On January 25, 1995, the ALJ issued her decision denying benefits. (tr. 14-25). The Appeals Council subsequently denied the plaintiff's request for review of the ALJ's decision, concluding that provisions contained in 20 C.F.R. § 416.1470 for SSI claims under Title XVI of the Act do not provide any basis for granting plaintiff's request. (tr. 6-7). The ALJ's decision is, therefore, the Secretary's final decision. The plaintiff filed her present motion for summary judgment on March 4, 1996. The Commissioner filed a cross-motion for summary judgment on April 3, 1996. The plaintiff filed a reply to the Commissioner's brief on April 18, 1996.
The standard of review of cases before this Court is whether the decision of the Commissioner to deny SSI benefits is supported by substantial evidence. 42 U.S.C.A. § 405(g); Richardson v. Perales, 402 U.S. 389, 401, 28 L. Ed. 2d 842, 91 S. Ct. 1420 (1971) (quoting Consolidated Edison Co. v. National Labor Relations Board, 305 U.S. 197, 229, 83 L. Ed. 126, 59 S. Ct. 206 (1938)); Allen v. Bowen, 881 F.2d 37, 39 (3d Cir. 1989); Smith v. Califano, 637 F.2d 968, 970 (3d Cir. 1981). Substantial evidence is "less than a preponderance, but must be such as a reasonable person would accept as adequate to support a conclusion." Gilliland v. Heckler, 786 F.2d 178, 183 (3d Cir. 1986) (citations omitted).
The Commissioner established a five (5) step sequential evaluation process in 20 C.F.R. §§ 404.1520, 416.920 (1995) to be used for determining whether a person is disabled within the meaning of the Social Security Act, 42 U.S.C.A. §§ 401-433, 1381-1383d. The first two (2) steps involve threshold determinations of whether the claimant is presently working and whether she has an impairment which meets the duration requirement and significantly limits her ability to work. See 20 C.F.R. §§ 404.1520(a)-(c); 416.909; 416.920(a)-(c) (1995). In the third step, the medical evidence of the claimant's impairment is compared to a list (the "Listings") of impairments presumed severe enough to preclude any gainful work. See 20 C.F.R. Part 404, Subpart P, App. 1 (Part A) (1995). If the claimant's impairment matches or is "equal" to one (1) of the listed impairments, she qualifies for benefits without further inquiry. 20 C.F.R. §§ 404.1520(d); 416.920(d) (1995). If the claimant cannot qualify under the Listings, the analysis proceeds to the fourth and fifth steps. At these steps, the inquiry is whether the claimant can do her own past work or any other work that exists in the national economy in view of her age, education, and work experience. If the claimant cannot do her past work or other work, she qualifies for benefits. 20 C.F.R. §§ 404.1520(e)-(f) and 416.920(e)-(f) (1995); see also, Bowen v. Yuckert, 482 U.S. 137, 140-42, 96 L. Ed. 2d 119, 107 S. Ct. 2287 (1987).
Application of these principles to the administrative record in this matter reveals that the Commissioner's decision to deny plaintiff SSI benefits is not supported by substantial evidence because the ALJ's opinion does not show a fair consideration of the evidence. Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981); Kaelin v. Heckler, 637 F. Supp. 1103, 1104 (W.D. Pa. 1986).
The ALJ found that the plaintiff "may have intermittent anxiety and depression, but that her emotional impairments are not severe and that she has not sought ongoing psychological treatment." (tr. 24).
Although the ALJ mentioned Dr. Rynier's report in the context of the Appeals Council's remand, she apparently accepted the view of the prior ALJ that the report was somehow internally inconsistent and contacted the psychiatrist for clarification of the report. (tr. 19). In fact, the Appeals Council directed that clarification was needed only if Dr. Rynier's reports were inconsistent with each other and the record as a whole. (tr. 393).
The record, however, does not contradict Dr. Rynier's findings, nor is there any internal inconsistency in his report. Other physicians who have treated the plaintiff have confirmed that emotional problems have either caused or contributed to her physical complaints. (tr. 480-81, 618-19). Drs. Samburg and Weiland prescribed anti-anxiety and anti-depressive medication. (tr. 258-59, 619).
