PATRICIA A. SULLIVAN, Magistrate Judge.
With the achievement of sobriety after years of substance abuse, regular treatment with a psychiatrist and relatively better compliance with his psychiatric medication regime, Plaintiff Michael Henley's mental health has stabilized; nevertheless, he remains isolated in his home, burdened by chronic depression, nightmares, paranoia, occasional suicidality, poor coping skills and flares of anger triggered by what he perceives as frustration or disappointment. This matter is before the Court on his motion for reversal of the decision of the Commissioner of Social Security (the "Commissioner"), denying Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") under §§ 205(g) and 1631(c)(3) of the Social Security Act, 42 U.S.C. §§ 405(g), 1383(c)(3) (the "Act"). Plaintiff contends that the Administrative Law Judge ("ALJ") committed reversible error by giving inadequate weight to the opinion his longtime treating psychiatrist, Dr. Ruth Stemp. Defendant Carolyn W. Colvin ("Defendant") has filed a motion for an order affirming the Commissioner's decision.
This matter has been referred to me for preliminary review, findings and recommended disposition pursuant to 28 U.S.C. § 636(b)(1)(B). Having reviewed the record, I find that the ALJ's decision is tainted by error and that her findings are not supported by substantial evidence. Accordingly, I recommend that Plaintiff's Motion to Reverse the Decision of the Commissioner (ECF No. 9) be GRANTED and Defendant's Motion for Order Affirming the Decision of the Commissioner (ECF No. 12) be DENIED. I further recommend that the matter be REMANDED to the Commissioner for further proceedings consistent with this report and recommendation pursuant to Sentence Four of 42 U.S.C. § 405(g), and final judgment should enter in favor of Plaintiff.
These applications for DIB and SSI are Plaintiff's second set; on January 5, 2009, he applied alleging disability based on depression and right knee and shoulder problems. Tr. 74. On May 18, 2011, an ALJ found that, although his mental impairments met the criteria for two Listings, he was not disabled under the Act based on the materiality of substance abuse. Tr. 84. The current applications were filed on May 31, 2011, alleging disability beginning the day following the first denial based on depression, glaucoma and problems with his right knee and right shoulder. Tr. 237, 241. By contrast with the first applications, the medical record for the second set establishes that Plaintiff had achieved sobriety prior to the alleged disability onset date (May 19, 2011) so that substance abuse is no longer a material contributor. Tr. 115, 131.
A high school graduate who completed one year of college, Tr. 241, Plaintiff was forty-four years old on the date of onset of the current period of disability. Tr. 208. Prior to 2007, he had worked for telemarketing firms and as an order picker; he was promoted to manager in the last years that he worked, with responsibility for hiring and firing. Tr. 49, 241-42. Until her death in late 2004, he lived with his wife and cared for his children from a prior marriage. His wife's death from cancer had a devastating emotional impact on Plaintiff; "when my wife died, my whole foundation broke down. I lost everything in that." Tr. 56. Within less than two years, he had stopped working, placed his children in the care of his own mother, lived alone and was engaged in serious substance abuse, although the prior record also suggests that the drug abuse was longstanding and that Plaintiff may have stopped work because of an on-the-job charge of embezzlement. Tr. 55, 78, 81. By 2011, he had stopped using illegal substances, relying instead on prescribed medication to control his symptoms of hearing voices, suicidal ideation, depressed mood, anxiety and anger, but still living an isolated life with persistent depression and anxiety, punctuated by feelings of anger towards other people and occasional suicidality. Tr. 314, 319. The record reflects that his mental status fluctuated; when he was feeling better, he enjoyed interacting with his children and saw his mother, but he also experienced periods of anger and seriously depressed mood when faced with disappointment. Tr. 314. For example, after he learned of the denial of his SSI/DIB applications in May 2011, he was consumed with disappointment and anger. At a therapy appointment a month later, he admitted to suicidal thoughts, bolted from the Providence Center where he had gone for treatment and required several days of active monitoring before his therapist opined that he was beginning to feel better and would contract not to harm himself. Tr. 318-22.
