United States District Court, M.D. Pennsylvania
JOY K. ALLEN, Plaintiff,
MICHAEL ASTRUE, COMMISSIONER OF SOCIAL SECURITY Defendant.
REPORT AND RECOMMENDATION
MARTIN C. CARLSON, District Judge.
This case presents legal and factual challenges, as we are called upon to assess an Administrative Law Judge (ALJ) analysis of a claimant who is beset by a host of mental, emotional and physical maladies. Moreover, we are constrained to note that, in some respects, our analysis of the issues in the instant social security appeal is not advanced by the plaintiff's decision on appeal to largely focus upon an ad hominem attack upon the Administrative Law Judge himself, accusing the ALJ of pervasive bias. This threshold issue, which dominates this appeal from the plaintiff's perspective, warrants an initial, brief threshold response. We find this ad hominem approach to the litigation of Ms. Allen's claims to be factually unwarranted,  legally misplaced,  and inappropriate.
However, while we reach this conclusion with respect to these ad hominem claims presented by the plaintiff, when we focus our attention on the sole issue that matters in this appeal-whether substantial evidence well articulated by the ALJ supports the denial of benefits-we find in this case that the ALJ's analysis is not sufficiently supported by the record, and, therefore, remand this matter for further consideration of Allen's claims.
I. Statement of Facts and of the Case
On December 11, 2008, Joy Allen applied for social security disability benefits, initially alleging an onset of disability in 2002. (Tr. 10.) Due to prior adjudications of previous claims submitted by Allen, the ALJ ultimately concluded that consideration of Allen's claims from August 2002 through September 2007 were barred by res judicata, and found that the "period at issue commences on September 6, 2007." (Id.) At the time of this disability application, Allen was 30 years old, had a highschool education, and had an employment history marked by brief, intermittent, and largely unsuccessful periods of employment as a semi-skilled worker. (Tr. 19.)
A. Medical Evidence
The medical evidence presented by Allen in support of this application revealed that the plaintiff suffered from a constellation of physical, emotional and psychological impairments, including depression and anxiety disorders, borderline personality disorder, and post traumatic stress disorder, which appeared related to physical, emotional and sexual abuse, as well as degenerative disc and joint disease of the cervical spine. (Tr. 12.) In addition, a consultative physical examination of Allen conducted at the request of the state agency by Dr. Deryck Brown on August 8, 2008, found that Allen: "has severe fibromyalgia related to her depression.... [and concluded that] She would find it very difficult to hold a job because of the combination of these factors." (Tr. 496.) Thus, Dr. Brown concluded that "it is highly unlikely that she will ever be able to function in a public setting or for that matter in a private setting." (Id.) Dr. Brown's consultative examination report observed that Allen was under the care of Dr. Kari Woods, (Tr. 491), and Dr. Brown's diagnosis of fibromyalgia was confirmed by Dr. Wood's treatment records which also state that Allen was diagnosed with fibromyalgia in February 2006. (Tr. 550.)
The extensive medical record presented to the ALJ was punctuated by the opinions of two consultative examining health care providers, each of whom independently found Allen to be disabled. Thus, on May 29, 2008, Lynnette Ruch, PH.D., provided a detailed psychological assessment of Brown at the request of the state agency. (Tr. 481-491.) This assessment described a significant mental health history spanning fifteen years, marked by episodes of suicidal and homicidal thought, and an extensive history of childhood physical, emotional and sexual abuse. (Id.) At the conclusion of this examination Dr. Ruch determined that Allen suffered from a chronic and severe post traumatic stress disorder, a borderline personality disorder, COPD, asthma, thyroid issues, collapsed arches, stomach issues, fibromyalgia, and degenerative joint disorder. (Id.) Dr. Ruch found that Allen's Global Assessment of Functioning score was 40, and concluded that her "prognosis is poor. Her psychological functioning is fairly limited. She has a history of abuse." (Tr. 486.) Dr. Ruch further specifically opined that Allen's ability to carry out instructions and interact with others were impaired, finding that she displayed a marked level of impairment in terms of her ability to interact with the public, respond appropriately to work pressures in a usual work setting, and make judgments on simple work-related decisions. (Tr. 489.)
This was a significant medical finding since a GAF score, or a Global Assessment Functioning scale, takes into consideration psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness and is not supposed to include the consideration of impairment in functioning due to physical (or environmental) limitations. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 34, Washington, DC, American Psychiatric Association, 2000. ("DSM-IV-TR"). GAF scores "in the range of 61-70 indicate some mild symptoms [of depression] or some difficulty in social, occupational, or school functioning.' Diagnostic and Statistical Manual of Mental Disorders (DSM IV') 34 (American Psychiatric Assoc.2000). GAF scores in the 51-60 range indicate moderate impairment in social or occupational functioning." Cherry v. Barnhart , 29 F.Appx. 898, 900 (3d Cir.2002). DaVinci v. Astrue, 1:11-CV-1470, 2012 WL 6137324 (M.D. Pa. Sept. 21, 2012) report and recommendation adopted, Davinci v. Astrue, 1:11-CV-1470, 2012 WL 6136846 (M.D. Pa. Dec. 11, 2012). A GAF score of 41-50 indicates serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) [or] any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).' DSM-IV at 34. A score of 50 is on the borderline between serious and moderate symptoms." Colon v. Barnhart , 424 F.Supp.2d 805, 809 (E.D. Pa. 2006).
