WILLIAM M. SKRETNY, District Judge.
1. Plaintiff Karoline Ilise Tyran challenges an Administrative Law Judge's ("ALJ") decision dated March 31, 2015, wherein the ALJ determined that she is not disabled within the meaning of the Social Security Act (the "Act"). Plaintiff now contends that this determination is not based upon substantial evidence, and remand is warranted.
2. Plaintiff protectively filed an application for supplemental security income on February 20, 2013, alleging a disability onset date of January 1, 2006. The claim was initially denied on June 11, 2011. Plaintiff thereafter requested a hearing before an ALJ and, on January 8, 2015, Plaintiff appeared and testified in Buffalo, NY. At the hearing, Plaintiff amended her disability onset date to February 20, 2013. The ALJ subsequently found, on March 31, 2015, that Plaintiff was not disabled within the meaning of the Social Security Act. Plaintiff filed an administrative appeal and the Appeals Council denied Plaintiff's request for review on November 2, 2016, rendering the ALJ's determination the Commissioner's final decision. Plaintiff filed the instant action on December 19, 2016.
3. Plaintiff and the Commissioner each filed a Motion for Judgment on the Pleadings pursuant to Rule 12(c) of the Federal Rules of Civil Procedure. (Docket Nos. 9, 13.) Judgment on the pleadings is appropriate where material facts are undisputed and where a judgment on the merits is possible merely by considering the contents of the pleadings.
4. A court reviewing a denial of disability benefits may not determine de novo whether an individual is disabled.
5. To determine whether the ALJ's findings are supported by substantial evidence, "a reviewing court considers the whole record, examining the evidence from both sides, because an analysis of the substantiality of the evidence must also include that which detracts from its weight."
6. The United States Supreme Court recognized the validity of this analysis in
7. This five-step process is detailed below:
8. Although the claimant has the burden of proof as to the first four steps, the Commissioner has the burden of proof on the fifth and final step.
9. The ALJ made the following findings with regard to the five-step process set forth above: (1) Plaintiff had not engaged in substantial gainful activity since February 20, 2013, the application date (R. 22)
10. Plaintiff challenges the decision, contending that the RFC determination is not supported by substantial evidence because rejection of certain medical opinions created a gap in the record that the ALJ was obligated to address. This Court agrees.
11. The ALJ found that Plaintiff has an RFC for light work with certain additional exertional limitations, but did not apply any non-exertional limitations or otherwise discuss Plaintiff's non-severe impairment of cognitive disorder. (R. 24.) An RFC determination specifies the "most [a claimant] can still do despite [her] limitations," 20 C.F.R. § 404.1545, and is reserved for the commissioner,
Further, the ALJ is required to "develop a complete medical record before making a disability determination,"
Plaintiff filed her application for benefits on February 20, 2013, claiming a disability onset date of January 1, 2006, which she later amended to February 20, 2013. The administrative record contains several medical records that pre-date the amended onset date, including from Dr. Sandra Jensen, a consulting psychiatric examiner, and Dr. D. Mangold, a consulting reviewer. Dr. Jensen conducted a psychiatric evaluation of Plaintiff on behalf of the state on July 8, 2010, and found that Plaintiff's attention, concentration and memory skills were mildly impaired due to limited intellectual functioning that was estimated to be in the borderline range, and that Plaintiff's fund of information appeared somewhat limited. (R. 234.) Dr. Jensen also found that Plaintiff had mild impairment maintaining attention and concentration, relating adequately with others, and appropriately dealing with stress caused by cognitive deficits. (R. 235.) Dr. Jensen diagnosed Plaintiff with cognitive disorder and alcohol dependence in early partial remission, and advised training and continued psych treatment. (R. 235-36.)
