LOUISE W. FLANAGAN, District Judge.
This matter comes before the court on the parties' cross-motions for judgment on the pleadings (DE 27, 30). In this posture, the issues raised are ripe for ruling. For the reasons that follow, the court remands to defendant for further proceedings.
Plaintiff filed an application for disability benefits on November 9, 2010, alleging disability beginning April 30, 2008. This application was denied initially and upon reconsideration. A hearing was held on April 6, 2012, before an Administrative Law Judge ("ALJ") who determined that plaintiff was not disabled in a decision dated May 15, 2012. The Appeals Council denied plaintiff's request for review on September 24, 2012, after granting additional time and considering additional evidence submitted by plaintiff. Thus, the ALJ's decision became defendant's final administrative decision. Plaintiff filed a complaint on November 25, 2013, seeking reversal of defendant's decision or, in the alternative, remand for further proceedings.
The court has jurisdiction under 42 U.S.C. § 405(g) to review defendant's final decision denying benefits. The court must uphold the factual findings of the ALJ "if they are supported by substantial evidence and were reached through application of the correct legal standard."
The ALJ's determination of eligibility for Social Security benefits involves a five-step sequential evaluation process, which asks whether:
In the instant matter, the ALJ performed the sequential evaluation. At step one, the ALJ found that plaintiff had not engaged in substantial gainful activity since April 30, 2008. At step two, the ALJ found that plaintiff had the following severe impairments: degenerative disc disease and wright wrist arthropathy. However, at step three, the ALJ further determined that these impairments were not severe enough to meet or medically equal one of the listed impairments in the regulations.
Prior to proceeding to step four, the ALJ determined that plaintiff had the residual functional capacity ("RFC") to perform medium work, except that he is limited to only occasionally climbing, and is limited to frequently but not constantly balancing, stooping, kneeling, crouching, and crawling, and is limited to frequently but not constantly handling with the right upper extremity. In making this assessment, the ALJ found plaintiff's statements about the severity of his symptoms not fully credible to the extent they were inconsistent with the ALJ's RFC assessment. At step four, the ALJ concluded plaintiff was capable of performing his past relevant work as an auto mechanic, and thus was not disabled from April 30, 2008, through the date of the ALJ's decision.
Plaintiff raises several grounds for reversal or remand of defendant's decision. First, plaintiff argues that defendant failed to review properly a Medicaid decision, issued October 23, 2012. Second plaintiff argues that defendant erred in not finding that all the evidence in the record, including new evidence submitted to the Appeals Council, supports a determination of disability. Third, plaintiff argues that defendant improperly evaluated his credibility. Fourth, plaintiff argues that defendant erred in finding that he could perform his past work as an auto mechanic, without benefit of vocational expert testimony. The court will address each ground in turn.
In denying plaintiff's request for review, the Appeals Council noted that it had considered and made a part of the record additional evidence, including a Notice of Decision from the State of North Carolina Department of Health and Human Services, dated October 23, 2012 (hereinafter the "Medicaid decision"), among other medical records dated after the date of the ALJ decision. The Appeals Council stated that it "found that this information does not provide a basis for changing the [ALJ's] decision." It explained its reasons as follows:
(Tr. 2).
"The Appeals Council must consider evidence submitted with [a] request for review in deciding whether to grant review if the additional evidence is (a) new, (b) material, and (c) relates to the period on or before the date of the ALJ's decision."
In this case, the Appeals Council considered the Medicaid decision and took it into the record. (Tr. 1-2, 6, 10-12). Having done so, the Appeals Council was required to consider the decision "in determining whether to grant review, even though it . . . ultimately decline[d] review."
The Medicaid decision in this case applied the same Social Security Regulations applicable to defendant's decision here. In particular, it concluded that plaintiff had a "severe impairment of cervical degenerative disc disease" that "significantly limits [his] ability to do basic work activities," as defined by Social Security Regulation, 20 C.F.R. 416.910 (2012). (Tr. 11). The Medicaid decision further concluded that plaintiff "meets the disability requirement referenced in 20 C.F.R. 416.920(d) [2012], Appendix 1, Listing 1.04, which directs a finding of disabled." (
"Because the purpose and evaluation methodology of both programs are closely related, a disability rating by one of the two agencies is highly relevant to the disability determination of the other agency."
