United States District Court, M.D. Pennsylvania
MEMORANDUM Docs. 1, 7, 8, 11, 14
GERALD B. COHN, Magistrate Judge.
The above-captioned action is one seeking review of a decision of the Commissioner of Social Security ("Commissioner") denying the application of Plaintiff John Austin ("Plaintiff") 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"). Plaintiff asserts that he is unable to perform light work because light work requires standing or walking for six hours out of an eight-hour work day and sit for two hours out of an eight-hour work day. Plaintiff submitted medical evidence of degenerative disc disease in his back and decreased sensation in his feet due to diabetes. The ALJ relied on an opinion by a state agency physician who testified at the hearing that Plaintiff could perform light work. However, Plaintiff had retained counsel only a few weeks before the hearing, and had not yet submitted most of his medical evidence. The medical records reviewed by the physician painted a starkly brighter picture of Plaintiff's impairments and functioning than the more detailed and voluminous records submitted after the hearing. The medical expert specifically testified that there was a paucity of records on which to base the opinion at the time of the hearing. The medical records submitted after the physician's opinion included new medical findings of repeat lumbar spasm, tenderness to palpation, pain on range of motion, pain on straight leg raise, loss of lumbar lordosis, hunched over gait, positive trigger points, positive straight leg raise, MRI findings, ans decreased sensation in his feet. The medical records that were submitted after the physician's opinion also indicated new treatment with a Lidoderm patch, a trigger point injection, an escalating dose of medications, and orthopedic shoes. In contrast, the records submitted prior to the hearing and reviewed by the physician showed normal physical examinations, normal X-rays, and only a single instance of lumbar spasm. Thus, the ALJ erred in concluding, without the benefit of a medical opinion, that the later-submitted records merely confirmed the inferences gleaned from the earlier-submitted records. The ALJ failed to identify any other evidence that contradicted Plaintiff's claimed limitations in sitting, standing, and walking. Consequently, the Court cannot conclude that substantial evidence supports the ALJ's determination. For the foregoing reasons, the Court will grant Plaintiff's appeal, vacate the decision of the Commissioner, and remand for further proceedings.
II. Procedural Background
On January 21, 2011, Plaintiff filed an application for DIB and SSI under the Social Security Act, 42 U.S.C. §§ 401-433, 1382-1383 (the "Act"). (Tr. 150-62). On May 13, 2011, the Bureau of Disability Determination denied these applications (Tr. 47-58), and Plaintiff filed a request for a hearing on May 18, 2011. (Tr. 59-61). On June 11, 2012, an ALJ held a hearing at which Plaintiff- who was represented by an attorney - and a vocational expert ("VE") appeared and testified. (Tr. 223-46). On August 27, 2012, the ALJ found that Plaintiff was not disabled and not entitled to benefits. (Tr. 8-22). On September 7, 2012, Plaintiff filed a request for review with the Appeals Council (Tr. 7), which the Appeals denied on September 30, 2013, thereby affirming the decision of the ALJ as the "final decision" of the Commissioner. (Tr. 1-6).
On November 25, 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 March 5, 2014, the Commissioner filed an answer and administrative transcript of proceedings. (Docs. 7, 8). On May 19, 2014, Plaintiff filed a brief in support of his appeal ("Pl. Brief"). (Doc. 11). On June 20, 2014, Defendant filed a brief in response ("Def. Brief"). (Doc. 14). On June 13, 2014, the parties consented to transfer of this case to the undersigned for adjudication. (Doc. 13, 15). 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 born on February 14, 1960, and was classified by the Regulations as a as a person closely approaching advanced age on his alleged onset date, his application date, and his date last insured. (Tr. 167). 20 C.F.R. § 404.1563. Plaintiff attended special education classes through the ninth grade and did not ...