T. MICHAEL PUTNAM, UNITED STATES MAGISTRATE JUDGE.
The plaintiff, Edwin Omar Perez, himself a former employee of the Social Security Administration, appeals from the decision of the Commissioner of the Social Security Administration ("Commissioner") denying his application for a period of
Mr. Perez was 57 years old on his alleged disability onset date of December 7, 2006. His past work experience includes employment as an eligibility worker for the Social Security Administration. (Tr. at 699). Mr. Perez claims that he became disabled due to pain and physical dysfunction stemming from herniated discs in his neck and back and diverticulitis. (Tr. at 112, 693).
Formerly employed as an eligibility worker for the Social Security Administration, Mr. Perez was granted a disability retirement by the Office of Personnel Management ("OPM"), effective March 6, 2007, under the Federal Employees Retirement System ("FERS").
FERS disability retirement required the claimant to apply for Social Security DIB.
Because the procedural history of the instant case is irregular, the court includes the following discussion by the Administrative Law Judge:
(Tr. at 688-89).
When evaluating the disability of individuals over the age of eighteen, the regulations prescribe a five-step sequential evaluation process. See 20 C.F.R. §§ 404.1520, 416.920; see also Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). The first step requires a determination of whether the claimant is "doing substantial gainful activity." 20 C.F.R. §§ 404.1520(a)(4)(i), 416.920(a)(4)(i). If he is, the claimant is not disabled and the evaluation stops. Id. If he is not, the Commissioner next considers the effect of all of the physical and mental impairments combined. 20 C.F.R. §§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii). These impairments must be severe and must meet the durational requirements before a claimant will be found to be disabled. Id. The decision depends on the medical evidence in the record. See Hart v. Finch, 440 F.2d 1340, 1341 (5th Cir. 1971). If the claimant's impairments are not severe, the analysis stops. 20 C.F.R. §§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii). Otherwise, the analysis continues to step three, which is a determination of whether the claimant's impairments meet or equal the severity of an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. 20 C.F.R. §§ 404.1520(a)(4)(iii), 416.920(a)(4)(iii). If the claimant's impairments fall within this category, he will be found disabled without further consideration. Id. If they do not, a determination of the claimant's residual functional capacity will be made and the analysis proceeds to the fourth step. 20 C.F.R. §§ 404.1520(e), 416.920(e). Residual functional capacity ("RFC") is an assessment, based on all relevant evidence, of a claimant's remaining ability to do work despite his or her impairments. 20 C.F.R. § 404.945(a)(1).
The fourth step requires a determination of whether the claimant's impairments prevent him from returning to past relevant work. 20 C.F.R. §§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv). If the claimant can still do his past relevant work, the claimant is not disabled and the evaluation stops. Id. If the claimant cannot do past relevant work, then the analysis proceeds to the fifth step. Id. Step five requires the court to consider the claimant's RFC, as well as the claimant's age, education, and past work experience, in order to determine if he or she can do other work. 20 C.F.R. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v). If the claimant can do other work, the claimant is not disabled. Id. The burden is on the Commissioner to demonstrate that other jobs exist in the local and national economy that the claimant can perform; and, once that burden is met, the claimant must prove his inability to perform those jobs in order to be found disabled. Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir. 1999).
Applying the sequential evaluation process in this case, the ALJ found that Mr. Perez last met the insured-status requirements of the Social Security Act on December 31, 2011. (Tr. at 691). He further determined that Mr. Perez has not engaged in substantial gainful activity since the alleged onset of his disability, December 7, 2006, through his last insured date
Turning to the task of determining the claimant's RFC, the ALJ did not find Mr. Perez's subjective complaints of pain to be totally credible, and he determined that Mr. Perez had the following RFC during the relevant time period before December 31, 2011:
(Tr. at 692, 696).
Based on this RFC, the ALJ determined at Step Four of the sequential analysis that, through the date last insured, the plaintiff was able to perform his past relevant work as an "eligibility worker." (Tr. at 699). An eligibility worker is defined under the rules as skilled work performed at a sedentary exertion level. Id. The ALJ determined that performance of such work did not require performance of any work-related activity not allowed by the RFC assessment. Id. The ALJ concluded his findings by stating that Plaintiff "was not under a disability, as defined in the Social Security Act, at any time from December 7, 2006, the alleged onset date, through December 31, 2011, the date last insured." Id.