Other independent medical evidence confirmed and corroborated that Allen suffered from longstanding serious-to-moderate mental health impairments. Thus, treatment records of Northern Tier Counseling, which had seen and treated Allen from 2004 through 2009 documented a past history of suicidal thought and self-mutilation, coupled with GAF scores ranging between 50 and 55, scores that were emblematic of prolonged severe-to-moderate psychiatric impairment. (Tr. 556-575.)
In addition, the consultative physical examination of Allen conducted at the request of the state agency by Dr. Deryck Brown on August 8, 2008 also found that Allen was disabled. This examination identified a cascading array of physical, mental and emotional ailments experienced by Allen, including thyroid disease, fibromyalgia, depression, anxiety, joint disorders, PTSD, and personality disorders. (Tr. 491.) In particular, Dr. Brown found that Allen: "has severe fibromyalgia related to her depression.... [and concluded that] She would find it very difficult to hold a job because of the combination of these factors." (Tr. 496.) On the basis of these findings, Dr. Brown opined that "it is highly unlikely that she will ever be able to function in a public setting or for that matter in a private setting." (Id.) Dr. Brown's consultative examination report observed that Allen was under the care of Dr. Kari Woods, (Tr. 491), and Dr. Brown's diagnosis of fibromyalgia was also confirmed by Dr. Wood's treatment records which reflect that Allen was diagnosed with fibromyalgia in February 2006. (Tr. 550.)
In contrast, to these two consulting examination reports, both of which were based upon an actual examination of Allen and both of which concluded that Allen was disabled, two state agency physicians conducted a review of Allen's medical records, and opined that Allen retained some limited capacity for work. (Tr. 586-609.) These document review forms were notable for their brevity, consisting largely of checkmarks on a state agency form, accompanied by modest factual narratives. (Id.) However, these evaluations also concluded that Allen suffered from medically determinable ailments, including fibromyalgia. (Tr. 591.) Further, these assessments documented Allen's history of suicidal thought and self-mutilation. (Tr. 609.)
B. ALJ Hearing and Decision
It is against the backdrop of this medical and emotional history that the ALJ conducted a hearing on Allen's disability claim on October 4, 2010. (Tr. 53-83.0) At this hearing the ALJ heard from Allen and also took testimony from an vocational expert. (Id.) Notably, the ALJ's hypothetical questions to the vocational expert, while comprehensive in their treatment of Allen's physical ailments, did not fully assess the degree to which Allen's emotional impairments would restrict her employment prospects, something which had been a material element in the disability findings of Dr. Ruch and Dr. Brown. (Tr. 77-82.)
Following this hearing, the ALJ issued an opinion on November 17, 2010, which denied Allen's application for benefits. (Tr. 10-20.) This decision was incomplete and enigmatic at several steps of the disability analysis process. For example, at Step 2 of the disability analysis process, the ALJ found that Allen suffered from a series of severe impairments, (Tr. 12.), but concluded without further explanation that "claimant also complained of knee pain and fibromyalgia, however, these conditions do not impose more than minimal limitations on her ability to work." (Tr. 12.) The ALJ reached this conclusion despite the fact that Dr. Kari Woods, Allen's treating physician had diagnosed Allen with fibromyalgia in February 2006. (Tr. 550.) This Step 2 analysis was also entirely at odds with the findings of the consultative physical examination of Allen conducted at the request of the state agency by Dr. Deryck Brown on August 8, 2008, which that Allen: "has severe fibromyalgia related to her depression.... [and concluded that] She would find it very difficult to hold a job because of the combination of these factors." (Tr. 496)(emphasis added). Further, this Step 2 determination was inconsistent with the findings of a medical records review conducted by the state agency which found that Allen suffered from medically determinable ailments, including fibromyalgia. (Tr. 591.) None of these medical findings, which contradicted the ALJ's Step 2 determination, were mentioned or addressed by the ALJ in any fashion in this stage of his disability analysis.
At Step 3 of this analysis the ALJ then concluded that Allen did not suffer from any conditions, singly or in combination, which met the listed criteria set forth in social security regulations, noting that with respect to Allen's psychiatric conditions, she would meet these listed criteria if she experienced marked impairment in any two listed categories, including social functioning, activities of daily living, concentration persistence or pace, or if she experienced repeated episodes of decompensation. (Tr. 13.) The ALJ then concluded that Allen did not meet these criteria, despite the fact that the state consultative psychologist, Dr. Ruch, specifically opined that Allen's ability to carry out instructions and interact with others were impaired, finding that she displayed a marked level of impairment in terms of her ability to interact with the public, respond appropriately to work pressures in a usual ...