, we must decide whether the Secretary applied the correct legal standards, and whether his findings of fact are supported by substantial evidence. Brown v. Bowen, 845 F.2d 1211, 1213 (3d Cir. 1988). The United States Court of Appeals for the Third Circuit defines substantial evidence as "such relevant evidence as a reasoning mind might accept as adequate to support a conclusion." Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981).
After reviewing the medical evidence in the record, the ALJ held that Mr. Jackman's alcoholism and mental impairments did not become disabling until January 7, 1987, six days after Mr. Jackman's disability insurance status expired. Thus, Mr. Jackman was ineligible for disability insurance benefits. According to the ALJ, she picked January 7, 1987 as the disability onset date because on this date Mr. Jackman's conditions "began to show significant deterioration." T. 12.
The Secretary concedes, however, that the ALJ picked this onset date because this was the date that the psychiatrist, Dr. Coleman, prepared an evaluation of Mr. Jackman's mental status. Government's Brief, at 9. According to the Secretary, although this date is somewhat arbitrary, this was the first date that objective medical evidence existed confirming Mr. Jackman's mental impairments. Id., at 9. Mr. Jackman argues that this date is illogical and arbitrary and is not supported by substantial evidence.
We agree. A review of the medical record clearly establishes that Mr. Jackman's mental impairments became disabling long before January 7, 1987. The ALJ accepted the opinion of the psychiatrist, Dr. Coleman, that the combination of Mr. Jackman's mental impairments and alcoholism was disabling. However, she incorrectly chose the onset date as that date in which the doctor recorded his evaluation of Mr. Jackman.
Dr. Coleman stated that Mr. Jackman suffered from, inter alia, continuous alcohol dependence. This contradicts the ALJ's assertion that Mr. Jackman's disabling mental impairments manifested themselves for the first time during his visit with Dr. Coleman. The arbitrariness of the ALJ's selection of January 7, 1987 as the disability onset date is highlighted by the fact that Dr. Coleman actually examined Mr. Jackman on January 6, 1987; January 7 was the date that the doctor prepared the report of the examination. Thus, according to the ALJ's analysis, Mr. Jackman's mental impairments became disabling not on the day of, but on the day after, his first psychiatric examination. This result, of course, is untenable. See McWilliams v. Bowen, 674 F. Supp. 12, 13 (W.D. Pa. 1987) ("Unlike a traumatic injury, a mental impairment such as depression does not arise full grown on the day the patient sees the doctor. . . .").
Moreover, objective evidence exists in the record establishing an onset date earlier than January 7, 1987. Mr. Jackman has been an alcoholic for at least 10 years, and a number of medical reports indicate that he may well have been alcohol dependent since he was 18 years old. T.222, 274. The record demonstrates that Mr. Jackman has been in a state of denial regarding his alcoholism, and that he has been unable to control his addiction. Although he attempted to decrease and/or eliminate his beer consumption in 1984, he failed and within a few months he was drinking 8 to 10 beers daily. T.283, 201. He has suffered a number of related physical symptoms associated with alcoholism, namely cardiomyopathy and liver disease, and Mr. Jackman was first hospitalized with these symptoms in 1983.
Regarding Mr. Jackman's mental impairments, the ALJ completely ignored Dr. Gardner's December 23, 1986 report documenting Mr. Jackman's mental health condition in 1984, the date Dr. Gardner had last treated the plaintiff. Dr. Gardner diagnosed Mr. Jackman as suffering from dysthymic disorder, continuous alcohol dependence and passive and immature personality traits. We note that Dr. Coleman rendered the same diagnosis of the plaintiff in 1987.
In the area of activities of daily living, Dr. Gardner thought that Mr. Jackman had good ability, but in the areas of social functioning and adaptation to stressful circumstances, he had poor ability. T.368-71. In the area of concentration and task persistence, Dr. Gardner rated Mr. Jackman's overall ability as good, but he noted that Mr. Jackman's ability to sustain a routine would be only good for limited periods, his ability to make decisions was fair, and he could not perform at a consistent pace. T.370. Mr. Jackman had poor to fair insight, and his prognosis for recovery was poor to fair with counseling. T.367.
The opinion of a claimant's treating physician is entitled to substantial weight if it is supported by clinical or laboratory findings. Butler v. Secretary of Health and Human Services, 543 F. Supp. 979, 980 (S.D. Ohio 1982). In addition, the Secretary is free to choose between properly submitted medical opinions or reject a medical opinion that is contradicted by other evidence in the record. However, he must give an explanation of the reasons why he rejected probative evidence, so that a reviewing court can determine whether the rejection was proper. Cotter v. Harris, 642 F.2d 700, 706 (3d Cir. 1981).
Dr. Gardner's medical opinion establishes that in 1984, Mr. Jackman suffered from severe listed mental disorders, and that in at least two areas of function, social functioning and deterioration or decompensation in work or work-like settings, Mr. Jackman was limited. Accordingly, pursuant to the regulations, the ALJ should have made a finding of disability as of this date.
However, the Secretary failed to consider Dr. Gardner's opinion regarding the status of Mr. Jackman's mental health in 1984. In addition, the Secretary ignored Mr. Jackman's testimony and various medical reports which established an onset date of 1984. This failure to consider uncontroverted medical evidence was improper.
Mr. Jackman testified during both his 1988 hearing and 1986 disability interview that his depression and drinking increased in 1983. T.50, 102. During this time he started isolating himself from his family and friends. Id. Moreover, in September and October, 1984, Mr. Jackman's physician started noting in his medical records that Mr. Jackman was suffering from chronic anxiety. T.226-31. On December 4, 1986, Richard Rosenbloom, M.D., examined Mr. Jackman and reported that he had suffered from depression for the past 5 years. Finally, between 1983 and 1985, Mr. Jackman was hospitalized on at least 3 occasions, suffering from alcoholism and alcohol-related physical impairments. T.272, 274.
The Secretary's decision that Mr. Jackman became disabled on January 7, 1987 is not supported by substantial evidence because the ALJ ignored uncontroverted medical evidence. The record clearly establishes that Mr. Jackman's mental impairments became disabling before January 7, 1987, and the objective medical evidence indicates that by August 1984 his conditions had deteriorated to the point where they rendered him disabled. Accordingly, the Secretary's determination denying disability insurance benefits is reversed, and we will enter judgment in favor of the plaintiff and award disability benefits beginning August 1, 1984.
An appropriate Order will issue.
AND NOW, to-wit, this 16th day of January, 1990, for the reasons stated in the accompanying Memorandum Opinion, it is hereby ORDERED, ADJUDGED and DECREED that:
1) The plaintiff's Motion for Summary Judgment be and hereby is GRANTED;
2) The defendant's Motion for Summary Judgment be and hereby is DENIED;
3) The Secretary's decision denying plaintiff disability insurance benefits be and hereby is VACATED and the plaintiff is entitled to an award of disability insurance benefits from and after August 1, 1984.
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