United States District Court, E.D. Pennsylvania
REPORT AND RECOMMENDATION
RICHARD A. LLORET, U.S. MAGISTRATE JUDGE.
Rosa was denied Social Security benefits by decision of an
Administrative Law Judge (“ALJ”). Rosa argues
that the unfavorable decision was reached in error.
Specifically, Rosa alleges that the ALJ failed to properly
weigh medical opinion evidence, resulting in a subsequent
failure to accurately convey her work-related limitations to
a testifying vocational expert.
careful review of the record, I find that the ALJ erred by
improperly discounting the medical opinion of Rosa's
treating psychiatrist. Accordingly, I respectfully recommend
that Rosa's request for review be granted, the final
decision of the Acting Commissioner be reversed, and the case
be remanded for further proceedings consistent with this
Report and Recommendation.
filed a claim for disability insurance benefits
(“DIB”) on June 27, 2013. R. 113-20. Her
application was denied at the initial level on September 18,
2013. R. 58-61. Rosa then requested a hearing with an ALJ. R.
hearing was held in Elkins Park, Pennsylvania on February 11,
2015. R. 33-48. Rosa testified at the hearing, where she was
represented by counsel. R. 33-48. A neutral vocational expert
also testified at the hearing. R. 33.
the hearing, the ALJ issued an unfavorable disability
decision on April 21, 2015. R. 15-32. In response to the
unfavorable decision, Rosa requested Appeals Council review.
R. 13-14. The Appeals Council denied Rosa's request on
July 15, 2016 (R. 6-10), making the ALJ's decision the
final decision of the Acting Commissioner. 20 C.F.R. §
404.981. This exhausted Rosa's administrative remedies.
request for review pursuant to 42 U.S.C. § 405(g)
followed. The matter was referred to me for a Report and
Recommendation. ECF No. 17.
Rosa's Personal Background and Work History
was born in 1971, making her forty-two years old at the time
of her DIB application. R. 113. She resides in a house in
Philadelphia with her husband, her father, and her sister. R.
131. She speaks and understands English. R. 131. Rosa
completed her education through the twelfth grade, then
completed a one-year medical assistant certification program.
stopped working entirely in October of 2012. R. 133. Most
recently, Rosa was employed at an ophthalmologist's
office as a technician. R. 134. She testified that the job
consisted of assisting the ophthalmologist with patient
visits. R. 39-40. Rosa voluntarily terminated her employment
because, as she puts it, “I didn't get along with
certain people at the job and especially my boss.” R.
40. At the time she quit, Rosa had worked at the
ophthalmologist's office for less than one year. R. 40.
After Rosa quit, she applied for and was determined eligible
for unemployment compensation after her employer failed to
contest the application. R. 40. The administrative record
indicates that Rosa received unemployment compensation from
the fourth quarter of 2012 through the second quarter of
2013. R. 126. Rosa applied for DIB in June 2013, around the
time her unemployment compensation payments stopped. R. 126.
to her employment in the ophthalmologist's office, Rosa
worked for Main Line Healthcare as a medical assistant. R.
121-22. Rosa testified that she held that job “for more
than 15 years.” R. 41. During her tenure with Main
Line Healthcare, Rosa transferred to different worksites four
times. R. 41. Rosa ultimately resigned because she
“just couldn't get along with [her] bosses”
and “just couldn't take the stress” of the
job. R. 41. Rosa informed the state disability evaluator that
she was unemployed for approximately ten months between the
two jobs. R. 134.
described the tasks associated with her two past jobs as
substantially similar. At both jobs, she worked eight-hour
days on a full-time basis. R. 140, 141. Both jobs required
Rosa to perform a combination of walking, standing, sitting,
and other postural movements for eight hours each day. R.
140, 141. Both jobs required Rosa to frequently lift up to
twenty-five pounds and to assist in lifting patients of
various weights. R. 140, 141. Rosa employed technical
knowledge or skills, wrote reports, and used machines, tools,
or equipment in both jobs. R. 140, 141. The testifying
vocational expert characterized Rosa's past work as
skilled work performed at a light exertional level. R. 45.
Subjective Evidence of Impairments
applied for DIB alleging a plethora of physical and mental
health impairments. R. 132. Rosa's alleged physical
impairments included three herniated discs in her neck,
carpal tunnel syndrome in both hands, arthritis in her knee,
and a weight of 170 pounds at 5'3” tall. R. 132.
Rosa also alleged seven discrete mental health impairments:
depression, anxiety, post-traumatic stress disorder, panic
attacks, mood swings, mood disorder, and bipolar disorder. R.
