JUDITH GAIL DEIN, Magistrate Judge.
The plaintiff, Katherine A. Dumont ("Dumont"), has brought this action pursuant to sections 205(g) and 1631(c)(3) of the Social Security Act, 42 U.S.C. §§ 405(g) and 1383(c)(3), in order to challenge the final decision of the Commissioner of the Social Security Administration ("Commissioner") denying her claims for Social Security Disability Insurance ("SSDI") and Supplemental Security Income ("SSI") benefits. The matter is before the court on the "Plaintiff's Motion to Reverse the Decision of the Commissioner" (Docket No. 22), by which the plaintiff requests that the court reverse the decision to deny her claims for benefits and remand the matter to the Social Security Administration for further administrative proceedings. It is also before the court on the "Motion to Affirm the Commissioner's Decision" (Docket No. 28), by which the Commissioner is seeking an order upholding her determination that Dumont is not disabled within the meaning of the Social Security Act, and is therefore not entitled to SSI or SSDI benefits. At issue is whether the findings of the Administrative Law Judge ("ALJ") regarding the plaintiff's residual functional capacity ("RFC") are internally consistent, and whether the ALJ appropriately considered expert medical evidence related to Dumont's mental capacity from two state agency medical consultants and an impartial medical expert. Also at issue is whether the ALJ clarified Dumont's RFC with respect to her social functioning as ordered by the Appeals Council. As detailed below, this court finds that the RFC is not internally inconsistent, but that the ALJ committed error in assessing the plaintiff's RFC by failing to appropriately consider the opinion evidence of two state agency medical consultants and an impartial medical expert that limits Dumont to performing simple as opposed to complex tasks. As a result, the case must be remanded. This court finds that the plaintiff's argument that the ALJ failed to comply with the Appeals Council's remand order is not fully developed. However, in light of the remand on other grounds, this court recommends that the ALJ revisit the social functioning component of the RFC. Therefore, and for all the reasons described herein, the plaintiff's motion to reverse or remand is ALLOWED, and the Commissioner's motion to affirm is DENIED.
Dumont was born on December 10, 1957, and was 52 years old at the expiration of her date last insured in 2009. (Tr. 65, 271-72). She completed high school and attended, but did not complete, college. (Tr. 66). When she was 19 years old, Dumont suffered a traumatic event. (Tr. 706). From 1998 to 2001, she worked as an office manager for a construction company. (Tr. 288). She was incarcerated for a year due to a conviction for embezzlement (Tr. 70) and then, in approximately 2003, began working as a registrar at Fisher College, where she remained until she was laid off in 2005. (Tr. 67, 288).
Dumont has a history of mental and physical health issues. She sought mental health treatment from 1996-1998 (Tr. 388-90, 436-61), 2001-2009 (Tr. 393-435, 1003-06), and 2010-2014
On September 7, 2010, Dumont filed applications for SSDI and SSI, claiming that she had been unable to work since May 31, 2005 due to PTSD, social phobia, manic depression, anxiety attacks, diabetes, and breathing problems. (Tr. 238-52). Her applications were denied initially on January 5, 2011, and upon reconsideration on September 9, 2011. (Tr. 129-34; 139-44). Dumont then requested and was granted a hearing before an ALJ, which took place on January 15, 2013 in Boston, Massachusetts. (Tr. 33-53; 145-50). The plaintiff, who was represented by counsel, appeared and testified at the hearing. (Tr. 33-53). On January 31, 2013, the ALJ issued a decision denying Dumont's claims for benefits. (Tr. 108-19).
Subsequently, Dumont filed a request for review of the ALJ's decision by the Social Security Appeals Council. (Tr. 182). The Appeals Council granted Dumont's request for review, and on July 2, 2014 remanded the matter to the ALJ for further evaluation of the record. (Tr. 125-27). In particular, but without limitation, on remand the ALJ was to determine the claimant's social limitations, with references to evidence in the record, and to obtain evidence from a vocational expert to clarify the assessed limitations on the claimant's occupational base. (Dec. 1; Tr. 14).
Following the remand, a hearing was held on December 18, 2014 in Boston, Massachusetts before a different ALJ. (Tr. 54-100). The plaintiff, who was represented by counsel, appeared and testified at the hearing. (
On March 19, 2015, the ALJ issued a decision denying Dumont's claims for benefits. (Tr. 14-24). On June 3, 2015, Dumont appealed the decision to the Appeals Council, which denied review on May 17, 2016, thereby making the ALJ's decision the final decision of the Commissioner for purposes of review. (Tr. 1-4, 9-10). Accordingly, the plaintiff has exhausted all of her administrative remedies and the case is ripe for judicial review pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3).
The ALJ concluded that from May 31, 2005 through the date of his decision on March 19, 2015, Dumont "ha[d] not been under a disability, as defined in the Social Security Act," which defines "disability" as "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment or combination of impairments that can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than 12 months." (Dec. Finding #7; Tr. 24).