Throughout the period of alleged disability, Plaintiff regularly received mental health treatment from his psychiatrist, Dr. Ruth Stemp, at the Providence Center, as well as counseling (until he became angry with her and stopped coming) from a Providence Center therapist, Courtney Bedard. In his own words, he explained why he cannot work
Tr. 47-48. Despite these struggles, the record also establishes that Plaintiff is able to use public transportation, make simple meals, shop for food and had never been fired because of his inability to get along with other people. Tr. 50-51, 262-65. Moreover, while Plaintiff testified to repeated altercations with other tenants in his building during the period of alleged disability and with coworkers while he was employed, Tr. 61 ("The people — I hate them"), the record has no reference to any legal difficulties resulting from these episodes.
The current applications allege disability based on depression, as well as right knee and shoulder pain and glaucoma. For this appeal, Plaintiff has abandoned his somatic impairments, alleging only that the ALJ erred in rejecting his claim based on his mental health impairments.
Plaintiff's treating relationship with his psychiatrist, Dr. Stemp, and her team at the Providence Center began well before the alleged date of onset with respect to these applications. In connection with this treatment, Dr. Stemp, together with the other providers on the team, regularly (as reflected in the record, approximately every six months) updated Plaintiff's treatment plan; the earliest post-onset plan, dated July 2011, reflects diagnoses of bipolar disorder NOS, major depressive disorder, recurrent episode moderate, post-traumatic stress disorder ("PTSD") and cocaine abuse. Dr. Stemp consistently assessed Plaintiff's GAF score as 50,
The relevant treating history begins on March 21, 2011, two months prior to onset, when Plaintiff saw his therapist, Ms. Bedard, and told her that he had missed his last appointment due to depression and feelings of "going downhill," after running out of medication and getting it from friends; she noted, "[c]lient seems to go through periods where he isolates, does not reach out for help with meds, etc. does not attend appointments and is noncompliant with meds." Tr. 344-45. Plaintiff saw Dr. Stemp the next day; she found him anxious, depressed, slightly irritable and guarded, though there were no delusions or suicidal or homicidal ideation. Tr. 312. At the April appointment with Dr. Stemp, Plaintiff was taking his medication as directed; while he remained isolated and his hygiene was only fair, his mood was improved, "more stable, fewer and less intense up and down," and he was visiting family "a lot." Tr. 314. Plaintiff denied suicidal ideation and hallucinations.
On June 24, 2011, Plaintiff appeared for an appointment with Ms. Bedard, still reacting to learning of the denial of SSI benefits over a month before. Tr. 318. He refused to talk except to express disappointment, anger and hopelessness "he feels so bad, at least he felt better when he was using [drugs]." Tr. 318. More importantly, he reported recent suicidal ideation and refused to contract for safety — in speaking of his suicidal thoughts, he told the therapist that, "with his luck, he would end up jumping off a bridge and becoming a paraplegic and stuck in a wheel chair." Tr. 318-19. Ms. Bedard walked him to Dr. Stemp's office, but when Plaintiff heard them speaking of sending him to the hospital, he ran. Tr. 319. Concerned about his safety, Ms. Bedard repeatedly called him, as well as the manager of his apartment building to arrange for a police wellness check, to no avail. According to Dr. Stemp, for several days, the Providence Center was concerned that he "[m]ay pose a suicide risk as he would not contract for safety." Tr. 320. After three days of calling, resulting in brief conversations, Ms. Bedard noted that Plaintiff had stayed with an aunt and was then with his mother; by the end of the weekend, Ms. Bedard observed that his mood had become more stable. Tr. 322-24.
At his next appointment, on July 12, 2011, Ms. Bedard found Plaintiff's affect constricted, his mood depressed and irritable, and his speech pressured; although he denied current suicidal ideation, she noted that, "he continues to struggle with this." Tr. 325. She reviewed his pre-crisis plan, including how to reach out to staff or to the hospital if he needed help.
At the August 5, 2011, appointment with Dr. Stemp, Plaintiff reported that he was taking his medication as directed with a minor exception; he denied side effects. Tr. 331. He told her that he "mostly stays inside his apartment . . . does his housework and talks to his Mom sometimes, otherwise is isolative." Tr. 331. On examination, Dr. Stemp observed that he was guarded and minimally talkative, his mood was depressed and anxious, though his thoughts were organized, and he denied delusions, hallucinations and suicidal ideation.
