Bruce v. Berryhill
Bruce v. Berryhill
Opinion of the Court
AND NOW, this 14th day of February, 2018, upon consideration of Plaintiff's Brief and Statement of Issues in Support of Request for Review, defendant's Response to Request for Review of Plaintiff, and plaintiff's reply thereto, and after review of the Report and Recommendation of *349United States Magistrate Judge Thomas J. Rueter, it is hereby
ORDERED
1. The Report and Recommendation is APPROVEDand ADOPTED.
2. Plaintiff's Request for Review is GRANTED, and the decision of the Commissioner of the Social Security Administration is REVERSEDto the extent that the matter is REMANDEDto the Commissioner under sentence four of
3. Judgment is entered in favor of plaintiff, reversing the decision of the Commissioner for the purpose of this remand only.
REPORT AND RECOMMENDATION
THOMAS J. RUETER, United States Magistrate Judge
Plaintiff, Thomas Bruce, filed this action pursuant to
Plaintiff filed a Brief and Statement of Issues in Support of Request for Review ("Pl.'s Br."), defendant filed a Response to Plaintiff's Request for Review ("Def.'s Br.") and plaintiff filed a reply thereto ("Pl.'s Reply"). For the reasons set forth below, this court recommends that plaintiff's Request for Review be GRANTED .
I. FACTUAL AND PROCEDURAL HISTORY
In July 2012, plaintiff filed applications for SSI and disability insurance benefits ("DIB") under Title II of the Act alleging disability beginning March 3, 1997. (R. 173-86.) The claims were denied initially and a request for a hearing was filed timely. (R. 109-20.) A hearing was held on March 12, 2014, before Administrative Law Judge ("ALJ") Frederick Timm. (R. 35-67.) Plaintiff, who was represented by counsel, appeared and testified. Steven H. Gumerman, Ph.D., a vocational expert ("VE"), also appeared and testified. (R. 62-66.) In a decision dated June 10, 2014, the ALJ found that plaintiff was not disabled under the Act. (R. 16-34.) Plaintiff filed a request for review of the decision of the ALJ that was denied and the ALJ's decision became the final decision of the Commissioner. (R. 1-15.)
In October 2014, plaintiff sought judicial review of the ALJ's decision pursuant to
By Order dated March 11, 2016, the Report and Recommendation was approved and adopted and the matter was remanded for further evaluation. (R. 1615.) On October 9, 2015, the Appeals Council remanded the claim to an ALJ for "further proceedings consistent with the order of the court." (R. 1616-19.)
The court notes that plaintiff filed subsequent applications for DIB and SSI on December 16, 2014. See R. 1793-1816. Upon review of these applications in January 2015, plaintiff was awarded SSI benefits at the initial level. See R. 1622-29. Plaintiff was found to be disabled as of December 16, 2014.
Pursuant to the Appeals Council remand order on the present applications for benefits, a second hearing was held before ALJ Timm on October 31, 2016. (R. 1534-63.) Plaintiff, represented by counsel, appeared and testified, as did VE Christine Slusarski. In a decision dated March 6, 2017, the ALJ found that plaintiff was not disabled under the Act. (R. 1508-33.) The ALJ made the following findings:
1. The claimant met the insured status requirements of the Social Security Act through June 30, 2006.
2. A decision is deferred as to whether the claimant engaged in substantial gainful activity from March 3, 1997, the alleged onset date, through December 15, 2014, the day prior to the date that the claimant was found disabled in the subsequent favorable determination issued on January 22, 2015 ( 20 CFR, 404.1520(b), 404.1571 et seq., 416.920(b) and 416.971 et seq. ).
3. From March 3, 1997, through December 15, 2014, the claimant had the following severe impairments: mild-to-moderate osteoarthritis of the left ankle status post fracture and open reduction internal fixation ; mild degenerative disc disease of the lumbar spine status post fusion; dilated aortic root/hypertension ; obstructive sleep apnea (OSA); asthma ; and major depressive disorder (MDD); and polysubstance dependence in partial remission ( 20 CFR 404.1520(c) and 416.920(c) ).
4. From March 3, 1997, through December 15, 2014, the claimant's impairments, including the substance use disorder, meet section 12.04 (Depressive, bipolar and related disorders) of 20 CFR Part 404, Subpart P, Appendix 1 ( 20 CFR 404.1520(d) and 416.920(d) ).