132. To support her alleged impairments, Rosa testified at
her hearing, submitted medical records, and provided a
medical opinion from her treating psychiatrist. Meanwhile,
Rosa's husband Joangel Aletriz completed a Function
Report, a Third-Party Function Report, and a Supplemental
Function Questionnaire on Rosa's behalf. R. 142-60.
hearing, Rosa provided no testimony describing her alleged
physical impairments, perhaps because neither the ALJ nor
Rosa's attorney inquired about her physical conditions.
R. 33-48. Rosa did, however, testify regarding the impact her
alleged mental health issues have on her daily life. Rosa
stated that she has five dogs in her house, two of which are
primarily hers. R. 37. These two dogs spend most of their
time in Rosa's room with her. R. 37. Since her dogs are
paper trained, Rosa need not walk them. R. 37. Rosa testified
that she spends most of her day in bed at home with the dogs.
R. 38. Rosa's husband performs all household chores,
including caring for the dogs. R. 38, 144.
testified that she takes Xanax to fall asleep every night
then sleeps until early afternoon each day. R. 42. Sometimes,
Rosa testified, she goes two or three days without bathing,
which she attributed to depression. R. 43. When questioned
about her ability to focus, Rosa reported that she cannot
focus to read “like I used to.” R. 43. Rosa also
stated that her “memory's not that good.” R.
testified that she does very little outside the house. She
never leaves the house unless accompanied by her husband. R.
42. Social situations make Rosa feel very uncomfortable, and
she “ha[s] to take medicine before [she] leaves the
house.” R. 42. She has limited contact with her
children, other family members, and friends. R. 38-39. Rosa
also testified as to her difficulties working with others,
difficulties that have led to her quitting her two most
recent jobs. R. 39-41.
testified that her doctor prescribed various medications for
her mental health impairments. R. 44. Using a list of
medications compiled by Rosa, the ALJ established that Rosa
took Xanax, Latuda, clonidine, Tenex, Trileptal, and
Anafranil at various times. R. 44-45. Rosa's treating
psychiatrist prescribed all of these medications. R. 44-45.
When asked whether medication improved her condition, Rosa
responded “Sometimes I don't think it does.”
R. 45. Rosa reported that her medications made her tired and
fatigued. R. 42.
addition to Rosa's testimony, her husband, Joangel,
completed three Function Reports. The Function Reports paint
a painful portrait of Rosa's daily life. Joangel wrote
that Rosa is afraid to do things on her own (R. 143), has a
hard time controlling her anger (R. 143), gets very
confrontational with people, especially bosses and men (R.
143), isolates herself in her bedroom (R. 143), sleeps a lot
and cries a lot (R. 144), feeds the dogs but leaves the
remainder of their care to Joangel (R. 144), used to work out
frequently and maintain a positive outlook but is now subject
to losing her temper (R. 144), has to be reminded to change
her clothes and take a bath (R. 144), relies on Joangel to
comb her hair and cook her meals (R. 144), relieves herself
in a “commode” kept in the bedroom because she
does not like walking to the bathroom at night (R. 144), must
be reminded to take her medications (R. 145), does no cooking
and no house work (R. 145), is afraid to go out on her own
and only leaves the house if Joangel accompanies her (R.
146), shops infrequently, and then only for dog food and
cereal (R. 146), cannot pay bills or manage money due to
memory problems (R. 146-47), has recently gained fifty pounds
after she stopped exercising (R. 147), attends religious
meetings twice each week, but only after Joangel pleads with
her to go (R. 147, 157), has stopped talking to the people
who open their doors when she and Joangel evangelize
door-to-door (R.157), has trouble getting along with others
when she does not take her medication (R. 148), can only walk
two blocks before her anxiety increases and she begins
getting irritated with the people around her (R. 148), can
only pay attention for thirty minutes at a stretch and cannot
finish what she starts (R. 148), does not handle stress well
(R. 149), does not like change (R. 149), and has disruptive
nightmares, one so intense that she bit Joangel's arm in
her sleep, drawing blood (R. 150).
completed another Function Report form reiterating much of
what he conveyed in the first form, with a few additions
worth noting. R. 153-60. Regarding Rosa's dogs, Joangel
reported that “she doesn't even walk them they go
out on deck [and] son picks up crap.” R. 154. Attesting
to Rosa's issues falling asleep at night, Joangel wrote
that “she can't sleep unless she takes her Xanax if
not she's up all night doing nothing talking to her dogs
like if they were people.” R. 154. Joangel reported
that he tries to motivate Rosa and, with the help of
Rosa's sister, can occasionally get Rosa to walk around
the block or sit on the porch before she returns to her
bedroom. R. 155. According to Joangel, Rosa “sucks at
following instruction” and he “ha[s] to be on top
of her like a child.” R. 158. Joangel also reported
that Rosa was “crying all the time and angry always
stating she wants to die [and] hates life.” R. 151.