In order to lose entitlement to benefits for refusal to follow prescribed treatment
, the refusal must be willful and without a justifiable excuse. Schena v. Secretary of Health and Human Services, 635 F.2d 15 (1st Cir. 1980). The plaintiff has been found to suffer from a mental illness. Although she has discontinued prescribed medications, any noncompliance on her part could have been a result of her mental impairment and, therefore, neither willful nor without a justifiable excuse. See Sharp v. Bowen, 705 F. Supp. 1111, 1124 (W.D. Pa. 1989).
When Dr. Rynier was unable to provide further information because of the passage of time, the plaintiff was sent to John Tardibuono, Ed.D., who is not a psychiatrist, for evaluation. (tr. 594-98). Dr. Tardibuono reported that the plaintiff has only fair ability to follow work rules, deal with work stresses, function independently, maintain concentration, understand complex instructions, behave in an emotionally stable manner, and demonstrate reliability. (tr. 596-97). Dr. Rynier had found that the plaintiff's restrictions in these areas were more pronounced. (tr. 355-64). The opinion of a medical specialist is entitled to greater deference than a conflicting opinion by a non-specialist. Mason v. Shalala, 994 F.2d 1058, 1067 (3d Cir. 1993); Woody v. Secretary of Health and Human Services, 859 F.2d 1156, 1161 (3d Cir. 1988) (error to reject opinion of only psychiatrist to examine plaintiff); 20 C.F.R. § 416.927 (1995).
The ALJ also mischaracterized the plaintiff's testimony regarding her daily activities, commenting that the ability "to care for her eight (8) year old child, prepare meals, perform volunteer work at a local school, and perform some housecleaning . . . would not be inconsistent with the capacity for light work activity." (tr. 21) In describing the extent of her daily activities, the plaintiff testified that even on a good day, she feels tired, weak, and nauseous and has pain in her right leg. (tr. 103). She lives with her mother and her daughter-in-law comes daily to help care for the plaintiff's daughter. The Amish help with the housework and she buys microwaveable food for meals. (tr. 106-07). She used to volunteer at school, but has not done so for a year. (tr. 108).
The ALJ's finding that "the testimony of the [plaintiff] is not credible when viewed in the light of the medical and other evidence of record" improperly ignores the abundant medical evidence that the plaintiff suffers from a variety of well-documented physical and mental impairments which can cause her symptoms. An ALJ is not free to set her own expertise against that of physicians presenting competent medical advice. Ferguson v. Schweiker, 765 F.2d 31, 37 (3d Cir. 1985); Van Horn v. Schweiker, 717 F.2d 871, 874 (3d Cir. 1983).
When the ALJ presented to the VE a hypothetical which assumed an ability to do light or unskilled sedentary work of a low stress nature, avoiding dust, fumes, odors, and pollutants, the VE stated that there were jobs in the local economy that the plaintiff could perform. (tr. 128-29). However, when the VE was asked to consider Dr. Rynier's report, she said that his conclusions about the plaintiff would preclude work. (tr. 131).
Finally, the ALJ's decision is fundamentally flawed because it contains no rationale manifesting how she reached her conclusions in her analysis of the "B" criteria of the Psychiatric Review Technique Form. That omission is a major violation of both Third Circuit law and the Commissioner's own regulations. Woody v. Secretary of Health and Human Services, 859 F.2d 1156, 1159 (ALJ must discuss evidence considered in reaching conclusions expressed on form); 20 C.F.R. § 404.1520a(c)(4) (1995).
The ALJ's finding that plaintiff is not disabled is not supported by substantial evidence. She has not given proper weight to such considerations as plaintiff's subjective complaints of fatigue, dizziness, nausea, and pain, the reports of her treating physicians, the combination of her impairments, and the opinion of the VE. The record is sufficiently developed and substantial evidence on the record as a whole indicates that the plaintiff is disabled and entitled to benefits. Podedworny v. Harris, 745 F.2d 210 (3d Cir. 1984).
Accordingly, I make the following
Now, this 18th day of June, 1996, IT IS HEREBY RECOMMENDED that the plaintiff's motion for summary judgment should be GRANTED and this matter be REMANDED for a calculation and an award of benefits. The Secretary's motion should be DENIED.
RICHARD A. POWERS, III
CH. M. JUDGE