United States District Court, M.D. Pennsylvania
GERALD B. COHN, Magistrate Judge.
I. Procedural Background
On August 20, 2010, Plaintiff filed an application for disability insurance benefits ("DIB") and supplemental security income ("SSI") under the Social Security Act, 42 U.S.C. §§ 401-433, 1382-1383 (the "Act"). (Tr. 111-21). On September 15, 2010, the Bureau of Disability Determination denied this application (Tr. 72-89), and Plaintiff filed a request for a hearing on November 17, 2010. (Tr. 92). On October 4, 2011, an ALJ held a hearing at which Plaintiff- who was represented by an attorney-and a vocational expert ("VE") appeared and testified. (Tr. 42-71). On January 19, 2012, the ALJ found that Plaintiff was not disabled and not entitled to benefits. (Tr. 25-41). On March 16, 2012, Plaintiff filed a request for review with the Appeals Council (Tr. 18-20), which the Appeals denied on August 21, 2013, thereby affirming the decision of the ALJ as the "final decision" of the Commissioner. (Tr. 1-5).
On October 18, 2013, Plaintiff filed the above-captioned action pursuant to 42 U.S.C. § 405(g) to appeal the decision of the Commissioner. (Doc. 1). On April 3, 2014, the Commissioner filed an answer and administrative transcript of proceedings. (Docs. 10, 11). On May 19, 2014, Plaintiff filed a brief in support of her appeal ("Pl. Brief"). (Doc. 12). On June 27, 2013 Defendant filed a brief in response ("Def. Brief"). (Doc. 17). On July 7, 2014, the parties consented to transfer of this case to the undersigned for adjudication. (Doc. 18, 19). The matter is now ripe for review.
II. Standard of Review
When reviewing the denial of disability benefits, the Court must determine whether substantial evidence supports the denial. Johnson v. Comm'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008); Brown v. Bowen, 845 F.2d 1211, 1213 (3d Cir. 1988). 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 Consol. Edison Co. of New York v. N.L.R.B., 305 U.S. 197, 229 (1938)). In other words, substantial evidence requires "more than a mere scintilla" but is "less than a preponderance." 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)).
III. Sequential Evaluation Process
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 also Plummer 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 ultimate burden of proving disability within the meaning of the Act lies with the claimant. See 42 U.S.C. § 423(d)(5)(A); 20 C.F.R. § 416.912(a).
IV. Relevant Facts in the Record
Plaintiff was treated at Williamsport Hospital in 1991 and 1993 for an injury to her knee and a fall at work. (Tr. 300-06). The record does not contain any subsequent medical records until March of 2004, when Plaintiff had an overnight inpatient psychiatric admission at Geisinger Medical Center. (Tr. 506-09).
On April 22, 2004, Plaintiff followed-up with Dr. Jill Nye, D.O., her primary care physician. (Tr. 307-18). She reported that she "really wants further surgical eval[uation] of an umb[ilical] hernia that she has had for" more than ten years. (Tr. 307). Plaintiff also indicated that she "does not follow with a [doctor] regularly since she really has never had health ins[urance]." (Tr. 307). She followed-up with Dr. Nye on November 7, 2005 and reported that her "umbilical hernia is still bothering her and getting larger." (Tr. 315). Plaintiff was attempting to get insurance so that the hernia could be fixed. (Tr. 315).
On January 9, 2006, Plaintiff had umbilical hernia surgery. (Tr. 321, 548-66). On March 16, 2006, she had a cervical biopsy. (Tr. 531-32). She continued to complain of abdominal pain, and presented to the emergency room with an abdominal mass. (Tr. 510-66, 573-77, 591-630, 637-667). On June 9, 2006, she underwent an exploratory laparotomy, a total abdominal hysterectomy with bilateral salpingo-oophorectomy, and a partial omentectomy. (Tr. 631-634). After surgery, she had her staples removed and was diagnosed with a degenerating myoma. (Tr. 597-630, 637-77). She returned to the emergency room complaining of abdominal pain on June 18, 2006. (Tr. 361-77, 631-36).
Between February and July of 2006, Plaintiff saw Dr. Nye four times, complaining of chronic fatigue and other impairments. (Tr. 332-60, 391-426). In July of 2006, she indicated that she was following up for an abnormal cardiac test done as part of pre-operative management for her hysterectomy. (Tr. 392). However, a stress test had been "completely normal" and she reported that she never had any symptoms of a cardiac episode. (Tr. 392). She denied other symptoms and was not taking any prescriptions. (Tr. 392). Dr. Nye noted that she was "leaving for nsg school in York soon and just wanted to be squared away with that." (Tr. 392). Plaintiff followed-up with Dr. Nye in August and September of 2007, and was diagnosed with new onset diabetes type II. (Tr. 196-240). Plaintiff followed-up with Dr. Nye every three months until January 30, 2009. (Tr. 196-240, 391-426).
Plaintiff presented to the emergency room at Shamokin Area Community Hospital in March and July of 2008, complaining of sinus, urinary, and skin impairments. (Tr. 241, 361-77).
On January 30, 2009, Dr. Nye noted that Plaintiff "was hoping to apply for disability due to having her medical problems and getting sick all the time'" (Tr. 400). Plaintiff also stated, "I just don't think that I can work anymore" (Tr. 400). Dr. Nye wrote:
[Plaintiff] is rarely here for any app[ointmen]t not related to her normal diabetes follow-up so she is not sick frequently at least in the eyes of her chart here. I can't see where she could be disabled at least not based on her diabetes etc. She does have issues with her nerves. Seeing Dr. Tolan in sunbury thru MH/MR but doesn't like him. Since her M[edical] A[ssistance] card will run out not sure if she will follow up with ...