5. From March 3, 1997, through December 15, 2014, if the claimant stopped the substance use, the remaining *351limitations would cause more than a minimal impact on the claimant's ability to perform basic work activities; therefore, the claimant would continue to have a severe impairment or combination of impairments.
6. From March 3, 1997, through December 15, 2014, if the claimant stopped the substance use, the claimant would not have an impairment or combination of impairments that meets or medically equals any of the impairments listed in 20 CFR Part 404, Subpart P, Appendix 1 ( 20 CFR 404.1520(d) and 416.920(d) ).
7. From March 3, 1997, through December 15, 2014, if the claimant stopped the substance use, the claimant would have the residual functional capacity to perform light work as defined in 20 CFR 404.1567(b) and 416.967(b) except: cannot operate foot controls with one lower extremity; must never climb ladders, ropes, or scaffolds; can perform the other postural maneuvers on occasion; and must avoid concentrated exposure to extreme cold, extreme heat, wetness, humidity, and environmental irritants. From a mental standpoint the claimant is limited to unskilled tasks that are goal-oriented rather than production-paced; no significant interaction with the general public; no more than occasional interaction with supervisors and co-workers; and requires a stable workplace, defined as involving few if any changes of setting, processes, and tools.
8. The claimant has no past relevant work ( 20 CFR 404.1565 and 416.965 ).
9. The claimant was born on March 16, 1962 and was 34 years old, which is defined as a younger individual age 18-49, on the alleged disability onset date ( 20 CFR 404.1563 and 416.963 ). On March 15, 2012, the claimant's age category changed to an individual closely approaching advanced age ( 20 CFR 404.1563 and 416.963 ).
10. The claimant has at least a high school education and is able to communicate in English ( 20 CFR 404.1564 and 416.964 ).
11. Transferability of job skills is not an issue because the claimant does not have past relevant work ( 20 CFR 404.1568 and 416.968 ).
12. From March 3, 1997, through December 15, 2014, if the claimant stopped the substance use, considering the claimant's age, education, work experience, and residual functional capacity, there would be a significant number of jobs in the national economy that the claimant could perform ( 20 CFR 404.1560(c), 404.1566, 416.960(c), and 416.966 ).
13. With respect to the period from March 3, 1997, through December 15, 2014, the substance use disorder is a contributing factor material to the determination of disability because the claimant would not be disabled if he stopped the substance use ( 20 CFR 404.1520(g), 404.1535, 416.920(g) and 416.935 ). Because the substance use disorder is a contributing factor material to the determination of disability, the claimant has not been disabled within the meaning of the Social Security Act at any time from March 3, 1997, the alleged onset date, through December 15, 2014, the day prior to the date that the claimant was found disabled in the *352subsequent favorable determination issued on January 22, 2015.
(R. 1514-26.)
Plaintiff did not file a request for review with the Appeals Council, see Def.'s Br. at 3, making the ALJ's decision the final decision of the Commissioner. Plaintiff now seeks judicial review of the ALJ's decision pursuant to
When remanding the present case for further review, the Appeals Council stated that it neither affirmed nor reopened the State agency award of benefits on plaintiff's subsequent application, and directed that the period for review before the ALJ was limited to the period prior to December 16, 2014. See R. 1512, 1618. In his decision, the ALJ addressed plaintiff's subsequent, successful SSI claim as follows:
In that more than two years have passed since the State agency issued a favorable determination on January 22, 2015, finding the claimant disabled beginning December 16, 2014, based on the subsequent claim for Title XVI disability benefits filed on December 16, 2014, and there is no evidence of fraud or similar fault, the undersigned Administrative Law Judge will not reopen this favorable determination ( 20 CFR 416.1487 and 416.1488 ). The claimant is alleging disability since March 3, 1997. As a result, this decision is limited to the closed period from March 3, 1997, the alleged onset date, through December 15, 2014, the day prior to the date that the claimant was found disabled in the favorable determination issued on January 22, 2015.
(R. 1512.)
II. STANDARD OF REVIEW
The role of this court on judicial review is to determine whether there is substantial evidence in the record to support the Commissioner's decision. Hagans v. Comm'r of Soc. Sec.,
To be eligible for benefits, the claimant must demonstrate an "inability to engage in any substantial gainful activity by reason *353of 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 12 months." 42 U.S.C. § 1382c(a)(3)(A). Specifically, the impairments must be such that the claimant "is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy." 42 U.S.C. § 1382c(a)(3)(B). Under the Act, the claimant has the burden of proving the existence of a disability and must furnish medical evidence indicating the severity of the impairment.