In September 2011, Plaintiff told Dr. Stemp that he was taking his medications as directed, but that bed bugs in his building were causing him "a lot of stress," that he does not like his building and the people there and that stress is adversely affecting his sleep. Tr. 351. On examination, Dr. Stemp observed that Plaintiff was feeling a "global sense of paranoia about others," and was very anxious with dysphoric and slightly irritable mood, although his thoughts were organized, he denied hearing voices, suicidal ideation and hallucinations and said he felt good on his current medication.
As reflected in the record, Plaintiff's last appointment with Ms. Bedard was on December 1, 2011. Tr. 360-61. When she tried to check on his mood, he did not talk too much. Tr. 361. She noted, "[b]aseline depressed and frustrated," but also that he wanted to find out about courses he could take for part-time work. Tr. 361. Not reflected in these notes, but described by Plaintiff at the hearing, Tr. 51-53, was an incident during which he became "really frustrated and. . . mad" with Ms. Bedard because he perceived she was not doing things he wanted her to do; he refused to continue to see her. As a result, in the next treatment plan, Plaintiff was shifted to "MD only status." Tr. 365-66.
At his February 2012, appointment with Dr. Stemp, Plaintiff reported that he had been largely compliant in taking medication, though he also described "chronic long standing moodiness and discomfort around others . . . he does not like people," as well as "chronic distrust and fear of others." Tr. 362. He said that he spent his time going for walks and visiting with his mother or son.
In April 2012, Plaintiff told Dr. Stemp that he had stopped Lexapro for a week because it was making him vomit, though he was taking all other medications, and that his best friend had died three days before; she found him more depressed and irritable, very sad, "[r]eport[ing] chronic dislike of people and stays mostly in his room," although he enjoyed a recent visit with his children. Tr. 364. Two months later, Plaintiff stated that he had run out of Lexapro the previous month; although he was compliant with other medications, his moods had been up and down and he was more irritable and anxious. Tr. 369. During the appointment, he said "he mostly stays in his apartment and isolates as he has trouble being around other people."
On June 17, 2011, state agency reviewing psychologist JoAnne Coyle, Ph.D., reviewed Plaintiff's records as of that date and completed a Mental Residual Functional Capacity ("RFC")
Dr. Stemp signed her treating source opinion on August 23, 2011. Tr. 335. In it, she agreed with the state agency opinion with respect to the lack of materiality of substance abuse. She opined that Plaintiff suffers from recurrent major depression, bipolar disorder and PTSD, causing an array of disabling impairments "chronic severe paranoia, depression, volatility, low stress tolerance, poor coping skill, suicidal thoughts, anger attacks, mood instability." Tr. 337. Her RFC assessed severe limits in his ability to relate to other people including supervisors and coworkers, and to respond to customary work pressures, including with respect to the ability to perform even simple tasks. Tr. 335-36. Based on these findings, she concluded that Plaintiff would be unable to work full time. Tr. 337.
A second state agency reviewing psychologist, J. Stephen Clifford, Ph.D., agreed with the moderate limitations set out in Dr. Coyle's opinion; his mental RFC assessment was signed on October 5, 2011. Tr. 132-34.
Plaintiff filed his applications for DIB and SSI on May 31, 2011, alleging that he became disabled on May 19, 2011. Tr. 208-09, 212-20. Plaintiff's applications were denied initially, Tr. 153-56, and on reconsideration, Tr. 163-68, and he requested a hearing before an ALJ. Tr. 169. On October 3, 2012, the ALJ held a hearing at which Plaintiff, who was represented by counsel, and a vocational expert appeared and testified. Tr. 41-70. On October 15, 2012, the ALJ issued a decision finding that Plaintiff was not disabled from May 19, 2011, through the date of the decision. Tr. 23-36. The Appeals Council denied Plaintiff's request for review, Tr. 4-7, rendering the ALJ's decision the final decision of the Commissioner. Plaintiff timely filed this action.
At his October 3, 2012, hearing, Plaintiff testified about his difficulties with coworkers while he was working ("I'd probably get into a frenzy state"), with his therapist at the Providence Center ("it just got really frustrating"), and with other tenants in his building ("I hate them"). Tr. 48, 53, 61. He explained that he prefers to stay in the house and goes to see his mother only because she gets concerned and will come to check on him if he does not go to see her; his son lives with his mother because "I'm not well enough to take care of him." Tr. 54-55. Plaintiff was candid that he did not have any difficulties with bathing or dressing, he can take the bus, prepare meals, do shopping and laundry and has a few friends, though he seldom visits them or goes anywhere with them. Tr. 50-51, 53, 54, 62. When asked how he gets along with other people, Plaintiff stated, "I try to avoid people the most I can. . . . I can put the mask on, but it's not me. It doesn't work. It doesn't work, because then the mask falls off, the mask melts, and then I just get angry." Tr. 61.
