YVETTE KANE, District Judge.
The above-captioned action is one seeking review of a decision of the Acting Commissioner of Social Security ("Commissioner")
Disability insurance benefits are paid to an individual if that individual is disabled and "insured," that is, the individual has worked long enough and paid social security taxes. The last date that a claimant meets the requirements of being insured is commonly referred to as the "date last insured." It is undisputed that Ragen met the insured status requirements of the Social Security Act through December 31, 2013. (Tr. 25).
SSI is a federal income supplement program funded by general tax revenues (not social security taxes). It is designed to help aged, blind or other disabled individuals who have little or no income. Insured status is irrelevant in determining a claimant's eligibility for supplemental security income benefits.
Ragen applied protectively for DIB on May 20, 2013 and SSI on May 3, 2013, alleging disability for both claims beginning February 7, 2013. (Tr. 23). Ragen's date last insured for purposes of his DIB claim is December 31, 2013. (Tr. 25, 46). His claims were initially denied on August 21, 2013. (Tr. 23, 111-38).
Ragen requested a hearing before the Administrative Law Judge ("ALJ") Office of Disability and Adjudication and Review of the Social Security Administration, and one was held on September 5, 2014. (Tr. 23, 44-90). At the hearing, Ragen was represented by counsel, and a Vocational Expert testified. (Tr. 44-90). On December 11, 2014, the ALJ issued a decision denying Ragen's applications. (Tr. 127-43). Ragen's request for a review with the Appeals Council was denied on May 5, 2016. (Tr. 1-6). Thus, the ALJ's decision stood as the final decision of the Commissioner.
Ragen filed a complaint in this Court on July 11, 2016. (Doc. 1). The Commissioner filed an answer on September 16, 2016. (Doc. 13). After supporting and opposing briefs were submitted (Docs. 15 and 16), the appeal
Ragen was born on June 25, 1971 (Tr. 37), has a limited education, and is able to communicate in English. (Tr. 37). In the past, Ragen worked as a stock person, industrial cleaner, loader/unloader, packager and cleaner/janitor. (Tr. 36, 37). Ragen has not engaged in substantial gainful activity since the alleged onset date of February 7, 2013. (Tr. 25).
The ALJ found Ragen to have the following severe impairments: coronary artery disease, history of myocardial infarction, hypertension, bipolar disorder, anxiety disorder, and cannabis abuse. (Tr. 25).
When considering a social security appeal, the Court has plenary review of all legal issues decided by the Commissioner.
The plaintiff must establish that there is some "medically determinable basis for an impairment that prevents him from engaging in any substantial gainful activity for a statutory twelve-month period."
The ALJ went through each step of the sequential evaluation process and found that (1) Ragen had not engaged in substantial gainful activity since February 7, 2013, the alleged onset date; (2) Ragen had the severe impairments of coronary artery disease, history of myocardial infarction, hypertension, bipolar disorder, anxiety disorder, and cannabis abuse; (3) Ragen's impairments did not meet or equal a listed impairment; (4) Ragen lacked credibility; and (5) Ragen could not perform his past relevant work, but could perform light work with several limitations (Tr. 25-38). Specifically, the ALJ crafted the residual functional capacity ("RFC") of Ragen to:
(Tr. 29).
Ragen appeals the ALJ's determination on four grounds: (1) the ALJ failed to find that Ragen's cervical subluxation is a severe impairment; (2) the RFC is unsupported by substantial evidence because the RFC and hypothetical question to the vocational expert did not reflect Ragen's difficulties with concentration, persistence, or pace; (3) the ALJ failed to properly weigh the opinion evidence; and (4) substantial evidence does not support the ALJ's credibility assessment.