The Social Security Administration employs a five-part procedure to determine whether an individual has met this burden.
III. BACKGROUND
At the administrative hearing on October 31, 2016, the ALJ noted that the evidence from the prior administrative hearing remained of record for his consideration. (R. 1537.) As such, the ALJ sought "updated testimony" from plaintiff. (R. 1538.)
At the time of the October 2016 administrative hearing, plaintiff had been living in an apartment in Wayne, Pennsylvania with a friend for the past three to four months. (R. 1547.) Prior to that time, plaintiff rented a room in a friend's home and also lived with his sister for a time. (R. 1548.) Plaintiff has two children; he had not seen them in person "in a little bit" but he paid child support. (R. 1551-52.) In the past, plaintiff helped his brother perform "odd jobs," but plaintiff indicated that he does not have the necessary energy to perform work. (R. 1552.) Plaintiff does not have a driver's license. (R. 1553.)
With respect to his mental impairments, plaintiff explained that since the date of the first administrative hearing, his major depressive disorder and anxiety disorder have remained "about the same."
*354(R. 1539.) Plaintiff is also prescribed medication for pain. (R. 1543.)
With respect to social interactions, plaintiff stated that his relationship with his older sister and mother had "improved a little bit" because they now "understand [more] what [plaintiff is] going through." (R. 1540.) However, plaintiff explained such improvement pertained only to his relationship with his older sister and mother because plaintiff has "no friends that [he goes] out with or talk[s] to."
Plaintiff stated that he had not used substances "for at least the last six months" and that he "had a beer or two."
With respect to his physical abilities, plaintiff had spinal fusion surgery in 2000. (R. 1541-42.) He continues to have pain in his left leg due to a herniated disc that caused nerve damage. (R. 1542.) In 2006, plaintiff broke his ankle; to repair the break, surgeons inserted five screws and a plate.
With respect to the vocational testimony, the ALJ first indicated that he would "rely on Dr. Gumerman's testimony [from the first administrative hearing] that there was past work here as a Sheer Operator and a Handheld Crane Operator, and that these were heavy and medium, respectively, with no transferable skills to sedentary exertion." (R. 1555.) The ALJ then stated that he would pose hypothetical questions to VE Slusarski about other work that the hypothetical individual could perform.
The RFC I reached previously was for light exertion, generally, no foot controls with one lower extremity, meaning the left lower extremity, not that, I don't think it matters, but-never to climb ladder, rope, scaffold. The remaining postural exertion and the remaining postural maneuvers occasional. Needing to *355avoid concentrated exposure to extreme cold, extreme heat, wetness, humidity and environmental irritants.
And then in the mental domain, limited to unskilled tasks, to goal oriented, rather than production paced tasks, no significant interaction with the general public, no more than occasional interaction with supervisors and coworkers, and requiring stable work place, meaning few if any changes of setting, processes and tools.
(R. 1555-56.) Plaintiff's counsel then questioned the ALJ whether the use of the RFC and hypothetical questions fashioned at the first administrative hearing would be in contravention of the court's remand directive. See R. 1556-57. In response, the ALJ indicated that he would "again consider all hypotheticals presented, both by myself in the previous hearing, by you on cross-examination to Dr. Gumerman. And now I'm going to present an additional hypothetical to Ms. Slusarski." (R. 1557.) The ALJ then asked the VE to consider what impact, if any, a "reduction to standing and walking three to four hours of the eight-hour work day" would have on the light occupations of sorter, packer and laundry worker. (R. 1558.) VE Slusarski opined that such reduction would not eliminate the identified occupations.
All right. So do you have any questions for Ms. Slusarski? I, essentially, am going to rely on Dr. Gumerman's testimony. Because on further review, I think it really did cover all of the relevant hypothetical limitations.
(R. 1562.)
IV. DISCUSSION
The Social Security Act was amended in 1996 to preclude an award of benefits if drug addiction or alcoholism ("DAA") would be "a contributing factor material to the Commissioner's determination that the individual is disabled." See 42 U.S.C. § 1382c(a)(3)(J). The Commissioner's regulations provide that if a claimant is found disabled and the record contains medical evidence of DAA, the ALJ must determine whether DAA is a contributing factor material to the determination of disability.
