KATHERINE P. NELSON, Magistrate Judge.
Plaintiff Karen Denise Coleman brought this action under 42 U.S.C. §§ 405(g) and 1383(c)(3) seeking judicial review of a final decision of the Defendant Commissioner of Social Security ("the Commissioner") denying her application for supplemental security income ("SSI") under Title XVI of the Social Security Act, 42 U.S.C. § 1381, et seq. Upon consideration of the parties' briefs (Docs. 14, 17) and those portions of the administrative record (Doc. 12) (hereinafter cited as "(R. [page number(s) in lower-right corner of transcript])") relevant to the issues raised, and with the benefit of oral argument held November 27, 2018, the Court finds that the Commissioner's final decision is due to be
On March 20, 2015, Coleman filed a Title XVI application for supplemental security income, alleging disability beginning November 27, 2013.
The Commissioner's decision on Coleman's application became final when the Appeals Council for the Office of Disability Adjudication and Review denied her request for review of the ALJ's decision on March 5, 2018. Coleman subsequently filed this action under § 405(g) and § 1383(c)(3) for judicial review of the Commissioner's final decision. See 42 U.S.C. § 1383(c)(3) ("The final determination of the Commissioner of Social Security after a hearing [for SSI benefits] shall be subject to judicial review as provided in section 405(g) of this title to the same extent as the Commissioner's final determinations under section 405 of this title."); 42 U.S.C. § 405(g) ("Any individual, after any final decision of the Commissioner of Social Security made after a hearing to which he was a party, irrespective of the amount in controversy, may obtain a review of such decision by a civil action commenced within sixty days after the mailing to him of notice of such decision or within such further time as the Commissioner of Social Security may allow."); Ingram v. Comm'r of Soc. Sec. Admin., 496 F.3d 1253, 1262 (11th Cir. 2007) ("The settled law of this Circuit is that a court may review, under sentence four of section 405(g), a denial of review by the Appeals Council.").
"In Social Security appeals, [the Court] must determine whether the Commissioner's decision is `"supported by substantial evidence and based on proper legal standards. Substantial evidence is more than a scintilla and is such relevant evidence as a reasonable person would accept as adequate to support a conclusion."'" Winschel v. Comm'r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011) (quoting Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 2004) (per curiam) (internal citation omitted) (quoting Lewis v. Callahan, 125 F.3d 1436, 1439 (11th Cir. 1997))). However, the Court "`may not decide the facts anew, reweigh the evidence, or substitute our judgment for that of the [Commissioner].'" Id. (quoting Phillips v. Barnhart, 357 F.3d 1232, 1240 n.8 (11th Cir. 2004) (alteration in original) (quoting Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983))). "`Even if the evidence preponderates against the [Commissioner]'s factual findings, [the Court] must affirm if the decision reached is supported by substantial evidence.'" Ingram, 496 F.3d at 1260 (quoting Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990)).
"Yet, within this narrowly circumscribed role, [courts] do not act as automatons. [The Court] must scrutinize the record as a whole to determine if the decision reached is reasonable and supported by substantial evidence[.]" Bloodsworth, 703 F.2d at 1239 (citations and quotation omitted). See also Owens v. Heckler, 748 F.2d 1511, 1516 (11th Cir. 1984) (per curiam) ("We are neither to conduct a de novo proceeding, nor to rubber stamp the administrative decisions that come before us. Rather, our function is to ensure that the decision was based on a reasonable and consistently applied standard, and was carefully considered in light of all the relevant facts.").
However, the "substantial evidence" "standard of review applies only to findings of fact. No similar presumption of validity attaches to the [Commissioner]'s conclusions of law, including determination of the proper standards to be applied in reviewing claims." MacGregor v. Bowen, 786 F.2d 1050, 1053 (11th Cir. 1986) (quotation omitted). Accord, e.g., Wiggins v. Schweiker, 679 F.2d 1387, 1389 (11th Cir. 1982) ("Our standard of review for appeals from the administrative denials of Social Security benefits dictates that `(t)he findings of the Secretary as to any fact, if supported by substantial evidence, shall be conclusive ....' 42 U.S.C.A. s 405(g) ... As is plain from the statutory language, this deferential standard of review is applicable only to findings of fact made by the Secretary, and it is well established that no similar presumption of validity attaches to the Secretary's conclusions of law, including determination of the proper standards to be applied in reviewing claims." (some quotation marks omitted)). This Court "conduct[s] `an exacting examination' of these factors." Miles v. Chater, 84 F.3d 1397, 1400 (11th Cir. 1996) (per curiam) (quoting Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990)). "`The [Commissioner]'s failure to apply the correct law or to provide the reviewing court with sufficient reasoning for determining that the proper legal analysis has been conducted mandates reversal.'" Ingram, 496 F.3d at 1260 (quoting Cornelius v. Sullivan, 936 F.2d 1143, 1145-46 (11th Cir. 1991)). Accord Keeton v. Dep't of Health & Human Servs., 21 F.3d 1064, 1066 (11th Cir. 1994).