On January 1, 2013, Ragen was seen by Tiffany Griffiths, Psy.D. for a psychological consultative examination. (Tr. 633). Dr. Griffiths noted that Ragen's symptoms are consistent with major depressive disorder which is recurrent and severe, panic with agoraphobia, and alcohol abuse, in full sustained remission. (Tr. 634). She further noted that his symptoms include insomnia, suicidal thoughts with no current plan, social anxiety, ruminating thoughts, fluctuating mood, irritability, lethargy, social paranoia, poor concentration, poor appetite, psychomotor slowing, and panic. (
On May 1, 2013, Ragen saw Guido Boriosi, M.D., of NHS Human Services ("NHS") for a medication follow-up and prescription refills. (Tr. 646). Dr. Boriosi's notes reveal that Ragen had several superficial lacerations on his forearms because he could not handle the stress. (
Ragen presented to an urgent care in early June, 2013 for complaints of shoulder pain. (Tr. 664). He was sent to the ER for labs, an EKG, and xrays and was informed to follow-up with his doctor at the Carbondale Family Health Center. (
Ragen had an electrocardiogram at Moses Taylor Hospital on June 13, 2013 that revealed normal sinus rhythm and prominent anterior forces. (Tr. 834). On that same day, Ragen was voluntarily admitted to Geisinger Community Medical Center because of severe depression, suicide attempt, and not being able to contract for safety. (Tr. 780). During hospitalization, diagnostic impression included bipolar disorder, mixed, hypertension, history of coronary artery disease, and severe, multiple social, financial, and interpersonal problems. (Tr. 781). Ragen received individual, group, milieu, activity, recreational and pharmacotherapy. (Tr. 776). He was discharged on June 17, 2013, with a principal diagnosis of bipolar disorder and advised to follow-up with treatment at NHS. (
Ragen had a follow-up visit with Carbondale Family Health Center on June 21, 2013. (Tr. 827). The medical notes show that he was doing well with the adjustment of his medications, that his shoulder no longer hurt, his blood pressure was stable, and that he did not have any suicidal or homicidal ideation. (
On December 18, 2013, Ragen was admitted to Wilkes-Barre Behavioral Hospital due to an overdose of an unknown amount of Ativan in order to stop the voices that were bothering him. (Tr. 842). Psychiatric evaluation notes state that Ragen had been banging his head to the wall to stop the voices which had command auditory hallucination asking him to hurt himself. (
Ragen had a follow-up visit at Carbondale Family Health Center for hypertension and coronary artery disease on January 6, 2014. (Tr. 793). The medical notes indicate that he has been doing well with physical therapy, his coronary artery disease had been stable and he was doing well with current medications, and reported no chest pain or dyspnea. (
Ragen was next seen on January 9, 2014 by Satish Mallik, M.D. of NHS. (Tr. 721). Dr. Mallik notes that Ragen feels that the medications Celexa, Risperdal, Trazodone, and Ativan are working and helping him but not all the way because he still struggles with sleep and anxiety. (
On a medication follow-up visit at NHS on April 16, 2014,
Ragen was again admitted to Geisinger Community Medical Center on June 18, 2014 due to a sudden onset of chest pain, retrosternal with radiation to the left arm. (Tr. 757). Ragen's condition stabilized and he was discharged on June 20, 2014, with discharge diagnoses of chest pain, hypertension, dyslipidemia, coronary artery disease, myocardial infarction, depression and bipolar I disorder. (Tr. 738).
On July 24, 2014, Ragen was seen at Carbondale Family Health Center for a requested visit. (Tr. 783). Medical notes show that Ragen has been very noncompliant with follow-up and routine labs. (
On January 26, 2013, Tiffany Griffiths, Psy.D, completed a medical source statement after conducting a psychological consultative examination. (Tr. 633, 640). Dr. Griffiths opined that Ragen had moderate limitations in carrying out short, simple instructions, and marked limitations in carrying out detailed instructions and making judgments on simple work-related decision. (
On July 11, 2013, Anne Zaydon, M.D., a State Agency medical consultant, reviewed Ragen's medical records and completed a physical residual functional capacity assessment. (Tr. 111-36). Dr. Zaydon opined that claimant is capable of occasionally lifting/carrying up to 50 pounds and frequently lifting/carrying up to 25 pounds. (Tr. 118, 131). Dr. Zaydon stated that Ragen could stand and/or walk for a total of 6 hours in an 8-hour workday and could sit for 6 hours in an 8-hour workday. (
On August 19, 2013, Melissa Diorio, Psy.D., a State Agency psychological consultant, reviewed Ragen's medical records and completed a mental residual functional capacity assessment. (Tr. 111-36). Dr. Diorio opined that Ragen is moderately limited in his ability to understand and remember detailed instructions. (Tr. 120, 133). As for Ragen's sustained concentration and persistence limitations, Dr. Diorio opined that he is moderately limited in his ability to: carry out detailed instructions; maintain attention and concentration for extended periods; make simple-work-related decision; and complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods. (