On remand, the ALJ in the case at bar evaluated plaintiff's claim, considering whether substance use is a contributing factor material to the determination of disability. In so doing, the ALJ found that the evidence of record establishes plaintiff had the following severe impairments from March 3, 1997 through December 15, 2014: mild-to-moderate osteoarthritis of the left ankle status post fracture and open reduction internal fixation ; mild degenerative disc disease of the lumbar spine status post fusion; dilated aortic root/hypertension ; obstructive sleep apnea (OSA); asthma ; major depressive disorder (MDD); and polysubstance dependence in *356partial remission, impairments which do not meet or medically equal one of the impairments listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. (R. 1515.) The ALJ further found that, from March 3, 1997, though December 15, 2014, if plaintiff stopped the substance use, the remaining limitations would cause more than minimal impact on plaintiff's ability to perform basic work activities; therefore, plaintiff would continue to have a severe impairment or combination of impairments. (R. 1518.) Ultimately, the ALJ concluded that plaintiff retained the residual functional capacity ("RFC") to perform a limited range of light work and that there would be a significant number of jobs in the national economy that plaintiff could perform. (R. 1520, 1525.)
Plaintiff contends that substantial evidence does not support the ALJ's decision. Specifically, plaintiff argues that the ALJ improperly determined that substance use was a contributing factor material to the determination of disability, and that the ALJ erred in assessing plaintiff's RFC because the ALJ relied upon VE testimony that was based upon an incomplete hypothetical question. See Pl.'s Br. at 9-21; Pl.'s Reply at 3-10. Both of these assertions relate to the ALJ's RFC determination and the mental health related determinations therein. Defendant maintains that substantial evidence supports the decision of the ALJ. (Def.'s Br. at 4-13.) The court will address plaintiff's second argument first.
A. Mental RFC/Hypothetical to the VE
The Commissioner's regulations provide that if a claimant's impairments do not meet or equal a listed impairment, the RFC assessment is used at step four of the sequential evaluation process to determine if a claimant can do his past relevant work and at step five to determine if the claimant can adjust to other work. See
*357In the present case, plaintiff argues that the ALJ erred by not properly conveying to the VE all of the credibly established limitations that the ALJ himself found to be present. (Pl.'s Br. at 16-21; Pl.'s Reply at 3-6.) It is well-established that the ALJ must include in the hypothetical to the VE all of a claimant's limitations which are supported by the medical record. Plummer,
Furthermore, the Third Circuit has explained that "objections to the adequacy of hypothetical questions posed to a vocational expert often boil down to attacks on the RFC assessment itself." Rutherford,
That is, a claimant can frame a challenge to an ALJ's reliance on vocational expert testimony at step 5 in one of two ways: (1) that the testimony cannot be relied upon because the ALJ failed to convey limitations to the vocational expert that were properly identified in the RFC assessment, or (2) that the testimony cannot be relied upon because the ALJ failed to recognize credibly established limitations during the RFC assessment and so did not convey those limitations to the vocational expert. Challenges of the latter variety (like Rutherford's here) are really best understood as challenges to the RFC assessment itself.
At the first administrative hearing on March 12, 2014, the ALJ asked the VE to consider a hypothetical individual of plaintiff's age, education, and work experience
Additionally, the ALJ asked the VE to consider a second hypothetical question which contemplated the individual as described by the ALJ in the first hypothetical question, but who was further limited in that he could stand and walk for three to four hours in an eight hour workday.
In his June 10, 2014 decision, the ALJ determined at step three of the sequential analysis that plaintiff did not have an impairment or combinations of impairments that meets or medially equals the severity of one of the listed impairments. (R. 22.) In so finding, the ALJ considered the paragraph B criteria of Listing 12.04 and determined that plaintiff had mild restrictions in activities of daily living, moderate limitations in social functioning, moderate limitations with regard to concentration, persistence and pace, and had experienced no episodes of decompensation of extended duration. See R. 22-23. The ALJ detailed plaintiff's RFC as follows:
[Plaintiff] has the residual functional capacity (RFC) to perform light work as defined in 20 CFR 404.1567(b) and 416.967(b) except that he cannot operate foot controls with one lower extremity; must never climb ladders, ropes, or scaffolds; can perform the other postural maneuvers on occasion; and must avoid concentrated exposure to extreme cold, extreme heat, wetness, humidity, and environmental irritants. From a mental standpoint the claimant is limited to unskilled tasks that are goal-oriented rather than production-paced; no significant interaction with the general public; no more than occasional interaction with supervisors and co-workers; and requires a stable workplace, defined as involving few if any changes of setting, processes, and tools.