In sum, courts "review the Commissioner's factual findings with deference and the Commissioner's legal conclusions with close scrutiny." Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). See also Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005) (per curiam) ("In Social Security appeals, we review de novo the legal principles upon which the Commissioner's decision is based. Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). However, we review the resulting decision only to determine whether it is supported by substantial evidence. Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158-59 (11th Cir. 2004).").
Thornton v. Comm'r, Soc. Sec. Admin., 597 F. App'x 604, 609 (11th Cir. 2015) (per curiam) (unpublished).
Winschel, 631 F.3d at 1178 (citing 20 C.F.R. §§ 404.1520(a)(4)(i)-(v), 416.920(a)(4)(i)-(v); Phillips, 357 F.3d at 1237-39).
"These regulations place a very heavy burden on the claimant to demonstrate both a qualifying disability and an inability to perform past relevant work." Moore, 405 F.3d at 1211 (citing Spencer v. Heckler, 765 F.2d 1090, 1093 (11th Cir. 1985)). "In determining whether the claimant has satisfied this initial burden, the examiner must consider four factors: (1) objective medical facts or clinical findings; (2) the diagnoses of examining physicians; (3) evidence of pain; and (4) the claimant's age, education, and work history." Jones v. Bowen, 810 F.2d 1001, 1005 (11th Cir. 1986) (per curiam) (citing Tieniber v. Heckler, 720 F.2d 1251, 1253 (11th Cir. 1983) (per curiam)). "These factors must be considered both singly and in combination. Presence or absence of a single factor is not, in itself, conclusive." Bloodsworth, 703 F.2d at 1240 (citations omitted).
If, in Steps One through Four of the five-step evaluation, a claimant proves that he or she has a qualifying disability and cannot do his or her past relevant work, it then becomes the Commissioner's burden, at Step Five, to prove that the claimant is capable—given his or her age, education, and work history—of engaging in another kind of substantial gainful employment that exists in the national economy. Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir. 1999); Sryock v. Heckler, 764 F.2d 834, 836 (11th Cir. 1985). Finally, although the "claimant bears the burden of demonstrating the inability to return to [his or] her past relevant work, the Commissioner of Social Security has an obligation to develop a full and fair record." Shnorr v. Bowen, 816 F.2d 578, 581 (11th Cir. 1987). See also Ellison v. Barnhart, 355 F.3d 1272, 1276 (11th Cir. 2003) (per curiam) ("It is well-established that the ALJ has a basic duty to develop a full and fair record. Nevertheless, the claimant bears the burden of proving that he is disabled, and, consequently, he is responsible for producing evidence in support of his claim." (citations omitted)). "This is an onerous task, as the ALJ must scrupulously and conscientiously probe into, inquire of, and explore for all relevant facts. In determining whether a claimant is disabled, the ALJ must consider the evidence as a whole." Henry v. Comm'r of Soc. Sec., 802 F.3d 1264, 1267 (11th Cir. 2015) (per curiam) (citation and quotation omitted).
When the ALJ denies benefits and the Appeals Council denies review of that decision, the Court "review[s] the ALJ's decision as the Commissioner's final decision." Doughty, 245 F.3d at 1278. But "when a claimant properly presents new evidence to the Appeals Council, a reviewing court must consider whether that new evidence renders the denial of benefits erroneous." Ingram, 496 F.3d at 1262. Nevertheless, "when the [Appeals Council] has denied review, [the Court] will look only to the evidence actually presented to the ALJ in determining whether the ALJ's decision is supported by substantial evidence." Falge v. Apfel, 150 F.3d 1320, 1323 (11th Cir. 1998).
At Step One, the ALJ determined that Coleman's earnings did not equate to the level of substantial gainful activity as defined in 20 CFR 416.974 and that she had not engaged in substantial gainful activity since the application date, March 20, 2015
At Step Four,
Phillips, 357 F.3d at 1238-39 (footnote omitted).
The ALJ determined that Coleman had the RFC "to perform medium work as defined in 20 CFR 416.967(c) except she should avoid all exposure to heights and hazards." (R. 20). Based on this RFC and the testimony of a vocational expert (VE), the ALJ determined that Coleman is limited to simple, routine, repetitive tasks; simple work-related decisions; occasional interaction with supervisors and coworkers; no direct interaction with the public; and gradual change in a routine work setting. (R. 20). Coleman does not have past relevant work. Alternatively, the ALJ proceeded to Step Five and found that there exist a significant number of jobs in the national economy that Coleman could perform given her RFC, age, education, and work experience. (R. 25). Thus, the ALJ found that Coleman was not disabled. (R. 28).