The first inquiry in the five-step evaluation process is whether the claimant is "engaged in substantial gainful work activity[.]"
The second inquiry is whether the claimant has a "severe impairment," meaning an "impairment or combination of impairments which significantly limits [her] physical or mental ability to do basic work activities[.]" 20 C.F.R. §§ 404.1520(c), 416.920(c). If not, the claimant is deemed not to be disabled and the application for benefits is denied.
The third inquiry is whether the claimant has an impairment equivalent to a specific list of impairments contained in Appendix 1 of the Social Security regulations, in which case the claimant would automatically be found disabled.
The fourth inquiry asks whether "the applicant's `residual functional capacity' is such that he or she can still perform past relevant work[.]"
(Dec. Finding #5; Tr. 19) (footnote added).
In reaching his conclusion regarding the plaintiff's RFC, the ALJ first considered all of Dumont's symptoms and the extent to which those symptoms were consistent with the objective medical evidence and other evidence in the record. (Dec. 6; Tr. 19). Accordingly, the ALJ reviewed the plaintiff's medical records, which consisted of records covering the time period from February 1996 through November 2014. (
Dumont contends that the ALJ committed three reversible errors in assessing her RFC. First, Dumont challenges the RFC as internally inconsistent. Second, she asserts that the ALJ ignored the opinions of Dr. Maliszewski, Dr. Lasky and Dr. Reddick, that her mental capacity limits her to performing simple tasks, a conclusion that is inconsistent with the ALJ's RFC finding that she is capable of performing work up to and including SVP-8 work. Third, Dumont argues that the ALJ failed to clarify Dumont's RFC with respect to her social functioning as ordered by the Appeals Council on remand. For the reasons described below, this court finds that the RFC is not internally inconsistent, but that the ALJ's handling of the medical opinion testimony was insufficient and that, therefore, remand is warranted. This court also finds that the plaintiff's argument that the ALJ failed to comply with the Appeals Council's remand order to clarify Dumont's social limitation is not fully developed by the plaintiff.
After explaining the basis for his RFC determination, the ALJ compared Dumont's RFC to the physical and mental demands of her past work as a college registrar and office manager, and considered the VE's testimony that an individual with Dumont's age, education, work history and RFC would be capable of returning to each of those positions. (Dec. 10-11; Tr. 23-24). The ALJ concluded that Dumont was capable of performing her past relevant work as the work is actually and generally performed in the national economy. (
If an ALJ finds that the claimant has the RFC to perform her past relevant work, the claimant is deemed not to be disabled, and there is no need for the ALJ to proceed to step five.
The fifth inquiry is whether, given the claimant's RFC, education, work experience and age, the claimant is capable of performing other work.
Additional factual details relevant to this court's analysis are described below where appropriate.
In this action, Dumont is seeking judicial review of the Commissioner's "final decision" pursuant to the Social Security Act § 205(g), 42 U.S.C. § 405(g) (the "Act"). The Act provides in relevant part as follows:
42 U.S.C. § 405(g) (emphasis added). The Supreme Court has defined "substantial evidence" to mean "more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion."
As the First Circuit has explained:
"Even in the presence of substantial evidence, however, the Court may review conclusions of law, and invalidate findings of fact that are `derived by ignoring evidence, misapplying the law, or judging matters entrusted to experts.'"
In support of her motion to reverse the Commissioner's decision and remand, Dumont contends that the ALJ committed error by (1) assessing an RFC that it is internally inconsistent;
(2) failing to appropriately address medical opinion evidence from Dr. Maliszewski, Dr. Lasky, and Dr. Reddick that her mental capacity limits her to performing simple, as opposed to complex, tasks; and (3) failing to clarify the RFC with respect to Dumont's social functioning in contravention of the Appeals Council's directive. This court will take each argument in turn.
The RFC provides that with certain limitations, Dumont is capable of performing "routine tasks up to and including SVP-8 level work." (Dec. Finding #5; Tr. 19). The plaintiff asserts that the phrase "routine tasks up to and including SVP-8 level work" is internally inconsistent. (Pl. Mem. (Docket No. 23) at 7). This court disagrees.
SVP stands for "Specific Vocational Preparation" and is defined by the Dictionary of Occupational Titles ("DOT") as "the amount of lapsed time required by a typical worker to learn the techniques, acquire the information, and develop the facility needed for average performance in a specific job-worker situation."