(R. 23-24.) The ALJ also found that plaintiff could not perform his past relevant work, but that based on the VE's testimony, considering plaintiff's age, education, work experience, and RFC, plaintiff was capable of making a successful adjustment to other work that exists in significant numbers in the national economy. (R. 28-29.)
In the interim between the ALJ's first and second decisions, the regulations setting forth the criteria for evaluating mental disorders were amended, effective January 17, 2017. See
*359At the time of the ALJ's June 10, 2014 decision, the regulations directed the ALJ to evaluate a claimant's functional limitations in the following four functional areas when considering Listing 12.04: "activities of daily living"; "social functioning"; "concentration, persistence, or pace"; and "episodes of decompensation." See
*360As noted supra, in the March 9, 2017 decision, the ALJ explicitly found at step three of the sequential analysis that, even if plaintiff stopped the substance use, in terms of the paragraph B criteria of Listing 12.04, plaintiff had moderate limitations in the four functional areas of "understanding, remembering, or applying information," "interacting with others," "concentrating, persisting or maintaining pace," and "adapting or managing oneself." (R. 1519.) However, the ALJ applied the same RFC that he assessed in 2014. Compare R. 23-24 with R. 1520. In addition, at step five of the sequential analysis, the ALJ concluded "[b]ased on the ... [VE's testimony from the March 12, 2014 hearing] that, if the claimant stopped the substance use, he would be capable of making a successful adjustment to work that exists in significant numbers in the national economy." (R. 1526.) As plaintiff correctly points out, the hypothetical questions posed to the VE in 2014, and thereby the 2014 RFC, did not address or contemplate a limitation comparable to moderate limitations in the functional areas of "understanding, remembering, or applying information"
The law of this Circuit provides that a VE's testimony may be relied upon at step five of the sequential analysis to establish the existence of jobs in the national economy consistent with a claimant's RFC only if the question posed to the VE accurately portrays the claimant's individual physical and mental impairments. Burns,
Here, the ALJ based his step five determination that plaintiff is capable of making an adjustment to work that exists in significant numbers in the national economy in part on the VE's 2014 testimony. See R. 1526. However, the hypothetical question posed to the VE in 2014 did not convey all of the functional limitations that the ALJ deemed established in 2017. Therefore, because the moderate limitations in "understanding, remembering, or applying information" and "adapting or managing oneself" were not presented to the VE in 2014, the VE's 2014 testimony cannot be relied upon in 2017 to establish the existence of jobs in the national economy consistent with plaintiff's RFC. See, e.g., Tung Thinh Lam v. Astrue,
In addition, the court cannot discern from a reading of the transcript of the October 31, 2016, administrative hearing whether the ALJ considered the limitations in "understanding, remembering, or applying information" and "adapting or managing oneself" when contemplating the VE testimony. There appeared to be some confusion concerning the testimony of the VEs at the first and second hearing. See R. 1556-62. For example, at the October 2016 hearing, plaintiff's counsel repeatedly asked the ALJ for clarification on the questions posed to the VE and whether the hypothetical questions and RFC assessment were in accordance with the court's directives on remand, particularly with respect to plaintiff's mental impairments. See
Thus, the 2014 VE testimony is not substantial evidence on which the ALJ may base his RFC because the 2014 VE testimony does not incorporate all of the functional limitations that the ALJ himself found present even while plaintiff engages in substance use. In the 2014 decision and the 2017 decision, the ALJ expressly relied on the testimony of the VE from the 2014 hearing to identify representative unskilled jobs that plaintiff could perform within the limitations of his RFC. (R. 62-66, 1555-62). Because the ALJ failed to include all of plaintiff's credibly established limitations in the hypothetical used to support his step five determination, it was not supported by substantial evidence. See Ramirez,
B. Materiality of DAA
Social Security Ruling 13-2p explains the procedure to be used in determining DAA materiality, delineating a series of six steps. See SSR 13-2p, Titles II & XVI: Evaluating Cases Involving Drug Addiction & Alcoholism (DAA),
The guidance also indicates that the materiality determination must be based on evidence. Id. at *10. With respect to mental impairments, SSR 13-2-p acknowledges that many people with DAA have co-occurring mental disorders and states that to "support a finding that DAA is material, we must have evidence in the case record that establishes that a claimant with a co-occurring mental disorder(s) would not be disabled in the absence of DAA. Unlike cases involving physical impairments, we *363do not permit adjudicators to rely exclusively on medical expertise and the nature of a claimant's mental disorder." Id. at *9.
