STEPHAN M. VIDMAR, United States Magistrate Judge Presiding by Consent.
THIS MATTER is before the Court on Plaintiff's Motion to Reverse and Remand for a Rehearing with Supporting Memorandum [Doc. 17] ("Motion"), filed on November 7, 2014. The Commissioner responded on January 30, 2015. [Doc. 22]. Plaintiff replied on March 11, 2015. [Doc. 23]. The parties have consented to the undersigned's entering final judgment in this case. [Doc. 8]. Having meticulously reviewed the entire record and being fully advised in the premises, the Court finds that the Administrative Law Judge ("ALJ") failed to apply the correct legal standards in evaluating certain medical opinions. Thus, the Motion will be granted, and the case will be remanded for an immediate award of benefits.
The standard of review in a Social Security appeal is whether the Commissioner's final decision
"Substantial evidence is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Langley, 373 F.3d at 1118. The decision "is not based on substantial evidence if it is overwhelmed by other evidence in the record or if there is a mere scintilla of evidence supporting it." Id. While a court may not reweigh the evidence or try the issues de novo, its examination of the record as a whole must include "anything that may undercut or detract from the [Commissioner]'s findings in order to determine if the substantiality test has been met." Grogan v. Barnhart, 399 F.3d 1257, 1262 (10th Cir.2005). "The possibility of drawing two inconsistent conclusions from the evidence does not prevent [the] findings from being supported by substantial evidence." Lax v. Astrue, 489 F.3d 1080, 1084 (10th Cir. 2007) (quoting Zoltanski v. F.A.A., 372 F.3d 1195, 1200 (10th Cir. 2004)).
In order to qualify for disability benefits, a claimant must establish that she is unable "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. § 1382c(a)(3)(A); 20 C.F.R. § 416.905(a).
When considering a disability application, the Commissioner is required to use a five-step sequential evaluation process ("SEP"). 20 C.F.R. § 416.920; Bowen v. Yuckert, 482 U.S. 137, 140, 107 S.Ct. 2287, 96 L.Ed.2d 119 (1987). At the first four steps of the evaluation process, the claimant must show: (1) she is not engaged in "substantial gainful activity"; and (2) she has a "severe medically determinable... impairment ... or a combination of impairments" that has lasted or is expected to last for at least one year; and (3) her impairment(s) either meet or equal one of the Listings
The procedural history of the case is complicated by the fact that Plaintiff filed
Plaintiff protectively filed her first application for SSI on May 19, 2008. Tr. 501. Her claim was denied initially and on reconsideration. Id. Plaintiff requested a hearing before an ALJ. Id. ALJ George W. Reyes held a hearing on December 15, 2009. Tr. 16, 30, 501. He ultimately determined that Plaintiff was not disabled, and he denied the claim on March 25, 2010. Tr. 25-26. Plaintiff sought review from the Appeals Council ("AC") on May 14, 2010. Tr. 10.
While the first application was pending before the AC, Plaintiff filed a second application for SSI on May 17, 2010. See Tr. 2. The second application was approved.
The AC denied review of the first application on February 25, 2011. Tr. 1. The AC expressly "considered the fact that [Plaintiff was] found to be under a disability beginning May 17, 2010, based on the application(s) [she] filed on May 17, 2010; however, [the AC] found that this information [did] not warrant a change in [ALJ Reyes's] decision." Tr. 2.
Plaintiff appealed ALJ Reyes's decision (denying her first application) to this Court on April 26, 2011. Jaramillo v. Astrue, No. 11-cv-0341 JAP/LAM ("Jaramillo I"), [Doc. 3]. Plaintiff argued that ALJ Reyes had committed various errors in performing the five-step SEP. Jaramillo I, [Doc. 21]. The Honorable Lourdes A. Martínez, United States Magistrate Judge, agreed. She found that ALJ Reyes had erred in evaluating the opinions of two doctors. The presiding district judge adopted Judge Martínez's opinion and remanded the case to the Commissioner on August 27, 2012. Tr. 474-92; Jaramillo I, [Docs. 25-27].
