WILLIAM M. SKRETNY, District Judge.
1. Plaintiff Paul F. Maietta challenges the determination of an Administrative Law Judge ("ALJ") that he is not disabled within the meaning of the Social Security Act ("the Act"). Plaintiff alleges that he has been disabled since April 16, 2012 due to severe depression, anxiety disorder, and a heart condition. Plaintiff contends that his impairments render him unable to work and, thus, that he is entitled to disability benefits under the Act.
2. Plaintiff applied for disability benefits on December 20, 2012. Plaintiff thereafter requested a hearing before an ALJ. On June 5, 2015, ALJ William M. Weir held a hearing in Buffalo, New York, at which Plaintiff appeared with counsel and testified. The ALJ considered the case de novo, and on September 25, 2015, issued a decision granting Plaintiff's application for benefits. Neither party appealed.
3. On November 13, 2015, the Appeals Council notified Plaintiff that it was sua sponte reviewing the ALJ's decision, and on January 19, 2016, the Appeals Council issued a remand order. The Appeals Council found two errors in the ALJ's decision. First, substantial evidence did not support the ALJ's determination that Plaintiff's anxiety disorder meets the "anxiety-related disorder" as an impairment under the regulations, primarily because the opinions and records from treating psychologist Dr. Christopher Pino, upon which the ALJ heavily relied in reaching his initial determination, were not deserving of controlling weight. The Appeals Council heavily emphasized that while Dr. Pino treated Plaintiff regularly since April 2012 and ultimately diagnosed Plaintiff with depression and anxiety, his opinion deserved little weight because Plaintiff's alleged onset date was in 2007, five years before Dr. Pino treated him. The ALJ also found it problematic that "most" of Dr. Pino's notes were "handwritten and illegible." Second, the ALJ erred in concluding that Plaintiff's substance abuse disorders were not contributing factors material to the determination of disability. Accordingly, the Appeals Council remanded for the ALJ to, among other things, "further evaluate the medical and other opinions of record . . . explaining the reasons for the weight given to such opinion evidence." (R. at 143).
4. A second hearing was held before ALJ William M. Weir on March 4, 2016, at which Plaintiff and a vocational expert testified. At the outset of the hearing, Plaintiff amended his alleged onset date to April 16, 2012, which the ALJ accepted (Plaintiff's brief submitted in advance of the hearing also amended the outset date). (R. at 37-38, 363). On December 16, 2016, the ALJ issued a written decision denying Plaintiff's application for benefits. The Appeals Council denied Plaintiff's request for review on March 21, 2017. Plaintiff filed the current action on May 2, 2017, challenging the Commissioner's final decision.
5. On January 26, 2018, Plaintiff filed a Motion for Judgment on the Pleadings under Rule 12(c) of the Federal Rules of Civil Procedure. (Docket No. 10). On April 18, `, the Commissioner filed a Motion for Judgment on the Pleadings. (Docket No. 15). Plaintiff filed a reply on May 24, 2018 (Docket No. 18), at which time this Court took the matter under advisement without oral argument. For the following reasons, Plaintiff's motion is granted, and Defendant's motion is denied.
6. A court reviewing a denial of disability benefits may not determine de novo whether an individual is disabled.
7. "To determine on appeal whether an 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."
8. The Commissioner has established a five-step sequential evaluation process to determine whether an individual is disabled under the Act.
9. The five-step process is as follows:
10. Although the claimant has the burden of proof on the first four steps, the Commissioner has the burden of proof on the fifth and final step.
11. In this case, the ALJ made the following findings with regard to the five-step process set forth above: (1) Plaintiff has not engaged in substantial gainful activity since
12. Plaintiff's brief raises three points. The first two are challenges to the decision below (that the ALJ misapplied the treating-physician rule and failed to sufficiently develop the record in accordance with the Remand Order). The third point is a request to remand for calculation of benefits. Having reviewed the ALJ's decision in light of Plaintiff's arguments, the Court finds reversible error.
13. Plaintiff argues that the ALJ misapplied the treating physician rule when it afforded Dr. Pino's opinion little weight based on both an erroneous onset date and for deeming Dr. Pino's notes "mostly illegible." (Pl.'s Br. at 26-32). Relatedly, Plaintiff argues that the ALJ compounded this error by not re-contacting Dr. Pino to clarify his opinion, in violation of the Appeals Council's remand order. (Pl.'s Br. at 19). "The SSA recognizes a rule of deference to the medical views of a physician who is engaged in the primary treatment of a claimant. Thus, the opinion of a claimant's treating physician as to the nature and severity of the impairment is given controlling weight so long as it is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in the case record."
14. Given the high deference afforded to the medical views of the treating physician, the ALJ must give "good reasons" for giving a treating physician's medical opinion less than controlling weight, and the failure to do so is grounds for remand.
15. First, the ALJ primarily gave little weight to Dr. Pino's findings because "Dr. Pino did not start treating the claimant regularly until April 2012, five (5) years after the claimant's alleged disability onset date." (R. at 26). In so concluding, the ALJ relied on an erroneous onset date of 2007. But the record is clear that Plaintiff amended, and the ALJ accepted, his alleged onset date to April 16, 2012.
16. Second, the ALJ rejected Dr. Pino's opinion because his "handwritten notes" "are not only difficult to read, but are mostly illegible." (R. at 26). Yet, the ALJ then concludes that the same illegible notes "fail to document that the claimant experienced recurrent panic attacks." (R. at 26). The ALJ's analysis here makes no sense; both things cannot be true. Compounding that error, the ALJ then concludes that Dr. Pino's illegible notes "are inconsistent with and contradicted by" other medical evidence in the record. (R. at 26). The Court finds difficulty concluding that such an analysis rests on substantial evidence, given the illegible nature of Dr. Pino's notes. "[I]t is insufficient for the ALJ to merely assert a conclusion about the treating physician's opinion without supplying supporting facts because in so doing `. . . the ALJ [comes] dangerously close to . . . substituting his own judgment for that of a physician.'"
17. "Although other reasons may exist to discount the opinion, the ALJ's determination to discount a legible treating physician opinion on the grounds that it is illegible was improper; at the very least, the ALJ should have contacted [Dr. Pino] to decipher those portions the ALJ found to be illegible," especially in light of the Appeals Council's January 19, 2016 remand order directing the ALJ to do so.
18. The ALJ's opinion leaves far too much to interpretation. As Plaintiff's treating physician, the opinion of Dr. Pino must receive adequate consideration, in accordance with the applicable statutory authority. Remand is therefore required for the ALJ to properly consider the medical opinion evidence from the correct onset date of April 16, 2012, and for the ALJ to properly comply with the Appeals Council's January 19, 2016, Remand Order.
IT HEREBY IS ORDERED, that Plaintiff's Motion for Judgment on the Pleadings (Docket No. 10) is GRANTED.
FURTHER, that Defendant's Motion for Judgment on the Pleadings (Docket No. 15) is DENIED.
FURTHER, that this case is REMANDED to the Commissioner of Social Security for further proceedings consistent with this decision.
FURTHER, that the Clerk of Court is directed to CLOSE this case.
SO ORDERED.