Plaintiff contends that the ALJ erred as a matter of law when he found that substance use is material to the determination of disability because plaintiff's impairments would improve if he stopped substance use, pointing to several alleged errors in support of this argument. (Pl.'s Br. at 9-16; Pl.'s Reply at 7-10.) For example, plaintiff avers that the ALJ improperly discounted probative opinion evidence. See Pl.'s Br. at 11-12; Pl.'s Reply at 7-8.
Of note, plaintiff argues that the ALJ erred in his consideration of the opinion evidence, inter alia, by attributing little weight to the opinion of plaintiff's treating psychiatrist, Dr. Gyulai of the VA Medical Center who opined in March 2014 that plaintiff "has major depression when drug free."
If the opinion of a treating physician conflicts with that of a non-treating, non-examining physician, the ALJ may choose whom to credit but cannot reject evidence for no reason or for the wrong reason. Morales v. Apfel,
It is unclear from the ALJ's analysis in the case at bar whether these standards were met. The court notes that certain of the factors cited by the ALJ in discounting the treating physician's opinions undermine his analysis. For example, inter alia, the ALJ reasoned that the opinions of Drs. Rivera and Gyulai "are also inconsistent with the claimant's activities of daily living, including months of college (although unsuccessful), odd jobs in the community, *365full-time work as a housekeeper in a vocational rehab program (although in a structured setting), and some care of a younger family member (Exhibit18F/40)." It would seem that an unsuccessful attempt at completing college coursework is weak evidence to contradict treating psychiatrists' opinions that plaintiff's mental impairments render plaintiff unable to adjust to work activity. Moreover, the ALJ's assertion that plaintiff provided "some care of a younger family member" appears to be taken out of context. The medical record to which the ALJ cites in support of this conclusion consists of a cardiologist's treatment note dated December 17, 2013, when plaintiff sought assessment for recurrent syncope. (R. 1450.) The treatment note indicates that plaintiff experienced a syncopal episode "[i]n September, [when] he was going to the kitchen to get his niece something. He denies any prodrome. His last memory was closing the juice lid and he woke up on the floor. No one has witnessed these events but his niece heard him fall."
It is well-established that "[a]n ALJ may accept some of a medical source's opinions while rejecting other opinions from the same source." Comiskey v. Astrue,
V. CONCLUSION
After a careful and thorough review of all of the evidence in the record, and for the reasons set forth above, this court finds that the ALJ's findings are not supported by substantial evidence. Accordingly, the court makes the following:
RECOMMENDATION
AND NOW, this 30th day of January, 2018, upon consideration of plaintiff's Brief and Statement of Issues in Support of Request for Review, defendant's response, and plaintiff's reply, it is respectfully recommended that plaintiff's Request for Review be GRANTED and this case be REMANDED
The parties may file objections to the Report and Recommendation. See Loc. R. Civ. P. 72.1. Failure to file timely objections may constitute a waiver of any appellate rights.
Throughout his decision, the ALJ describes the relevant time period as beginning on March 3, 1997, the alleged onset date. See, e.g., R. 1512, 1514-15. At the administrative hearing on October 31, 2016, plaintiff's counsel indicated that the case involved "a closed period from the original date of application, July 2012 to December 16, 2014, which was the date of the allowance on the new application." (R. 1537.) Plaintiff points out in his brief that he is ineligible for SSI benefits prior to July 2012. See Pl.'s Br. at 2-3 n.2.
