NOEL L. HILLMAN, District Judge.
This matter comes before the Court pursuant to Section 205(g) of the Social Security Act, as amended, 42 U.S.C. § 405(g), to review the final decision of the Commissioner of the Social Security Administration, denying Plaintiff's application for Supplemental Security Income ("Social Security benefits") under Title XVI of the Social Security Act. 42 U.S.C. § 401, et seq. The issue before the Court is whether the Administrative Law Judge ("ALJ") erred in finding that there was "substantial evidence" that Plaintiff was not disabled at any time since his alleged onset date of disability, August 28, 2008. For the reasons stated below, this Court will reverse and remand, in part, and affirm in part.
Plaintiff filed an application for supplemental security income claiming that as of August 28, 2008, he suffered from depression, arthritis pain in the right side of his body, including his right knee, and residual chronic pain and loss of manual dexterity in his right hand. The middle finger on his right hand had been surgically re-attached after being severed in an accident. Plaintiff completed two years of college and was previously employed as a plumber's helper.
Plaintiff's claim was denied on April 6, 2009, and denied on reconsideration on June 22, 2009. A hearing before the ALJ was held on February 23, 2011, in which Plaintiff was represented by counsel. After the hearing, the ALJ determined that Plaintiff was under a disability, but that a substance use disorder was a contributing factor material to the determination of disability. The ALJ found that absent substance abuse, the Plaintiff was not disabled under the Social Security Act.
Plaintiff appealed the decision. The Appeals Council reviewed the ALJ's decision, and upheld it, thus rendering it as final. Plaintiff now seeks this Court's review.
Under 42 U.S.C. § 405(g), Congress provided for judicial review of the Commissioner's decision to deny a complainant's application for Disability Insurance Benefits.
A reviewing court has a duty to review the evidence in its totality.
The Commissioner "must adequately explain in the record his reasons for rejecting or discrediting competent evidence."
The Third Circuit has held that access to the Commissioner's reasoning is indeed essential to a meaningful court review:
The Social Security Act defines "disability" for purposes of an entitlement to a period of disability and disability insurance benefits as the 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.
The Commissioner has promulgated regulations for determining disability that require application of a five-step sequential analysis.
20 C.F.R. § 404.1520(b)-(f). Entitlement to benefits is therefore dependent upon a finding that the claimant is incapable of performing work in the national economy.
This five-step process involves a shifting burden of proof.
Plaintiff argues that the ALJ erred in finding his past drug use a material factor contributing to the determination of disability, and that the ALJ erred in misapplying SSR 96-5p to Dr. Goldstein's medical source statement. The Court finds that there is insufficient evidence in the record to support a finding that Plaintiff had a substance use disorder after his alleged onset date of disability and, therefore, shall remand to the ALJ for clarification of Plaintiff's history of substance use. However, with regard to Dr. Goldstein's opinion, the Court finds no error in the ALJ's refusal to consider Dr. Goldstein's opinion regarding Plaintiff's ability to work as that is a decision reserved to the ALJ.
In this case, the ALJ found that Plaintiff had not engaged in substantial gainful activity since the alleged onset of disability (Step One). The ALJ next found that Plaintiff had the following severe impairments: a right third finger injury 15 years ago, a depressive disorder and a substance use disorder (Step Two). The ALJ then found that Plaintiff's mental impairment, including his substance abuse disorder, met the medical equivalence criteria. The ALJ concluded that if Plaintiff stopped the substance use, the remaining limitations would cause more than a minimal impact on his ability to perform basic work activities and, therefore, would continue to have a severe impairment or combination of impairments. However, if Plaintiff stopped the substance use, he would not have an impairment or combination of impairments that met or medically equals any of the listed impairments (Step Three). Particularly, the ALJ found that without substance use, the Plaintiff had no more than mild limitations in terms of his activities of daily living, moderate limitations in social functioning, and moderate limitations in maintaining concentration, persistence and pace.
At Step Four, the ALJ found that even though Plaintiff worked in the past as a plumber's helper, this work did not reach substantial gainful activity levels, did not meet the "earnings" requirement and, therefore did not qualify as "past relevant work" under the Social Security Act.
At Step Five, the ALJ determined that if Plaintiff stopped the substance use, he would have the residual functional capacity to perform a full range of work at all exertional levels, but with the following non-exertional limitations: he would be able to perform simple, routine and repetitive tasks, with no interaction with the public. The ALJ concluded that if Plaintiff stopped the substance abuse, considering his age, education, work experience and residual functional capacity, there would be a significant number of jobs in the national economy that the Plaintiff could perform, such as laundry classifier, hand packager, and hospital cleaner.