Pursuant to that remand order, the AC, in turn, remanded the case to an ALJ on December 5, 2012. Tr. 495-96. Again, the AC expressly acknowledged that Plaintiff's second application (filed on May 17, 2010) had been approved. Tr. 495. The AC explained that the approval had been based on an October 10, 2010 opinion of a consultative examiner. Id. However, as to the time period between the filing of the first application and the second application (i.e., May 19, 2008 and May 16, 2010), it determined that:
Tr. 495-96. This remand for "a new decision on the issue of disability before May 17, 2010" indicates that the October 10, 2010 opinion was not relevant to the first application. See id. (Indeed, the October 10, 2010 opinion is not part of the record on the first application, nor does Plaintiff argue that it should be.)
The ALJ issued her unfavorable decision on January 24, 2014, pursuant to the familiar five-step SEP. Tr. 501-18. At step one, she found that Plaintiff had not engaged in substantial gainful activity since the alleged onset date. Tr. 506. Because Plaintiff had not engaged in substantial gainful activity for at least 12 months, the ALJ proceeded to step two. Id. There, she found that Plaintiff suffered from the following severe impairments: "scoliosis; depression; borderline intellectual functioning; and anxiety[.]" Id. At step three, the ALJ found that none of Plaintiff's impairments, alone or in combination, met or medically equaled a Listing. Tr. 506-08.
Because none of Plaintiff's impairments met a Listing, the ALJ went on to assess Plaintiff's RFC. Tr. 508-16. She found that:
Tr. 508. At step four, the ALJ found that Plaintiff had no past relevant work. Tr. 516. At step five, the ALJ found that, based on Plaintiff's RFC, age, education, and work experience and the testimony of the VE,
The Commissioner's final decision in this case will be reversed, and the case will be remanded for an immediate award of benefits. The Court finds that ALJ Fernandez Rice was correct to apply the SEP in determining whether Plaintiff was disabled between May 19, 2008, and May 16, 2010. However, the ALJ impermissibly ignored the opinions of Plaintiff's treating providers and failed to adequately explain why portions of the opinions of examining physicians
As an initial matter, the Court addresses Plaintiff's argument that ALJ Fernandez Rice erred in applying the traditional five-step SEP. [Doc. 17] at 9-11. Plaintiff argues that because her second application had been approved, she was already found to be disabled and, thus, ALJ Fernandez Rice should have applied Social Security Ruling ("SSR") 83-20 instead of the SEP. Id. The Court is not persuaded.
SSR 83-20 applies where a claimant has already been found disabled. It sets forth the process for determining the onset date of disability. A finding of disability is a predicate to utilization of SSR 83-20; there is no need to determine the onset date if the plaintiff is not disabled. Here, Plaintiff argues that the approval of her second application triggers the utilization of SSR 83-20 with respect to her first application. [Doc. 17] at 9. The Court disagrees.
Approval of a "subsequent claim does not invade the period previously adjudicated by the ALJ decision." HALLEX § 1-5-3(III)(B)(2)
Plaintiff's reliance on Blea v. Barnhart, 466 F.3d 903 (10th Cir. 2006), is misplaced. In Blea, there was only one application and one adjudication period at issue.