The Social Security Administration recently promulgated amendments to selected regulations. For example, the regulations governing how the Commissioner determines severity, previously codified at
At step five of the sequential analysis, where a claimant has only exertional limitations, the Commissioner may use the Medical-Vocational Guidelines (the "Grids") to determine whether other work exists in significant numbers in the national economy. See 20 C.F.R. Pt. 404, Subpt. P, App. 2. However, when a claimant has exertional and nonexertional impairments, the Commissioner may not satisfy its burden at step five by reliance on the Grids alone. See Sykes v. Apfel,
In making a disability determination or decision at step 5 of the sequential evaluation process (or the last step in the sequential evaluation process in continuing disability review claims), we cannot use the grid rules exclusively as a framework for decisionmaking when an individual has a nonexertional limitation(s). Before denying disability benefits at step five when a claimant has a nonexertional limitation(s), we must: (1) take or produce vocational evidence such as from a vocational expert, the DOT or other similar evidence (such as a learned treatise); or (2) provide notice that we intend to take or are taking administrative notice of the fact that the particular nonexertional limitation(s) does not significantly erode the occupational job base, and allow the claimant the opportunity to respond before we deny the claim.
AR 01-1(3). The Ruling "does not apply to claims where we rely on an SSR that includes a statement explaining how the particular nonexertional limitation(s) under consideration in the claim being adjudicated affects a claimant's occupational job base. When we rely on such an SSR to support our finding that jobs exist in the national economy that the claimant can do, we will include a citation to the SSR in our determination or decision."Id.
VE Gumerman classified plaintiff's past work as a sheer operator as heavy work and the work as a handheld crane operator as medium work. (R. 62.) The VE indicated that there were no skills transferable to sedentary work.
The VE stated that such testimony was consistent with the Dictionary of Occupational Titles. (R. 63.) In addition, when asked by plaintiff's attorney whether the hypothetical individual could perform the identified jobs if the hypothetical individual were further limited in that he was "seriously, seriously limited or totally precluded from working because of work stresses and dealing with work stresses for his ability to complete a normal workday or workweek without interruption from psychologically based symptoms." (R. 63-64.) The VE opined that such individual could perform no work under such parameters. (R. 64.) Similarly, the VE opined that such individual could perform no work if he "would be totally precluded in behaving in an emotionally stable manner" or if he could not relate predictably in social situations or demonstrate reliability.
It should be noted that the regulations again were amended with an effective date of March 27, 2017. Nevertheless, the court will refer to the version of the regulations in effect at the time of the ALJ's March 9, 2017 decision.
At the time of the ALJ's June 10, 2014 decision, Listing 12.04 provided that affective disorders are "[c]haracterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome. Mood refers to a prolonged emotion that colors the whole psychic life; it generally involves either depression or elation." 20 C.F.R. § Pt. 404, Subpt. P, App. 1 (version effective February 26, 2014 to December 8, 2014). The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied.
Medically documented persistence, either continuous or intermittent, of one of the following:
1. Depressive syndrome characterized by at least four of the following: a. Anhedonia or pervasive loss of interest in almost all activities; or b. Appetite disturbance with change in weight; or c. Sleep disturbance; or d. Psychomotor agitation or retardation; or e. Decreased energy; or f. Feelings of guilt or worthlessness; or g. Difficulty concentrating or thinking; or h. Thoughts of suicide; or i. Hallucinations, delusions, or paranoid thinking; or
2. Manic syndrome characterized by at least three of the following: a. Hyperactivity; or b. Pressure of speech; or c. Flight of ideas; or d. Inflated self-esteem; or e. Decreased need for sleep; or f. Easy distractibility; or g. Involvement in activities that have a high probability of painful consequences which are not recognized; or h. Hallucinations, delusions or paranoid thinking; or
3. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes (and currently characterized by either or both syndromes).Id.
The paragraph B criteria are satisfied when a claimant demonstrates mental impairments that result in at least two of the following: (1) marked restriction of activities of daily living; (2) marked difficulties in maintaining social functioning; (3) marked difficulties in maintaining concentration, persistence, or pace; or (4) repeated episodes of decompensation, each of extended duration.
At the time of the ALJ's March 9, 2017 decision, Listing 12.04 provided that affective disorders are satisfied when the requirements in both paragraph A and paragraph B are satisfied, or when the requirements in paragraph A and paragraph C are satisfied. See 20 C.F.R. § Pt. 404, Subpt. P, App. 1 (version effective January 17, 2017 to March 26, 2017). The Listing provides as follows:
A. Medical documentation of the requirements of paragraph 1 or 2:
1. Depressive disorder, characterized by five or more of the following: a. Depressed mood; b. Diminished interest in almost all activities; c. Appetite disturbance with change in weight; d. Sleep disturbance; e. Observable psychomotor agitation or retardation; f. Decreased energy; g. Feelings of guilt or worthlessness; h. Difficulty concentrating or thinking; or i. Thoughts of death or suicide.