This court's role in reviewing claims brought under the Social Security Act is a narrow one. The scope of its review is limited to determining (1) whether there is substantial evidence in the record as a whole to support the findings of the Commissioner, and (2) whether the correct legal standards were applied. See Richardson v. Perales, 402 U.S. 389, 390, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971); Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002). The court approaches the factual findings of the Commissioner with deference, but applies close scrutiny to the legal conclusions. See Miles v. Chater, 84 F.3d 1397, 1400 (11th Cir. 1996). The court may not decide facts, weigh evidence, or substitute its judgment for that of the Commissioner. Id. "The substantial evidence standard permits administrative decision makers to act with considerable latitude, and `the possibility of drawing two inconsistent conclusions from the evidence does not prevent an administrative agency's finding from being supported by substantial evidence.'" Parker v. Bowen, 793 F.2d 1177, 1181 (11th Cir. 1986) (Gibson, J., dissenting) (quoting Consolo v. Federal Mar. Comm'n, 383 U.S. 607, 620, 86 S.Ct. 1018,
The court must keep in mind that opinions such as whether a claimant is disabled, the nature and extent of a claimant's residual functional capacity, and the application of vocational factors "are not medical opinions, ... but are, instead, opinions on issues reserved to the commissioner because they are administrative findings that are dispositive of a case; i.e., that would direct the determination or decision of disability." 20 C.F.R. §§ 404.1527(e), 416.927(d). Whether the plaintiff meets the listing and is qualified for Social Security disability benefits is a question reserved for the ALJ, and the court "may not decide facts anew, reweigh the evidence, or substitute [its] judgment for that of the Commissioner." Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005). Thus, even if the court were to disagree with the ALJ about the significance of certain facts, the court has no power to reverse that finding as long as there is substantial evidence in the record supporting it.
Mr. Perez alleges that the ALJ's finding is not supported by substantial evidence for three reasons. First, he asserts that the ALJ erred as a matter of law by failing to give "great weight" to the Office of Personnel Management's ("OPM") decision that the plaintiff could no longer perform his past relevant work. Second, the plaintiff argues that the ALJ failed to give proper weight to the plaintiff's treating orthopedist, Dr. Jackson. Third, the plaintiff argues that the ALJ's RFC determination is not supported by substantial evidence.
The Code of Federal Regulations is clear that "[a] decision by any nongovernmental agency or any other governmental agency about whether you are disabled... is based on its rules and is not our decision.... We must make a disability or blindness determination based on social security law. Therefore, a determination made by another agency that you are disabled or blind is not binding on us." 20 C.F.R. § 404.1504. However, the CFR does define as evidence of disability "[d]ecisions by any governmental or nongovernmental agency about whether or not you are disabled or blind." 20 C.F.R. § 404.1512(b)(1)(v). The Eleventh Circuit addressed the weight due to findings of disability by other government agencies in Bloodsworth v. Heckler, stating that "[t]he findings of disability by another agency, although not binding on the Secretary [now Commissioner], are entitled to great weight." 703 F.2d 1233, 1241 (11th Cir. 1983) (emphasis added); citing Rodriguez v. Schweiker, 640 F.2d 682, 686; Epps v. Harris, 624 F.2d 1267, 1274 (5th Cir. 1980); DePaepe v. Richardson, 464 F.2d 92, 101 (5th Cir. 1972).
The Eleventh Circuit further discussed the issue the following year in Falcon v. Heckler, stating,
732 F.2d 827, 831 (11th Cir. 1984). The discussion in Falcon appears to indicate that one reason an ALJ may cite for giving less than great weight to the finding of disability by another government agency is that the definition of disability used by the other organization differs from that used by Social Security.
On March 5, 2007, the OPM issued a letter to the plaintiff confirming his disability. The letter states:
(Tr. at 174). No further discussion from the OPM is provided in the record, and the OPM's letter does not specifically address which medical records were examined in reaching the conclusion of disability. The plaintiff argues that the finding of disability is entitled to great weight, while the defendant argues that the ALJ appropriately articulated his reasons for failing to ascribe great weight to the OPM determination.
The ALJ addressed the OPM's decision as follows:
(Tr. at 698).
Eleventh Circuit case law consistently holds that disability determinations from other government agencies are entitled to great weight from the outset, and then, if there is good cause, the ALJ may articulate why he or she depreciates that weight. See Boyette v. Commissioner of Soc. Sec., 605 Fed.Appx. 777, 779 (11th Cir. 2015); Bloodsworth v. Heckler, 703 F.2d 1233, 1241 (11th Cir. 1983); Rodriguez v. Schweiker, 640 F.2d 682, 686 (5th Cir. 1981). By stating that only "consideration and some form of weight" is required for the OPM's determination, the ALJ applied the incorrect legal standard. (Tr. at 698). The ALJ is not bound by that other agency's opinion, as the CFR makes clear, but the ALJ must begin by giving the agency opinion great weight and step down from there if the facts warrant it, giving a clear explanation for why less than great weight is accorded.