On September 25, 2013, David Yatsonsky, M.D., of Carbondale Family Health Center and Ragen's treating physician, completed a residual functional capacity assessment. (Tr. 696-97). Dr. Yatsonsky stated that Ragen has a diagnosis of coronary artery disease, hypertension, neck pain, back pain, depression, left knee pain, bipolar disease and radiculopathy. (Tr. 696). Dr. Yatsonsky opined that Ragen's symptoms associated with his impairments are severe enough to constantly interfere with his attention and concentration required to perform simple work-related tasks, and that he would need to recline or lie down in excess of the typical breaks in an 8-hour workday. (
Dr. Yatsonsky also opined that Ragen would need to take unscheduled breaks four to five times during an 8-hour workday for 20 minutes before returning to work. (
Satish Mallik, M.D. of NHS completed a mental capacity assessment on March 24, 2014. (Tr. 699-701). Dr. Mallik opined that Ragen has marked limitations in his ability to remember locations and work-like procedures and his ability to understand and remember detailed instructions. (Tr. 699). With regard to Ragen's sustained concentration and persistence, Dr. Mallik opined that he has moderate limitations in the ability to carry out very short and simple instructions; marked limitations in the ability to carry out detailed instructions; and extreme limitations in the ability to: maintain attention and concentration for extended periods; perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances; sustain an ordinary routine without special supervision; work in coordination with or in proximity to others without being distracted by them; complete a normal workday without interruptions from psychologically based symptoms; complete a normal workweek without interruptions form psychologically based symptoms; and perform at a consistent pace with a standard number and length of rest periods. (Tr. 699-700). In an average month, Dr. Mallik opined that Ragen would have four or more absences. (Tr. 700).
Dr. Mallik also provided that Ragen had extreme limitations in social interaction; marked limitations in the ability to respond appropriately to changes in the work setting and be aware of normal hazards and take appropriate precautions; and extreme limitations in his ability to travel in unfamiliar places or use public transportation and to set realistic goals or make plans independently of others. (Tr. 700-01). The ALJ assigned limited weight to Dr. Mallik's opinion, stating that it is "not well-supported by treatment history of [her] own records dated January 9, 2014 as no mental status examination was conducted." (Tr. 35).
On August 8, 2014, W. Lawrence Stepczak, M.D., of Carbondale Family Health Center, also completed a residual functional capacity assessment. (Tr. 703-05). Dr. Stepczak opined that Ragen's symptoms associated with his impairments are severe enough to frequently interfere with his attention and concentration required to perform simple work-related tasks, and that he would need to recline or lie down in excess of the typical breaks in an 8-hour workday. (Tr. 703). Dr. Stepczak stated that Ragen would only be able to walk one city block before needing to rest or having significant pain and that he could sit a total of five hours and stand/walk for a total of three hours during an 8-hour workday. (
In terms of a competitive work situation, Dr. Stepczak opined that Ragen could lift and carry less than 10 pounds frequently and 10 pounds frequently. (Tr. 704). As a result of Ragen's impairments or treatment, Dr. Stepczak opined that Ragen would be absent from work more than four times a month and that he is physically incapable of working an 8-hour day, five days a week on a sustained basis. (
Finally, while Guido Boriosi, M.D. of NHS did not complete a mental capacity assessment form, the ALJ assigned moderate weight to the GAF score of 55 that was contained within Dr. Boriosi's treatment records dated May 1, 2013. (Tr. 34).
The Court will initially address Ragen's argument that the ALJ failed to properly weigh the opinion evidence, as remand is necessary on this basis. We will further instruct that the Commissioner consider Ragen's other contentions on remand when re-evaluating the claims.
Ragen primarily argues that the ALJ erred in failing to accord greater weight to the opinion of his treating physicians, specifically, Dr. Yatsonsky, as well as failing to even address Dr. Griffiths' medical opinion. The Commissioner asserts that the ALJ provided sufficient reasons for discounting Dr. Yatsonsky's opinion, and that even if the ALJ erred in not weighing Dr. Griffiths' opinion, Dr. Diorio, the State Agency psychological consultant, reviewed Ragen's medical records which contained Dr. Griffiths' opinion.