In contrast to Blea, where there was only one application and one adjudication period at issue,
Plaintiff argues that the ALJ committed reversible error when she failed make findings regarding the opinions of treating providers Dr. Smith, Dr. Garcia, and mental health counselor Hammond. [Doc. 17] at 19-20; [Doc. 23] at 10. These treating opinions all included significantly more restrictive limitations than those ultimately adopted by the ALJ. Compare Tr. 508 (ALJ's RFC assessment), with Tr. 632-33 (Dr. Smith's assessment), and 638-39 (Dr. Garcia's assessment), and 641-42 (counselor Hammond's assessment). For example, the treating providers all agreed that Plaintiff was either moderately or markedly limited in every area of functioning. Tr. 632-33 (Dr. Smith's assessment); 638-39 (Dr. Garcia's assessment); 641-42 (counselor Hammond's assessment). The Commissioner responds that no findings were required because the opinions were not probative. She explains that the adjudication period at issue is between May 19, 2008, and May 16, 2010, but the opinions were authored much later, in 2013. [Doc. 22] at 11. Plaintiff replies that the opinions are probative because they are expressly retroactive to the relevant adjudication period. [Doc. 23] at 10 (citing Tr. 632-33 (Dr. Smith); 638-39 (Dr. Garcia); 641 (counselor Hammond). Plaintiff is correct.
Social Security regulations require that, in determining disability, the opinions of treating physicians be given controlling weight when those opinions are well-supported by the medical evidence and are consistent with the record. 20 C.F.R. § 416.927(c)(2). This is known as the "treating physician rule."
When this case was first remanded by this Court, Judge Martínez found that ALJ Reyes had erred in failing to explain why he had rejected certain findings by Dr. Wynne, a State Agency examining psychologist. Tr. 488; Jaramillo I, [Doc. 25] at 12. Thus, Judge Martínez expressly directed the Commissioner to "either explicitly incorporate [certain] findings of [Dr.] Wynne ... into [the] RFC assessment, or explain why they are rejected." Tr. 488; Jaramillo I, [Doc. 25] at 12. Dr. Wynne's relevant findings were that Plaintiff "has difficulty read[ing] and remembering basic written instructions...[;] difficulty interacting with coworkers and supervisors ...[; and] difficulty adapting to changes in the workplace[.]" Tr. 369.
ALJ Fernandez Rice incorporated only one portion of Dr. Wynne's findings into the RFC assessment, to wit: a limitation to occasional interaction with coworkers. Tr. 508. Otherwise, she did not incorporate the findings into the RFC assessment. See Tr. 508 (RFC assessment). Despite Judge Martínez's express instructions, and despite clear law on the issue, ALJ Fernandez Rice failed to explain why Dr. Wynne's findings were rejected. See Tr. 508-16.
The ALJ gave specific reasons for rejecting other portions of Dr. Wynne's opinion that Judge Martínez did not address. See Tr. 511 (no limitation on ability to manage funds); Tr. 511 (rejecting diagnosis of Rule Out Panic Disorder without Agoraphobia); Tr. 511-12 (rejecting GAF
As with Dr. Wynne's opinion, when the case was first remanded by this Court, Judge Martínez expressly directed the Commissioner to "either explicitly incorporate [certain] findings of [Dr. Logan, a State Agency examining physician,] into [the] RFC assessment, or explain why they are rejected." Tr. 488; Jaramillo I, [Doc. 25] at 12. Those findings were that Plaintiff would be "markedly limited" in her (1) ability to understand, remember, and carry out detailed instructions and would have moderate limitations in (2) completing a normal workday and workweek without interruptions from psychologically based symptoms, performing at a
ALJ Fernandez Rice declined to incorporate into the RFC assessment Dr. Logan's opinion that Plaintiff was moderately limited in her "ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods." Compare Tr. 508 (RFC assessment), with Tr. 377 (Dr. Logan's report). Although the ALJ gave reasons for rejecting the opinion, see Tr. 508-16, those reasons are inadequate.
First, the ALJ explained that she was rejecting the opinion because she found that it was not actually a "medical opinion[]" and, thus, not applicable to the RFC. Tr. 514. She reasoned as follows: Dr. Logan had recorded his findings on a Mental RFC Assessment ("MRFCA") form, which is divided into three sections. Tr. 377-78. The opinions contained in Section I were not applicable to the RFC, and instead, only the opinions contained in Section III were applicable to the RFC. Tr. 514. The ALJ found that she was permitted to ignore the finding at issue here because it was contained in Section I; she was only required to include in her RFC the findings contained in Section III. Id. However, the Tenth Circuit sees it differently.