Dr. Mangold conducted a written psychiatric review of Plaintiff's records on behalf of the agency on August 26, 2010. (R. 241-58.) Dr. Mangold found that Plaintiff had moderate limitations in activities of daily living, maintaining concentration, persistence or pace, and maintaining social functioning. (R. 251, 241-258.) Dr. Mangold found Plaintiff had one or two episodes of de-compensation and noted her report of being severely depressed as well as her alcohol treatment and intent to harm herself. (R. 251, 253.) He concluded that Plaintiff was "mentally capable of performing simple, repetitive competitive [sic] work in a low contact setting." (R. 253.) Dr. Mangold also completed a mental RFC assessment where he found Plaintiff had moderate limitations in numerous areas, including understanding, memory, sustained concentration, persistence, social interaction, adaptation, ability to remember locations and work-like procedures, ability to work in coordination or proximity to others without being distracted by them, and ability to interact appropriately with the general public. (R. 255-57.)
Because these two opinions pre-dated the amended onset date by three years, the ALJ did not consider them in his decision, stating that the opinions of Drs. Jensen and Mangold were "given no weight." (R. 28.) An ALJ is generally only required to consider evidence dating one year before an application is filed.
Here, evidence of Plaintiff's mental impairments from the relevant period is minimal, but sufficient to suggest that her mental issues persisted after the alleged onset date. For example, non-exertional limitations are incorporated into an Undated Notice of Disapproved claim (R. 77-80), which noted that Plaintiff "has some trouble concentrating and remembering" and found that she could perform light work in which she "would not work directly with the public [or] closely with other people, and a job which would involve less stress than [her] past work." (R. 80.) They are also reflected in a Fibromyalgia RFC Questionnaire from treating nurse Melissa Fincher-Mergi, in which she notes that Plaintiff suffers from anxiety, panic attacks, and depression, that she is incapable of even "low stress" jobs, and that her attention and concentration would occasionally be insufficient to perform even simple work tasks. (R. 369-71.) Finally, Plaintiff testified that she experienced "bad days" about twenty times a month in which she "just mop[ed]" and did not "do too much of anything" (R. 54) and reported that has problems paying attention and difficulty staying on track (R. 202).
In his discussion of the RFC, the ALJ gave no insight as to why he was disregarding the prior assessment that Plaintiff would be limited to work involving minimal engagement with the public or co-workers. (R. 80.) Indeed, at least one of the representative occupations suggested by the ALJ, cashier II (R. 30), would appear to require significant public interaction. Perhaps this conflict is present because, having rejected the opinions of Drs. Jensen and Mangold, there was no medical opinion evidence regarding Plaintiff's mental RFC. The opinion to which the ALJ gave the most weight is that of consulting examiner Dr. Honbiao Liu, but that opinion does not address Plaintiff's cognitive disorder or any associated non-exertional limitations. (R. 347-50.)
"Where there are gaps in the administrative record, remand to the Commissioner for further development of the evidence is in order."
Despite having been alerted by the pre-onset date opinions that Plaintiff suffered from psychiatric or mental limitations, and having determined that Plaintiff's cognitive disorder is an impairment (albeit a non-severe one), the medical evidence that the ALJ states he relied on does not address Plaintiff's non-exertional symptoms or how they limited her functional capacities. "An ALJ is free to choose between properly submitted medical opinions, but cannot substitute his own expertise for that of a physician."
Because the ALJ failed to seek out medical opinions from Plaintiff's treating physicians or a consulting examiner, and because gaps in the record exist as to the functional limitations resulting from Plaintiff's cognitive disorder, remand for further proceedings is warranted.
12. In addition, Plaintiff argues that the exertional limitations set forth in the RFC are not supported by substantial evidence. The Commissioner is directed to consider these additional arguments on remand.
13. After carefully examining the record, this Court finds cause to remand this case to the ALJ for further administrative proceedings consistent with this decision. Plaintiff's Motion for Judgment on the Pleadings is therefore granted. Defendant's Motion for Judgment on the Pleadings is denied.
IT HEREBY IS ORDERED, that Defendant's Motion for Judgment on the Pleadings (Docket No. 13) is DENIED;
FURTHER, that Plaintiff's Motion for Judgment on the Pleadings (Docket No. 9) is GRANTED;
FURTHER, that this case is REMANDED to the Commissioner of Social Security for further proceedings consistent with this Decision and Order;
FURTHER, that the Clerk of the Court is directed to close this case.
SO ORDERED.