The ALJ must consider all of the relevant evidence and give a clear explanation to support his or her findings when determining the RFC.
The Third Circuit "`has consistently held that it is improper for an ALJ to credit the testimony of a consulting physician who has not examined the claimant when such testimony conflicts with testimony of the claimant's treating physician[.]'"
The ALJ accorded limited weight to Dr. Yatsonky's opinion on the basis that his opinions are "rather extreme . . . [and] are not well-supported by the objective medical evidence, treatment history or clinical findings of record." (Tr. 33). Such limited discussion does not permit adequate review of the ALJ's findings. Such a conclusory statement may have sufficed had the ALJ discussed all of the relevant evidence. However, the ALJ omitted discussion of relevant evidence; for example, the ALJ did not discuss, or even reference, any of the physical therapy notes of therapist Michelle McGregor, to whom Ragen was referred to by his treating physician. Michelle McGregor's notes indicate Ragen has pain with mobility, decreased hip, left knee and ankle range of motion in his gait, decreased stance time, poor balance, and positive straight leg test on his left side and a positive femoral nerve tension on his left side. (Tr. 805). Moreover, the ALJ failed to address the consistency of Dr. Yatsonky's opinion with that of Ragen's other physician, Dr. Stepczak's opinion, setting forth almost identical limitations. (Tr. 703). Such relevant evidence may well have supported Dr. Yatsonky's conclusions, and certainly was not inconsistent with his findings and opinion. Without any discussion of this evidence, it cannot be determined "if significant probative evidence was not credited or simply ignored."
Additionally, the ALJ never acknowledged the medical opinion of Dr. Griffiths. This is contrary to the duty of the ALJ. An ALJ must acknowledge and weigh every medical opinion. 20 C.F.R. § 404.1527(c) ("[W]e will evaluate every medical opinion we receive.");
The Commissioner contends that the psychological record review by Dr. Diorio of the State Agency, explicitly considered Dr. Griffiths' report, and further, that the moving party bears the burden of showing that the ALJ's error in failing to acknowledge Dr. Griffiths' report would have changed the decision. This argument fails for a number of reasons. First, Dr. Griffiths' opinion is consistent with the mental medical opinion of Ragen's other treating physician, Dr. Mallik. Similar to Dr. Griffiths, Dr. Mallik opined that Ragen had marked limitations in understanding and memory, extreme limitations in sustained concentration and persistence, extreme limitations in social interaction, and marked to extreme limitations in adaptation. (Tr. 699-701). Despite this consistency with Ragen's treating physician, the ALJ credited the opinion of the non-examining, consulting physician, Dr. Diorio. However, "it is improper for an ALJ to credit the testimony of a consulting physician who has not examined the claimant when such testimony conflicts with the testimony of the claimant's treating physician."
Second, the Third Circuit has not upheld any instance, in any precedential opinion, in which an ALJ has assigned less than controlling weight to an opinion rendered by a treating physician based solely on one opinion from a non-treating, non-examining examiner who did not review a complete case record.
In the case at hand, Dr. Diorio's opinion was rendered on August 19, 2013. This was prior to Dr. Mallik's mental capacity assessment on March 24, 2014, and before a number of hospitalizations and psychiatric appointments occurred. Specifically, Dr. Diorio's opinion was rendered before Ragen was again hospitalized for an overdose of Ativan in order to stop the voices that were bothering him (Tr. 842). Hospital psychiatric evaluation notes provide that Ragen had been banging his head to the wall to stop the voices which had command auditory hallucination asking him to hurt himself. (
Accordingly, I have determined that the ALJ improperly afforded great weight to the opinion of the non-treating, non-examining physician, Dr. Diorio, in determining Ragen's mental health RFC, because Dr. Diorio issued her opinion before substantial evidence of the record occurred that showed a worsening of Ragen's mental health impairment. Therefore, remand on the foregoing bases are necessary. I decline to address Ragen's other allegation of error, as remand may produce a different result on these claims, making discussion of them moot.
Given the foregoing, we find that substantial evidence does not support the ALJ's assessment. Pursuant to 42 U.S.C. § 405(g), we will vacate the Commissioner of Social Security's decision and remand this case for further proceedings. An appropriate order follows.