United States District Court, M.D. Pennsylvania
MARTIN C. CARLSON, Magistrate Judge.
In this case we are asked to consider whether substantial evidence supports an ALJ's decision denying benefits to the plaintiff, when the ALJ's decision included a form of ad hoc lay medical analysis by the ALJ expressed in terms that have been repeatedly rejected and criticized by the courts, a lay opinion which was also inconsistent with the factual findings set forth in the ALJ's decision. Finding that these errors, in combination, lead us to conclude that the ALJ's decision is not supported by substantial evidence, we will order that this case be remanded for further consideration by the Commissioner.
II. Statement of Facts and of The Case
The plaintiff, Robert Ridgway, was approximately 40 years old at the time of the alleged onset of his disability and had completed the 12th grade of high school in a special education program. (Tr. 42-43.) On June 3, 2009, Ridgway applied for Supplemental Security Income benefits, claiming that he had become disabled on May 15, 2009, as a result of a constellation of physical and mental conditions, including serious low back pain due to degenerative disc disease and a congenital spine abnormality, fibromyalgia, depression, anxiety, GERD, and Irritable Bowel Syndrome. (Tr. 112-115.)
On November 3, 2010, an ALJ conducted a hearing in Ridgway's case. (Tr. 37-68.) At this hearing, Ridgway and a vocational expert appeared and testified. (Id.) Following this hearing, on January 21, 2011, the ALJ issued a decision, denying Ridgway's application for benefits. (Tr. 9-25.) In reaching this decision, the ALJ found that Ridgway suffered from a series of severe impairments including fibromyalgia, degenerative disc disease, congenital spine abnormality, major depressive disorder, and bipolar disorder. (Tr. 11.) The ALJ also recognized that Ridgway's claims of intractable pain due to these disorders was a crucial component of this disability claim. The ALJ's treatment of the question of Ridgway's pain, however, was speculative and inconsistent. At the o utset, the ALJ's decision thoroughly documented the treatment that Ridgway sought over the years for his fibromyalgia and other pain-related syndromes. (Tr. 14-22.) In the course of this discussion, the ALJ specifically noted the effect of this disabling pain upon Ridgway's gait and ability to walk, and ultimately concluded that Ridgway "also requires the use of a cane for ambulation." (Tr. 14.)
However, after carefully documenting Ridgway's complaints of pain, and concluding that Ridgway could not longer walk without a cane, the ALJ summarily discounted Ridgway's medically documented claims of pain as disabling in a fashion which seemed to express a lay medical opinion, stating:
In this case, the claimant's case in establishing disability concerning his physical impairments is also directly dependent on the element of pain which is of an intractable nature. Pain is subjective and difficult to evaluate, both quantitatively and qualitatively. Nevertheless, most organic diseases produce manifestations other than pain and it is possible to evaluate the underlying processes and degree of resultant impairment by considering all of the symptoms. Generally, when an individual has suffered pain over an extended period, there will be observable signs such as a significant loss of weight, an altered gait or limitation of motion, local morbid changes, or poor coloring or station. In the present case, the claimant has complained of pain over an extended period of time. None of the above signs of chronic pain are evident. While not conclusory by itself, this factor contributes to the determination that the claimant is not disabled as a result of pain.
(Tr. 23.)(emphasis added.)
Thus, the ALJ's decision in this case rested, in large part, on the ALJ's decision to discount Ridgway's medically supported complaints of intractable pain. That decision, in turn, was based largely upon a lay, ad hoc medical opinion by the ALJ regarding how Ridgway's pain should have manifested itself. Moreover, this lay opinion was further undermined by an internal inconsistency. The ALJ discounted Ridgway's claims of pain, in part, based upon a finding that this pain should be confirmed by "an altered gait or limitation of motion, " stating that: "In the present case, the claimant has complained of pain over an extended period of time. None of the above signs of chronic pain are evident. " (Tr. 23.)(emphasis added.) Yet, the ALJ's decision contradicted this conclusion that Ridgway displayed no altered gait due to pain since the ALJ expressly concluded that Ridgway "also requires the use of a cane for ambulation." (Tr. 14.)
After exhausting his administrative appeals of this adverse ALJ decision, Ridgway filed this civil action seeking judicial review of the ALJ's disability determination. (Doc. 1.) The parties have fully briefed this matter, (Docs. 9 and 10.), and this case is now ripe for resolution. For the reasons set forth below, we find that it is necessary for this matter to be remanded
A. Standards of Review-The Roles of the Administrative Law ...