Even if the ALJ was not required to state explicitly that the OPM determination was entitled to great weight, he failed to explain adequately why he gave only "consideration and some form of weight" to it. Unlike Kemp v. Astrue, 308 Fed. Appx. 423, 426 (11th Cir. 2009), where the court of appeals found that the ALJ "implicitly" assigned great weight to the VA's determination of a disability because he "continuously refer[red] to the VA's evaluations and disability rating throughout the evaluation process," the only reference to the OPM disability determination in this case is a passing reference. Indeed, the ALJ expressly did not undertake a thorough analysis of the OPM determination because "the administrative law judge is unable to ascertain from what is available the circumstances, tenor and specific restrictions that were implied or considered by OPM in its determination." (Tr. at 698). The ALJ "declined to give any significant weight" to the OPM decision not because there were differences in the standards applied by the different agencies or because of shortcomings in the evidence considered by the OPM. He declined to give great weight precisely because the administrative record before him was incomplete. Nothing here indicates, unlike in Kemp v. Astrue, that the ALJ carefully considered the OPM determination and concluded that it was not entitled to great weight. The record here makes clear that the ALJ conducted no review of the basis for the OPM's decision.
Although claimants must establish their eligibility for benefits, Social Security courts are inquisitorial, not adversarial, and the ALJ has a duty to fully and fairly develop the record where important information is missing. See Ingram v. Commissioner of Soc. Sec. Admin., 496 F.3d 1253, 1269 (11th Cir. 2007). That is particularly true here where the additional information is to be found in the records of the Social Security Administration itself as the plaintiff's employer. If, as asserted by the claimant,
In sum, the court finds that the ALJ applied an incorrect rule of law by failing to assign "great weight" to the determination made by the OPM. Further, his explanation for assigning only "some form of weight" was not based on substantial evidence, but, expressly, on no evidence. The failure of the ALJ to take at least minimal steps to obtain additional information about the OPM's determination violated the Commissioner's duty to fully and fairly develop the record, especially where that additional information was likely in the Social Security Administration's own employment files. Because the ALJ determined erroneously at Step Four of the sequential analysis that the plaintiff could perform his past relevant work, despite the OPM's determination (allegedly based in part on a certification of no reasonable accommodation by the SSA itself) that he could not, the ALJ never made any findings about his ability to perform other work available in the economy at Step Five of the analysis.
The plaintiff further argues that the ALJ erred by failing to give appropriate
The Court must also be aware of the fact that opinions such as whether a claimant is disabled, the claimant's residual functional capacity, and the application of vocational factors "are not medical opinions,... but are, instead, opinions on issues reserved to the Commissioner because they are administrative findings that are dispositive of a case; i.e., that would direct the determination or decision of disability." 20 C.F.R. §§ 404.1527(e), 416.927(d). The Court is interested in the doctors' evaluations of the claimant's "condition and the medical consequences thereof, not their opinions of the legal consequences of his [or her] condition." Lewis, 125 F.3d at 1440. Such statements by a physician are relevant to the ALJ's findings, but they are not determinative, as it is the ALJ who bears the responsibility for assessing a claimant's residual functional capacity. See, e.g., 20 C.F.R. § 404.1546(c).
The ALJ addressed Dr. Jackson's opinions, along with the opinions of several other doctors, in his RFC analysis at Step Four of the sequential process. He determined that Dr. Jackson's opinion was entitled to little weight, explain as follows:
(Tr. at 697).