The ALJ issued her decision under the familiar five-step sequential evaluation process. At Step One, she found that Plaintiff had not engaged in substantial gainful activity since May 19, 2011, his alleged onset date. Tr. 28. At Steps Two and Three, the ALJ found that Plaintiff's major depressive disorder and post-traumatic stress disorder were severe impairments, but they did not meet or medically equal the requirements of the Listing of Impairments. Tr. 28-30. The ALJ's RFC determination was based on her conclusion that Plaintiff could perform a full range of work at all exertional levels, but with certain non-exertional limitations, including a moderate limitation in concentration, persistence and pace such that he could understand, remember and carry out simple tasks; and a moderate limitation in social interactions, limiting him to object-oriented tasks with only occasional work-related interactions with supervisors, coworkers and the general public. Tr. 31. At Step Four, the ALJ found that Plaintiff not only could perform his past relevant work but also that he could do other jobs, such as janitor, assembler or jewelry painter. Tr. 34-36. Accordingly, the ALJ concluded that Plaintiff was not disabled from May 19, 2011, through the date of her decision. Tr. 36.
Plaintiff's motion for reversal rests on one argument — that the ALJ gave inadequate weight to the opinion of Plaintiff's treating psychiatrist, Dr. Ruth Stemp.
The Commissioner's findings of fact are conclusive if supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is more than a scintilla — that is, the evidence must do more than merely create a suspicion of the existence of a fact, and must include such relevant evidence as a reasonable person would accept as adequate to support the conclusion.
The determination of substantiality is based upon an evaluation of the record as a whole.
The Court must reverse the ALJ's decision on plenary review, if the ALJ applies incorrect law, or if the ALJ fails to provide the Court with sufficient reasoning to determine that the law was applied properly.
The Court may remand a case to the Commissioner for a rehearing under Sentence Four of 42 U.S.C. § 405(g); under Sentence Six of 42 U.S.C. § 405(g); or under both sentences.
To remand under Sentence Four, the Court must either find that the Commissioner's decision is not supported by substantial evidence, or that the Commissioner incorrectly applied the law relevant to the disability claim.
In contrast, Sentence Six of 42 U.S.C. § 405(g) provides
incorporate such evidence into the record in a prior proceeding. 42 U.S.C. § 405(g). To remand under Sentence Six, the claimant must establish (1) that there is new, non-cumulative evidence; (2) that the evidence is material, relevant and probative so that there is a reasonable possibility that it would change the administrative result; and (3) there is good cause for failure to submit the evidence at the administrative level.
With a Sentence Six remand, the parties must return to the Court after remand to file modified findings of fact.
The law defines disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months. 42 U.S.C. § 416(I); 20 C.F.R. § 404.1505. The impairment must be severe, making the claimant unable to do previous work, or any other substantial gainful activity which exists in the national economy. 42 U.S.C. § 423(d)(2); 20 C.F.R. §§ 404.1505-1511.
Substantial weight should be given to the opinion, diagnosis and medical evidence of a treating physician unless there are good reasons to do otherwise.
Where a treating physician has merely made conclusory statements, the ALJ may afford them such weight as is supported by clinical or laboratory findings and other consistent evidence of a claimant's impairments.
A treating source who is not a licensed physician or psychologist
The ALJ is required to review all of the medical findings and other evidence that support a medical source's statement that a claimant is disabled. However, the ALJ is responsible for making the ultimate determination about whether a claimant meets the statutory definition of disability. 20 C.F.R. § 404.1527(d). The ALJ is not required to give any special significance to the status of a physician as treating or non-treating in weighing an opinion on whether the claimant meets a listed impairment, a claimant's residual functional capacity ("RFC"),
The ALJ must follow five steps in evaluating a claim of disability.
In determining whether a claimant's physical and mental impairments are sufficiently severe, the ALJ must consider the combined effect of all of the claimant's impairments and must consider any medically severe combination of impairments throughout the disability determination process. 42 U.S.C. § 423(d)(2)(B). Accordingly, the ALJ must make specific and well-articulated findings as to the effect of a combination of impairments when determining whether an individual is disabled.