Other Mental Health Records Relevant to this Appeal
submitted medical records documenting both her physical and
mental health impairments. R. 185-310. On appeal to the
district court, Rosa does not challenge the ALJ's
treatment of her alleged physical impairments. Accordingly,
my review focuses exclusively on Rosa's mental health
records. The entirety of the objective medical evidence
documenting Rosa's mental health impairments consists of
treatment notes from treating psychiatrist Alexandra McLean,
M.D. (R. 205-52) and a Mental Residual Functional Capacity
Questionnaire (“RFC form”) completed by Dr.
McLean (R. 201-204, 248-52).
Dr. McLean's Mental Residual Functional Capacity
McLean authored an opinion, the RFC form, assessing
Rosa's ability to perform certain work-related activities
in light of her mental health impairments. R. 248-52. The RFC
form contained Dr. McLean's diagnoses, a checklist of
symptoms, and a checklist evaluating Rosa's ability to
perform specific work-related functions. R. 248-52.
McLean averred that she had treated Rosa on a monthly basis
since 2009, a period of five years preceding her 2014
opinion. R. 248. Dr. McLean diagnosed Rosa with intermittent
explosive disorder and major depressive affective disorder
and listed “relationship with sons” as an
aggravating environmental stressor. R. 248. Dr. McLean opined
that Rosa exhibited “partial response to various
medication regimens and psychotherapy” without
elaborating on the treatments or Rosa's responses. R.
248. Per Dr. McLean, Rosa was prescribed trileptal (an
anticonvulsant used to treat seizures), clonidine (an
antihypertensive), Xanax, and Anafranil (used to treat
obsessive compulsive disorder). R. 248. “Fatigue”
was the only listed side effect of the prescribed
medications. R. 248. When prompted to describe clinical
findings that demonstrated the severity of Rosa's
problems, Dr. McLean wrote: “poor concentration/focus,
AO x3, poor judgment, poor impulse control, memory intact,
mood down, affect flat.” R. 248. Dr. McLean declared
Rosa's prognosis “poor, ” noting that Rosa
“cannot get along with peers in a work setting
[illegible word] verbal and physical altercations.” R.
form provided a list of fifty-six “signs and
symptoms” from which Dr. McLean was to identify the
ones that applied to Rosa. R. 249. Dr. McLean ticked off
twenty of these symptoms, including “[t]houghts of
suicide, ” [a]ppetite disturbance with weight change,
” “[r]ecurrent and intrusive recollections or a
traumatic experience, which are a source of marked distress,
” [p]aranoid thinking or inappropriate suspiciousness,
” “[p]athological dependence, ”
“[s]eclusiveness or autistic thinking, ” and
“[p]ersistent irrational fear of a specific object,
activity, or situation which results in a compelling desire
to avoid the dreaded object, activity or situation.” R.
checked boxes, Dr. McLean opined that Rosa had “[n]o
useful ability to function” in the following six areas:
work in coordination with or proximity to others without
being unduly distracted; complete a normal workday and
workweek without interruptions from psychologically based
symptoms; perform at a consistent pace without an
unreasonable number and length of rest periods; accept
instructions and respond appropriately to criticism from
supervisors; get along with co-workers or peers without
unduly distracting them or exhibiting behavioral extremes;
and deal with normal work stress. R. 250. Of the sixteen
total categories on the form, Dr. McLean opined that Rosa had
“no useful ability to function” in six of them.
McLean opined that Rosa's impairments would cause her to
be absent from work more than four days per month, the most
extreme check-box value available on the form. R. 252. Dr.
McLean's opinion included a prompt to “describe any
additional reasons not covered above why your patient would
have difficulty working at a regular job on a sustained
basis, ” to which Dr. McLean responded that Rosa
“cannot tolerate criticism at all.” R. 252.
The ALJ's Decision and Treatment of Dr. McLean's
upon the evidence in the record, the ALJ applied the
five-step sequential analysis of 20 C.F.R. §
404.1520(a)(4) to assess Rosa's entitlement to
Social Security benefits.
one, the ALJ determined that Rosa had not engaged in
substantial gainful activity since her alleged disability
onset date of October 1, 2012. R. 20.
two, the ALJ concluded that Rosa had the following severe
impairments: bipolar affective disorder, depression, anxiety,
and degenerative joint disease of the knees and spine. R. 20.
three, the ALJ determined that Rosa “does not have an
impairment or combination of impairments that meets or
medically equals the severity of one of the listed
impairments” in the Social Security regulations. R. 21.
Because Rosa's challenge turns on the ALJ's
evaluation of her alleged mental health impairments, I