The first issue to be decided on this appeal is whether the ALJ erred in determining that Plaintiff's substance use was a contributing factor material to the determination of disability. The Court finds that there is insufficient evidence to support a finding that Plaintiff had a substance use disorder after the onset date of disability and, therefore, shall remand this case.
In defining "disability", federal law states that "[a]n individual shall not be considered to be disabled for purposes of this subchapter if alcoholism or drug addiction would (but for this subparagraph) be a contributing factor material to the Commissioner's determination that the individual is disabled." 42 U.S.C. § 423 (d)(2)(C). Therefore, if there is evidence of substance use, the ALJ must evaluate the disability independent of the substance use. If a claimant's limitations are not disabling after eliminating the substance use related factors, the substance use is a material factor and the claimant is not eligible for benefits. However, if the limitations remain disabling without the substance use, the claimant is eligible for benefits.
Here, the ALJ determined that Plaintiff had a substance use disorder which was a contributing factor material to the determination of disability. The ALJ determined that without the substance use, Plaintiff's depression would result in moderate limitations in terms of social functioning and concentration, persistence or pace, and result in mild limitations in terms of activities of daily living.
Other than Dr. Fortuno's conflicting testimony, however, there is little to support this conclusion. Rather, there is evidence that indicates that Plaintiff stopped smoking cocaine and marijuana in 2007. Although, Plaintiff admitted to having a glass of wine at Thanksgiving, he testified that he is "not a drinker anymore." Plaintiff also testified that he stopped doing drugs and alcohol between four to six years before the hearing in 2011, which suggests that he stopped prior to the onset date of disability. Therefore, there is insufficient evidence cited to support a finding that Plaintiff used substances after his alleged onset date of disability on August 28, 2008.
Despite the fact that the ALJ found that Plaintiff had a substance use disorder, he was still required to undergo an analysis as to whether Plaintiff would still be disabled, absent any substance use disorder. The ALJ did this and gave a detailed analysis and properly completed each step. However, it is not clear whether the ALJ considered Plaintiff's level of depression to be affected by current drug use or whether without the drugs his depression might improve.
Whether the ALJ considered Plaintiff to be abusing substances comes into play in assessing Plaintiff's residual functional capacity. The ALJ concluded that if Plaintiff stopped the substance use, he would have the residual functional capacity to perform a full range of work at all exertional levels, with certain limitations. Again, although the ALJ gave a detailed analysis, it is not clear whether he considered Plaintiff's limitations in social functioning and activities of daily living to be due in part to substance use. The ALJ relied on Dr. Fortuno's testimony that if Plaintiff "stopped the substance use" his remaining depression would result in moderate limitations in social functioning and mild limitations in activities of daily living. This suggests that the ALJ may have considered that Plaintiff was using substances which detrimentally affected his social functioning and activities of daily living so that if Plaintiff were not using such substances, his abilities would improve, or at least would not preclude him from performing a full range of work with certain limitations.
Accordingly, this matter will be remanded for clarification as to what evidence supports a finding that Plaintiff used substances after the onset date of disability. If the ALJ determines that the records do not support a finding of substance use after the disability date, then the ALJ should provide an opinion as to whether Plaintiff's remaining impairments are severe and meet or medically equal the listed impairments, and if Plaintiff would have the residual functional capacity to perform certain work.
The second issue before the Court is whether the ALJ erred in applying SSR 95-5p
The ALJ did not misapply SSR 96-5p to Dr. Goldstein's medical source statement. The ALJ stated that he would not consider Dr. Goldstein's statement about Plaintiff's ability or inability to work. Since a conclusion as to the Plaintiff's ability to work is a determination reserved to the ALJ, there is no error.
As to Dr. Goldstein's other medical opinions, the ALJ stated that he gave "significant weight" to Plaintiff's treating physicians regarding the nature and severity of the Plaintiff's impairments. However, the ALJ noted that Dr. Goldstein was a family medicine practitioner, not a specialist in orthopedics, physical medicine, or psychiatry (the specialized fields in which Plaintiff had impairments). The ALJ also found that Dr. Goldstein's assessment of Plaintiff's limitations were not entirely consistent with the record as a whole. Although it is true that Social Security regulations provide that a treating physician will be afforded controlling weight as to the nature and severity of a claimant's impairment, that weight is not automatic — only if the opinion is well-supported by medically acceptable clinical and laboratory diagnostic techniques, and is not inconsistent with other substantial evidence of record, will the treating physician's opinion carry more weight than any other doctor.
For the reasons expressed above, this matter shall be remanded to the ALJ for clarification of his opinion as to whether the Plaintiff had a substance use disorder after the alleged onset date of disability and, if substance use is not a material factor, to undergo the five-step sequential process to determine whether the Plaintiff is disabled.
An accompanying Order will be issued.