"Skilled work" is defined by the Social Security Administration as requiring
20 C.F.R. §§ 404.1568(c), 416.968(c).
Dumont does not read the ALJ's reference to her ability to perform "routine tasks up to and including SVP-8 level work" as meaning she can perform "routine tasks," "SVP-8 level work" and everything in between, which is one plausible interpretation of the ALJ's assessment. Rather, Dumont contends that the ALJ was ruling that she could perform SVP-8 level work despite being limited to "routine tasks," and that this ruling was internally inconsistent. This court disagrees. Instead, as the Commissioner persuasively argues, "the restriction to `routine tasks up to and including SVP-8 level work' was clearly meant to convey that Plaintiff's mental impairments did not prevent her from doing the usual (
This reading is supported by the ALJ's hypothetical question to the VE, in which the ALJ equated the phrase "routine tasks" with the phrase "normal functions." (
Dumont argues that in assessing her RFC, the ALJ failed to address or provide reasons for rejecting medical opinions regarding her mental limitations. This court agrees.
The RFC assessment "must always consider and address medical source opinions." SSR 96-8p, 1996 WL 374184, at * 7. "If the RFC assessment conflicts with an opinion from a medical source, the adjudicator must explain why the opinion was not adopted."
The plaintiff persuasively argues that the ALJ failed to explain why opinions from three consulting medical experts, Dr. Maliszewski, Dr. Lasky and Dr. Reddick, that Dumont's mental capacity limited her to performing simple tasks, was not adopted.
On September 9, 2011, Dr. Maliszewski, a state agency non-examining medical consultant, reviewed Dumont's medical records and completed a Psychiatric Review Technique Form ("PRTF") (Tr. 779-92) and a Mental Residual Functional Capacity Assessment ("MRFCA") (Tr. 793-96). In the PRTF, Dr. Maliszewski rated the degree of the plaintiff's limitations in her activities of daily living, social functioning, and ability to maintain concentration, persistence, or pace. (Tr. 779-92). Dr. Maliszewski concluded that Dumont had a "mild" limitation in her activities of daily living but "moderate" limitations in maintaining social functioning and concentration, persistence, or pace. (Tr. 789). Specifically, in the MRFCA, Dr. Maliszewski checked off boxes indicating that Dumont was "moderately limited" in four out of eight areas of concentration and pace (Tr. 793-94), and "moderately limited" in two out of five areas of social interaction (Tr. 794). He also concluded that she was "moderately limited" in her ability to understand and remember detailed instructions and her ability to respond appropriately to changes in the work setting. (Tr. 793-94).
Importantly, Dr. Maliszewski also provided a narrative statement in which he translated his findings into a specific assessment of Dumont's mental RFC. (Tr. 795). Thus, Dr. Maliszewski opined that Dumont was "[c]apable of recall for simple tasks"; had "attention intact sufficiently to perform simple tasks"; "would perform better in a more independent job role"; and that her "mood would not prevent her from performing concrete tasks in a normal, structured work setting." (
The ALJ included in his recitation of facts that Dr. Maliszewski had opined that Dumont was "capable of performing simple tasks." (Dec. 8; Tr. 21). However, the ALJ did not adopt that opinion and provided no explanation as to why. The ALJ's full explanation of his treatment of Dr. Maliszewski's opinion is as follows:
(Dec. 9; Tr. 22) (citations omitted).
Thus, while the ALJ purported to adopt Dr. Maliszewski's opinion regarding Dumont's social limitations, he neither adopted nor provided an explanation for rejecting Dr. Maliszewski's opinions regarding her mental limitations, namely that her recall and attention limited her to performing "simple tasks," and that her mood would limit her to performing "concrete tasks.'' (Tr. 795). As the Commissioner conceded at oral argument, a limitation to simple tasks is inconsistent with a finding that a claimant can perform work at the SVP-8 level. It is clear that the ALJ failed to address a conflict in the evidence with regard to the level of work that Dumont is capable of performing.
The ALJ's assertion that he afforded Dr. Maliszewski's opinion "great weight to show that [Dumont] is capable of working in this case" does not adequately explain the basis for omitting any discussion of Dr. Maliszewski's opinion regarding Dumont's limitations to "simple" or "concrete" tasks, and this court is not entitled to speculate as to the reasons for the ALJ's apparent rejection of those limitations. The ALJ's failure to offer an explanation constitutes error warranting remand.
At oral argument the plaintiff challenged the ALJ's failure to address all aspects of the opinion proffered by Dr. Lasky, another state agency medical consultant.
On December 7, 2010, Dr. Lasky, a state agency non-examining consultant, reviewed Dumont's medical records and completed a PRTF (Tr. 713-26) and a MRFCA (Tr. 709-12). In the PRTF, Dr. Lasky rated the degree of the plaintiff's limitations in her activities of daily living, social functioning, and ability to maintain concentration, persistence, or pace. (Tr. 713-26). Dr. Lasky concluded that Dumont had "moderate" limitations in maintaining social functioning and "mild" limitations in concentration, persistence, or pace. (Tr. 723). In the MRFCA, Dr. Lasky checked off boxes indicating that Dumont was "moderately limited" in five out of eight areas of concentration, persistence and pace (Tr. 709-710), and "moderately limited" in two out of five areas of social interaction (Tr. 710). He also concluded that she was "moderately limited" in her ability to understand and remember detailed instructions. (Tr. 709).