The evaluation of a claim of disability based on mental illness requires use of a psychiatric review technique that assesses impairment in four work-related functions (1) activities of daily living; (2) social functioning; (3) concentration, persistence or pace; and (4) episodes of decompensation. 20 C.F.R. § 404.1520a(c)(3). The review technique is used to rate the severity of mental impairments at Steps Two and Three of the sequential evaluation process, and also serves as the backdrop for the more detailed mental RFC assessment at Step Four.
Plaintiff challenges the ALJ's decision to afford limited probative weight to the opinion of his well-qualified treating psychiatrist — Dr. Stemp — who has had a longitudinal treating relationship with him, grounded in regular and substantial face-to-face appointments and phone contact, beginning prior to and continuing over the course of the entire period of disability. Importantly, the rejected opinion is consistent with Dr. Stemp's treating records, which reflect objective medical findings made at each of the nine appointments reflected in the record. In her opinion, Dr. Stemp recorded severe limitations in his ability to relate to other people and to respond to customary work pressures, including the ability to perform even simple tasks, compelling a determination of disability. The ALJ relied instead on two state agency psychologists whose opinions were principally based on their review of Dr. Stemp's records, as well as the more limited records of the treating therapist, Ms. Bedard. The agency psychologists interpreted these treating records as establishing only moderate limitations in Plaintiff's ability to relate to other people and to complete a normal workday, compelling a determination of no disability. Plaintiff contends that the ALJ erred in rejecting the opinion of his treating psychiatrist. The issue is wrinkled by the therapist, Ms. Bedard, who worked closely with and under the supervision of Dr. Stemp, and whose notes are mostly consistent with those of Dr. Stemp, but who never recorded an observation of one of the serious impairments (paranoia) noted by Dr. Stemp.
The starting point for the analysis is the applicable regulations, which set out the factors to be utilized in evaluating the weight to be afforded to a treating source opinion. 20 C.F.R. § 404.1527(c). They are (1) the "[l]ength of the treatment relationship and the frequency of examination," 20 C.F.R. § 404.1527(c)(2)(i); (2) the "[n]ature and extent of the treatment relationship," 20 C.F.R. § 404.1527(c)(2)(ii); (3) the supportability of the opinion, 20 C.F.R. § 404.1527(c)(3); (4) the consistency of the opinion "with the record as a whole," 20 C.F.R. § 404.1527(c)(4); (5) the specialization of the source, 20 C.F.R. § 404.1527(c)(5); and (6) "[o]ther factors," 20 C.F.R. § 404.1527(c)(6).
To shore up the ALJ's decision, the Commissioner points to authority holding that, when the treating physician's opinion is inconsistent with other evidence in the record, the conflict is to be resolved by the Commissioner and not the courts.
The foundation for the ALJ's rejection of Dr. Stemp's opinion is the finding that it is "not supported by or consistent with the evidence of record and treatment records." Tr. 33. In drawing this conclusion, the ALJ began with her conclusion that Dr. Stemp's opinion reference to "chronic severe paranoia" lacks record support. This is not accurate — for example, while the ALJ correctly pointed out that Plaintiff described himself feeling only "a little paranoid," during the same appointment, Dr. Stemp's mental status examination resulted in the observation that Plaintiff was feeling a "global sense paranoia about others," while at the next appointment, she observed, "chronic distrust and fears of others." Tr. 351, 362;
Next, the ALJ concluded that the record references to "no suicidal/homicidal ideation" at most of his appointments clashes with Dr. Stemp's opinion that one of Plaintiff's impairments is "suicidal thoughts." Tr. 337. This is also not accurate. For example, on June 24, 2011, Dr. Stemp's notes state, "pt. very upset by not getting SSI, May pose a suicide risk as he would not contract for safety with his therapist." Tr. 320. Ms. Bedard wrote about the same incident, noting that "staff concerned that client is not safe." Tr. 319. The record reflects that Ms. Bedard spent a weekend repeatedly trying to call Plaintiff to ensure his safety. Tr. 321-23. Even at an appointment when Ms. Bedard assessed Plaintiff as "stable" and "in a better mood," she also noted that, although "[n]o current SI, no plan no intent," yet "client says he continues to struggle with this," and she went over his "pre crisis plan" including how to reach out to staff, emergency services or the hospital if he "felt like he was in crisis. Tr. 325-26.