The testimony of a treating physician is entitled to substantial weight unless good cause is shown not to give the opinion substantial weight. Good cause includes situations in which the treating physician's opinion is not supported by the record or his own findings or the evidence supports a different finding. Phillips v. Barnhart, 357 F.3d 1232, 1241 (11th Cir. 2004) (citingLewis, 125 F.3d at 1440); see also Edwards v. Sullivan, 937 F.2d 580, 583-84 (11th Cir. 1991). Although the Phillips examples are not presumed to be exhaustive, the list does not support the idea that a treating physician's opinion may be discredited due to "ambiguity" in the opinion. As the court of appeals explained in Lewis v. Callahan, 125 F.3d 1436 (11th Cir. 1997):
Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997). Indeed, in the case of ambiguity, the ALJ has a responsibility to expand the record in order to clarify the
In the instant case, the ALJ did request that Dr. Levine, a Social Security Administration expert, review the plaintiff's medical records and testify at the hearing, but Dr. Levine did not examine the plaintiff. (Tr. at 698). He did not, however, reach out to Dr. Jackson for clarification of his medical opinion, nor did he reach out to the plaintiff's other treating physicians, Drs. Small and Patel, for clarification of their medical opinions, all of which the ALJ determined to be "ambiguous" and entitled to little weight. (Tr. at 696-97). The ALJ is not entitled to simply supplant a treating physician's opinion for that of a non-examining consulting physician
Finally, the plaintiff asserts that the ALJ's RFC analysis is not supported by substantial evidence. Specifically, the plaintiff asserts that the ALJ's determination that the plaintiff would need to "change positions for one to two minutes every thirty minutes" is not supported by substantial evidence because the ALJ adopted Dr. Levine's findings rather than Dr. Jackson's, who is the plaintiff's treating physician. (Doc. 12, p. 24). It already has been determined that the ALJ erred in failing to either 1) give Dr. Jackson's opinion as a treating physician substantial
During the hearing, Dr. Levine attested that the plaintiff would need a sit/stand option and could not remain seated for more than 30 minutes at a time without the option to change positions. (Tr. at 728). Levine stated that the plaintiff would need to change positions for one to two minutes. Id. When asked about the discrepancy between his finding and Dr. Jackson's opinion that the plaintiff would need 5 minutes of position changes, Levine simply noted that it was "my opinion versus his." (Tr. at 732). The difference of opinion became significant when the Vocational Expert ("VE") was presented with hypothetical questions. When she was given a hypothetical including the one to two minute break for repositioning, she testified that the limitations "would allow access to the past work as an eligibility worker as described by the Department of Labor." (Tr. at 734). When asked about five minute breaks, the exchanges proceeded as follows:
(Tr. at 735). When the plaintiff's attorney questioned the vocational expert, the attorney clarified that it is the plaintiff's position that he needs the breaks to change position because his pain prevents him from being on task without such breaks. Id. According to the plaintiff, those breaks would be off-task time.
Ultimately, opinions such as the claimant's residual functional capacity and the application of vocational factors "are not medical opinions, ... but are, instead, opinions on issues reserved to the Commissioner because they are administrative findings that are dispositive of a case; i.e., that would direct the determination or decision of disability." 20 C.F.R. §§ 404.1527(e), 416.927(d). However, because the ALJ's evaluation of Dr. Jackson's opinion as a treating physician, as well as the ALJ's evaluation of the OPM finding of disability, erred as a matter of law, his RFC evaluation cannot be based on substantial evidence, as it is based on erroneous applications of law.
In 1993, the Tenth Circuit determined, in evaluating a disability claim which had been pending for 10 years, that "[t]he Secretary is not entitled to adjudicate a case `ad infinitum until it correctly applies the proper legal standard and gathers evidence to support its conclusion,'" and remanded the case for an immediate award of benefits. Sisco v. U.S. Dept. of Health and Human Services, 10 F.3d 739, 746 (10th Cir. 1993) (internal citations omitted). In 2001, the First Circuit acknowledged that,
Seavey v. Barnhart, 276 F.3d 1, 13 (1st Cir. 2001) (internal footnotes omitted).
Such findings also have been reached within this circuit. For example, in Goodrich v. Commissioner, the magistrate judge wrote in his Report and Recommendation, which was adopted by the district judge:
Goodrich v. Commissioner, 2012 WL 750291 *14 (M.D. Fla. Feb. 7, 2012) (internal footnotes omitted, emphasis in original); see also Ray v. Astrue, 2009 WL 799448 *8 (M.D. Fla. March 24, 2009) (remand for benefits after a fifteen-year delay, stating that "equitable considerations outweighed the need for further administrative adjudication.")
The instant case has been pending in some capacity since 2006. (Tr. at 688). The plaintiff's claim has been before an ALJ three times, before the Appeals Council twice, and before a United States District Court three times, including the instant case. The plaintiff has undisputed impairments, including cervical spine degenerative disc disease and lumbar degenerative disc disease, which are documented by medical records. According to the OPM, these impairments warranted the plaintiff's retirement due to disability.
The court could remand the action for further proceedings by the ALJ; however, there is a point at which continued delay becomes unjust. That point has been reached. Accordingly, the plaintiff's claim is due to be REVERSED and REMANDED with the instruction to AWARD BENEFITS.
An order of final judgment will be entered contemporaneously herewith.