Coleman claims that the ALJ "committed reversible error in violation of 20 C.F.R.§§404.1527(c)
"With good cause, an ALJ may disregard a treating physician's opinion, in a social security disability proceeding, but he must clearly articulate the reasons for doing so." Winschel v. Commissioner of Social Sec., 631 F.3d 1176, 1179(11th Cir. 2011). Furthermore, when and if "the ALJ fails to state with at least some measure of clarity the grounds for his decision, in a social security disability proceeding, the reviewing court will decline to affirm simply because some rationale might have supported the ALJ's conclusion." Social Security Act, § 205(g), 42 U.S.C.A § 405(g), Id.
On December 16, 2016, Dr. Kenneth Starkey completed Coleman's consultative psychological evaluation. (R. 23). The evaluation described Coleman as evasive and that she "exhibited significant symptom exaggeration behaviors and that her overall motivation and cooperation for completing the tasks of the assessment appeared questionable." (R. 23). After the evaluation, Dr. Starkey concluded that Coleman had antisocial personality disorder and decided that a "more accurate diagnosis and more reliable prognosis could not be established." In addition, Dr. Starkey noted that Coleman "clearly appeared to be malingering." (R. 23).
Coleman maintains that the ALJ "gave little weight to Dr. Starkey's estimates as to functioning, but did not address any weight given to his report." (Doc. 14 at 2). Coleman references the ALJ's statement in the RFC, noting that, "Dr. Starkey himself did not consider the conclusions to be reliable and his estimates as to functioning are therefore given little weight." (Doc. 14 at 2). The Commissioner contends that the ALJ performed a proper evaluation and correctly gave Dr. Starkey's findings and conclusions "little weight", based on statements provided. The ALJ explained: "(1) Dr. Starkey's conclusion that she `clearly appeared to be malingering' (Tr.23, 32) and (2) that Dr. Starkey's limitations are contradicted by other evidence in the record (Tr. 23-24)." (Doc. 17 at 4). Also, the ALJ noted:
As the Commissioner correctly notes, "it is the ALJ's duty to weigh medical evidence...she is not bound to adopt a medical opinion when other evidence in the record contradicts its. 20 C.F.R. §416.945(a)(3). Since an RFC assessment is not a medical assessment, the ALJ need not adopt any doctor's opinion to assess plaintiff's RFC..."(Doc. 17 at 4). Coleman argues that, "Dr. Starkey clearly stated in his medical source statement that, `Plaintiff may have been malingering or experiencing delirium secondary to unspecified medical condition (possibly untreated Hepatitis C)." (Doc.14 at 3). The Commissioner maintains that the ALJ was unable to find information in Coleman's record that would establish prior treatment for mental health issues from a mental health professional or psychiatric specialist. (Doc. 17 at 5). Thus, the ALJ deduced that the Coleman's treatment history "did not suggest mental health findings consistent with Dr. Starkey's limitations." Id.
Additionally, the Commissioner maintains that the ALJ considered Coleman's report of activities during her evaluation with Dr. Starkey
Coleman next argues that under the Hearings, Appeals, and Litigations Law Manual ("HALLEX"), the ALJ failed to call a medical expert to clarify the medical evidence of record. Pursuant to HALLEX I-2-5-34, an ALJ may need to obtain an ME (medical expert) opinion, either in testimony at a hearing or in response to written interrogatories, when the ALJ determines the degree of severity of a claimant's physical or mental impairment. HALLEX states that the ALJs are required to obtain a medical expert's opinion when: (1) the Appeals Council or the court so orders; (2) to evaluate and interpret background medical test data; or (3) when the ALJ is considering a finding that the claimant's impairment(s) medically equals a medical listing. The crux of Coleman's argument concerning HALLEX, yields to the discretion of the ALJ, placing emphasis on the word "may."
Coleman maintains that the ALJ's decision to not address the second part of Dr. Starkey's examination concerning her Hepatitis C, resulted in an RFC not supported by substantial evidence. (Doc. 14 at 5-6). Coleman asserts that the ALJ "formulated a residual functional capacity that is based on a lack of medical evidence," and that "the ALJ delineated a residual functional capacity that is not supported by substantial evidence...and essentially substitutes the Administrative Law Judge's own medical opinion." (Doc. 14 at 5-6).
In response, the Commissioner argues that none of the circumstances that require appointment of a medical expert are present in this case. Specifically, that Coleman does not present facts that highlight the ALJ's failure to act within the HALLEX guidelines or that the described circumstance required an medical expert's opinion. (Doc. 17 at 8). The undersigned concurs.
The ALJ did not err in her decision to not receive the opinion of a medical expert, and pursuant to HALLEX 1-2-5-34, was not required to do so. Accordingly, the Court
In accordance with the foregoing analysis, it is
Final judgment shall issue separately in accordance with this order and Federal Rule of Civil Procedure 58.