Here, although the Appeals Council reviewed the Medicaid decision, it found that it did not provide a basis for changing the ALJ's decision because it was "about a later time," and not "about whether [plaintiff was] disabled beginning on or before May 15, 2012." (Tr. 2). The record, however, does not demonstrate that discounting the Medicaid decision on this basis was appropriate. Rather, the record suggests that the Medicaid decision concerned, at least in part, the time period beginning with the March 2012 effective date of the decision, two months
Defendant also suggests that the Medicaid decision was not relevant because it was based upon a review of medical records post-dating the May 15, 2012, ALJ's decision. However, not all of the medical sources cited in the Medicaid decision post-date the ALJ's decision. For example, the Medicaid decision states that its finding of severe impairment is "supported by objective medical evidence which reveals . . . [plaintiff] had a discharge instruction from OBICI Hospital indicating that [plaintiff] had acute cervical radiculopathy." (Tr. 11). This discharge instruction was dated April 30, 2008. (
Further, while the remaining records specifically listed in the Medicaid decision are all dated between June, 2012, and August, 2012, the decision suggests, in light of its citation to the 2008 record, that those 2012 records are relevant to plaintiff's condition back to the effective date of the Medicaid decision in March 2012. In any event, the Appeals Council admitted into the record all the post-May 2012 records submitted by plaintiff. Whether these records themselves relate back to the period of disability under review is an independent issue, discussed separately below.
In sum, without further explanation of its reasons for discounting the Medicaid decision, this court is unable to determine whether substantial evidence supports defendant's decision. Accordingly, remand is required for further explanation of the reasons for discounting the Medicaid decision.
Along with the Medicaid decision, the Appeals Council considered and incorporated into the record several additional examination reports and records, dated between June 2012 and August 2012. (Tr. 1-2, 6, 10-12). Plaintiff contends that all the evidence, including the new evidence, requires a finding of disability on the basis of Listing 1.04 (
The new evidence consists of compelling evidence of disability, including an MRI taken in July 2, 2012, less than two months after the ALJ's decision, which showed "[d]isc chambers at C5-C6 more than C6-C7 with
Despite the defendant's discounting of the new evidence solely on the basis of its timing, "`the record is not so persuasive as to rule out any linkage' of the final condition of the claimant with his earlier symptoms."
In sum, remand is required for further consideration of the evidence in the record post-dating the ALJ's decision. Upon review of all the evidence in the record, the ALJ on remand may still decide that the weight of the evidence supports a determination of no disability for the period prior to May 2012. But, such weighing of the evidence is the province of the ALJ in the first instance on remand, not the court.
In assessing credibility, the ALJ must follow a two-step process: (1) the ALJ must determine whether the claimant's medically determinable impairments could reasonably cause the alleged symptoms, including pain, and (2) the ALJ must evaluate the credibility of the statements regarding those symptoms.
Pursuant to
(Tr. 16);
"The ALJ's error would be harmless if he properly analyzed credibility elsewhere."
Because remand is required for purposes of reassessing plaintiff's RFC, the court does not reach plaintiff's additional argument concerning the ALJ's determination of ability to perform past work, at step four of the sequential analysis. Furthermore, because it is the province of the ALJ in the first instance to weigh the evidence, the court rejects plaintiff's suggestion to reverse and order payment of benefits without remand. Instead, the court will grant plaintiff's alternative request to remand for further proceedings.
Based on the foregoing, the court GRANTS plaintiff's motion (DE 27), DENIES defendant's motion (DE 30), and REMANDS to the defendant for further proceedings consistent with this order, pursuant to sentence four of 42 U.S.C. 405(g).
SO ORDERED.