"[I]f a consultant's Section III narrative fails to describe the effect that each of the Section I moderate limitations would have on the claimant's ability, or if it contradicts limitations marked in Section I, the MRFCA cannot properly be considered part of the substantial evidence supporting an ALJ's RFC finding." Carver v. Colvin, 600 Fed.Appx. 616, 620 (10th Cir. 2015) (unpublished).
Here, Dr. Logan's narrative in Section III limits Plaintiff to "performing simple, repetitive work[-]related tasks in a routine work setting." Tr. 378. This Section III assessment does not describe the functional effect of Plaintiff's Section I moderate limitation in the "ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods." Tr. 377. Therefore, substantial evidence cannot support ALJ's Rice's reason for rejecting the limitation at issue.
District courts have discretion to remand either for further administrative proceedings or for an immediate award of benefits. Ragland v. Shalala, 992 F.2d 1056, 1060 (10th Cir. 1993). In making this decision, courts should consider both "the length of time the matter has been pending and whether or not given the available evidence, remand for additional fact-finding would serve [any] useful purpose but would merely delay the receipt of benefits." Salazar v. Barnhart, 468 F.3d 615, 626 (10th Cir. 2006) (internal quotation and citation omitted) (remanding for an immediate award of benefits where, inter alia, the application had been pending for more than five years). When the Commissioner has failed to satisfy her burden of proof at step five, and when there has been a long delay as a result of her erroneous disposition of the proceedings, remand for an immediate award of benefits may be appropriate. Ragland, 992 F.2d at 1060 (remanding for an immediate award of benefits "[i]n light of the Secretary's patent failure to satisfy the burden of proof at step five[] and the long delay [of at least four years] that has already occurred as a result of the Secretary's erroneous disposition of the proceedings[.]"). The Commissioner "is not entitled to adjudicate a case ad infinitum until [she] correctly applies the proper legal standard and gathers evidence to support [her] conclusion." Sisco v. U.S. Dep't of Health & Human Servs., 10 F.3d 739, 746 (10th Cir. 1993).
This case has been pending for nearly seven years. There have already been two administrative hearings and two decisions by ALJs. Both times, Plaintiff met her burden to show her disability at the first four steps of the SEP. The case was previously remanded to the Commissioner by this Court for further administrative proceedings in 2012. Despite the Court's explicit instructions, and despite clear law on the evaluation of medical source opinions, the Commissioner failed to apply the correct legal standards in evaluating the opinions of Drs. Wynne, Logan, Smith, and Garcia and counselor Hammond. Additionally, several of the Commissioner's reasons for weighing the opinions were either wholly conclusory or not supported by substantial evidence. Therefore, the Commissioner — for a second time — failed to meet her burden at step five to show that Plaintiff could perform other work.
This case concerns whether Plaintiff was disabled between May 19, 2008, and May 16, 2010. The administrative record is complete as to this time period. The VE testified that if Plaintiff's functioning were limited as Drs. Wynne and Logan opined, she would not be able to work. Tr. 470-71. The Commissioner has thus far been unable to explain why such limitations should be rejected. Additionally, the record contains opinions from three treating providers as to the relevant time period, and all agree that Plaintiff's limitations are actually significantly more limited than even Drs. Wynne and Logan opined. Therefore, the Court finds that there is no reasonable
The Commissioner's final decision in this case will be reversed, and the case will be remanded for an immediate award of benefits. Although the ALJ correctly applied the SEP rather than SSR 83-20, she still committed reversible errors. The ALJ impermissibly ignored the opinions of Plaintiff's treating providers and failed adequately to explain why she rejected portions of the opinions of examining physicians, Drs. Wynne and Logan. Considering that the case has been pending for nearly seven years and that no useful purpose would be served in requiring further administrative proceedings, the case will be remanded for an immediate award of benefits.
Tr. 514-15 (citing Tr. 378).