The ALJ also wrongly concluded that Dr. Stemp's opinion is inconsistent with record evidence in that, "[i]t was repeatedly stated . . . there were no significant abnormalities in mental status." Tr. 33. The basis for this assertion is unclear — Dr. Stemp performed mental status examinations at every face-to-face appointment and she recorded many abnormalities. For example, even during appointments when he was taking medication as directed, which seemed to control his extreme symptoms, she consistently made such observations as "very anxious, mood dysphoric . . . [p]t. expressing global sense of paranoia about others," Tr. 351, "[h]ygiene is fair. Pt. is baseline guarded, minimally talkative. Mood is depressed. Pt. is anxious, slightly irritable." Tr. 331;
Similarly, the ALJ incorrectly seized on an isolated instance when Ms. Bedard noted that Plaintiff's mood had improved, ignoring that his volatility — "good days and bad days" — was part of his illness and that such an improvement was followed at the very next appointment by Dr. Stemp's assessment that "Condition Worsened." Tr. 351. A similar error infects the ALJ's reliance on occasional record references to "stable" or "euthymic" — for example, Ms. Bedard used the term "stable"
Of the ALJ's litany of reasons for affording "limited probative weight" to Dr. Stemp's opinion, the only one that survives scrutiny, in that it appears to be accurately grounded in the record, is the discrepancy between Dr. Stemp's opinion that Plaintiff suffers from the disabling impairment of "chronic severe paranoia," Tr. 337, and the failure of the therapist, Ms. Bedard, to check off "paranoia" as an observation at the five appointments during which she recorded such observations. Tr. 325, 329, 332, 354, 360. The first step in determining whether this discrepancy is sufficient to justify the ALJ's decision to completely reject Dr. Stemp's opinion requires this Court to determine whether Ms. Bedard's notes constitute "substantial evidence" on this point. Given that this therapist is a non-acceptable medical source not qualified to diagnose the impairment of paranoia, towards whom Defendant expressed such distrust (one might say paranoia) that he refused to continue counseling with her, it seems an impermissible stretch, likely amounting to error, to find that Ms. Bedard's failure to check "paranoia" is substantial evidence that Plaintiff was not impaired by paranoia, in contradiction to Dr. Stemp's opinion.
However, it is not necessary to wrangle with whether Ms. Bedard's failure to record observations of paranoia amounts to "substantial evidence." Even if this Court were to assume that it is "substantial evidence," the ALJ's reliance on it as the sole basis for rejecting Dr. Stemp and relying instead on the agency psychologists is a leap of reasoning that ignores the analytical framework mandated by SSR 96-2p, which makes clear that, even with substantial inconsistent evidence, "[t]reating source medical opinions are still entitled to deference and must be weighed using all of the factors" and that, "[i]n many cases, a treating source's medical opinion will be entitled to the greatest weight and should be adopted, even if it does not meet the test for controlling weight." 1996 WL 374188, at *4. At bottom, the ALJ's failure to perform this analysis requires that this matter be remanded for further consideration.
In sum, Dr. Stemp recorded Plaintiff's isolative behavior due to his dislike and distrust of others; she observed Plaintiff during an episode of overt suicidality; she noted his inability to regulate his emotions when exposed to stress; she referred frequently to the chronic nature of his condition, including the lack of further improvement even when he was in compliance with treatment protocols and his substance abuse was in remission. Presented with such a treating opinion, from an acceptable medical source, well supported by clinical diagnostic techniques and observations and in sync with treating notes, I am constrained to find that the ALJ erred in affording it "limited probative weight." Tr. 33. Accordingly, I recommend that this Court remand the matter for a do-over on the weight to be afforded to Dr. Stemp's opinion.
I recommend that Plaintiff's Motion to Reverse the Decision of the Commissioner (ECF No. 9) be GRANTED and Defendant's Motion for Order Affirming the Decision of the Commissioner (ECF No. 12) be DENIED. The matter should be REMANDED to the Commissioner for further proceedings consistent with this report and recommendation pursuant to Sentence Four of 42 U.S.C. § 405(g), and final judgment should enter in favor of Plaintiff. Any objection to this report and recommendation must be specific and must be served and filed with the Clerk of the Court within fourteen (14) days after its service on the objecting party.