Importantly, Dr. Lasky also provided a narrative statement in which he translated his findings into a specific assessment of Dumont's mental RFC. (Tr. 711). Specifically, Dr. Lasky opined that Dumont had "mild to moderate" levels of mental health difficulties "but her general ability to function appears [within normal limits] . . . ." Dr. Lasky continued, "specifically, [claimant] appears: a. able to understand and recall short and simple instructions. b. able to sustain concentration, persistence and pace w/o interruptions from psych based [symptoms]. c. able to interact appropriately w/co-workers and supervisors [within normal limits]. d. able to adapt to routine changes in the work setting." (Tr. 711) (emphasis added).
In assessing Dumont's RFC, the ALJ considered and weighed Dr. Lasky's opinion but in doing so did not address Dr. Lasky's opinion regarding Dumont's limitation to understanding and recalling short and simple instructions. As the ALJ found:
(Dec. 9; Tr. 22) (citations omitted). The ALJ did not address Dr. Lasky's opinion regarding short and simple instructions in the RFC, although the ALJ did acknowledge that opinion in his recitation of facts. (Dec. 7-8; Tr. 20-21) ("Dr. Lasky gave the opinion that the claimant was capable of understanding and recalling short and simple instructions . . . ."). However, like in the case of Dr. Maliszewski, nowhere in his decision did the ALJ provide a reason for rejecting this opinion in the RFC. This court is not entitled to speculate as to the reasons for the ALJ's apparent rejection of the limitation regarding recall and understanding of short and simple instructions. As the cases cited above hold, his failure to offer an explanation constitutes error warranting remand.
Dumont was not capable of performing complex tasks. Dr. Reddick, an impartial medical expert, testified at the December 2014 administrative hearing regarding the medical evidence that had been presented to her for her review. The ALJ posed the following question: "based on your review . . . is there anything you would see in the nature of restrictions of limitations which should be imposed based on [Dumont's] psychiatric problems?" (Tr. 59-60). Dr. Reddick answered:
(Tr. 60). Dr. Reddick also testified that Dumont had worked since having suffered a traumatic experience at age 19. (Tr. 61).
In assessing Dumont's RFC, the ALJ considered and weighed Dr. Reddick's opinion as follows:
(Dec. 9; Tr. 22) (citation omitted).
Though the ALJ concluded from Dr. Reddick's testimony that Dumont was capable of working, the ALJ failed to address Dr. Reddick's opinion as to the level of work Dumont could perform given her mental capacity, namely, that Dumont was capable of performing "basic work." (Tr. 60) (emphasis added). Because a finding that Dumont is capable of performing "basic work" is insufficient to support the ALJ's finding that Dumont could perform SVP-8 level work, and, as the ALJ did not address Dr. Reddick's opinion as to "basic work," remand is warranted. While, as the Commissioner argues, the ALJ need not adopt the entirety of a medical opinion in the record and may adopt portions of an opinion, that does not excuse the ALJ from addressing or resolving conflicts in the evidence. (
Dumont also argues that the ALJ failed to comply with the Appeals Council's remand order to clarify Dumont's social limitation. However, as detailed herein, this argument is not fully developed by the plaintiff.
In an opinion dated July 2, 2014, the Appeals Council remanded Dumont's case to the ALJ, finding on review that while the ALJ had in his decision dated January 31, 2013 determined that Dumont had moderate difficulty maintaining social functioning, the RFC failed to contain corresponding social limitations and, in contrast, explicitly provided that Dumont was "able to interact appropriately with co-workers and supervisors[.]" (
The case was remanded to a different ALJ, who in his March 19, 2015 decision, also concluded that Dumont had moderate difficulties in social functioning. (
While the ALJ did not address Dumont's ability to interact with co-workers or the public, beyond needing her own workspace, the plaintiff has not identified evidence in the record that the ALJ failed to properly consider. Nor does the plaintiff identify techniques that the ALJ failed to apply as directed by the Appeals Council. Moreover, it is unclear whether this matter will be addressed by the same or a different ALJ on remand. Therefore, this court will not further address the sufficiency of the ALJ's compliance with the directive of the Appeals Council. Nevertheless, this court recommends that, on remand, the ALJ revisit the finding regarding the social functioning component of the RFC in accordance with the Appeals Council's instructions.
For all the reasons detailed herein, the "Plaintiff's Motion to Reverse the Decision of the Commissioner" (Docket No. 22) is ALLOWED, and the defendant's "Motion to Affirm the Commissioner's Decision" (Docket No. 28) is DENIED. The matter shall be remanded to the ALJ for further proceedings consistent with this decision.