2. Bipolar disorder, characterized by three or more of the following: a. Pressured speech; b. Flight of ideas; c. Inflated self-esteem; d. Decreased need for sleep; e. Distractibility; f. Involvement in activities that have a high probability of painful consequences that are not recognized; or g. Increase in goal-directed activity or psychomotor agitation.
AND
B. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):
1. Understand, remember, or apply information (see 12.00E1).
2. Interact with others (see 12.00E2).
3. Concentrate, persist, or maintain pace (see 12.00E3).
4. Adapt or manage oneself (see 12.00E4).
OR
C. Your mental disorder in this listing category is "serious and persistent;" that is, you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both:
1. Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder (see 12.00G2b); and
2. Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life (see 12.00G2c).
The listings define this functional area as follows:
This area of mental functioning refers to the abilities to learn, recall, and use information to perform work activities. Examples include: Understanding and learning terms, instructions, procedures; following one-or two-step oral instructions to carry out a task; describing work activity to someone else; asking and answering questions and providing explanations; recognizing a mistake and correcting it; identifying and solving problems; sequencing multi-step activities; and using reason and judgment to make work-related decisions. These examples illustrate the nature of this area of mental functioning. We do not require documentation of all of the examples.
20 C.F.R. § Pt. 404, Subpt. P, App. 1, Listing 12.00E1 (version effective January 17, 2017 to March 26, 2017).
The listings define this functional area as follows:
This area of mental functioning refers to the abilities to regulate emotions, control behavior, and maintain well-being in a work setting. Examples include: Responding to demands; adapting to changes; managing your psychologically based symptoms; distinguishing between acceptable and unacceptable work performance; setting realistic goals; making plans for yourself independently of others; maintaining personal hygiene and attire appropriate to a work setting; and being aware of normal hazards and taking appropriate precautions. These examples illustrate the nature of this area of mental functioning. We do not require documentation of all of the examples.
20 C.F.R. § Pt. 404, Subpt. P, App. 1, Listing 12.00E4 (version effective January 17, 2017 to March 26, 2017).
The mental component of the 2017 RFC assessment limited plaintiff to "unskilled tasks that are goal-oriented rather than production-paced; no significant interaction with the general public; no more than occasional interaction with supervisors and co-workers; and requires a stable workplace, defined as involving few if any changes of setting, processes, and tools." (R. 1520.)
Although he primarily focuses on alleged errors pertaining to the mental limitations of the RFC, plaintiff also argues that the record evidence demonstrates that plaintiff is limited to sedentary work which would render him disabled under the Grids. See Pl.'s Br. 17-19. Defendant counters that the ALJ fully accounted for plaintiff's credibly established physical functional limitations by restricting plaintiff to a limited range of light work. See Def.'s Br. at 11-13. Given the court's recommendation that the case be remanded to reassess plaintiff's RFC in light of the functional limitations assessed by the ALJ in the March 2017 decision, the court will not reach this question.
If the ALJ determines that DAA is a medically determinable impairment and that a claimant is disabled considering all of the claimant's medically determinable impairments, the ALJ will apply the sequential evaluation process a second time to determine whether the claimant would continue to be disabled if he stopped using drugs or alcohol.
Plaintiff also avers that the January 2015 award of benefits demonstrates that the ALJ improperly concluded that substance use is material to the disability determination. See Pl.'s Br. at 10-11. The court notes that the fact that plaintiff was awarded benefits in a subsequent application does not, in itself, warrant remand or reversal. Cunningham v. Comm'r of Soc. Sec.,
Additionally, plaintiff contends that the ALJ improperly concluded that plaintiff's mental impairments would improve to the point of nondisability in the absence of substance use. (Pl.'s Br. at 11, 13-15; Pl.'s Reply at 8-9.) SSR 13-2p explains how periods of abstinence are considered when making the materiality determination, especially in the case of a claimant with a co-occurring mental disorder. Id. at *12-13. SSR 13-2p provides in relevant part:
i. Improvement in a co-occurring mental disorder in a highly structured treatment setting, such as a hospital or substance abuse rehabilitation center, may be due at least in part to treatment for the co-occurring mental disorder, not (or not entirely) the cessation of substance use. We may find that DAA is not material depending on the extent to which the treatment for the co-occurring mental disorder improves the claimant's signs and symptoms. If the evidence in the case record does not demonstrate the separate effects of the treatment for DAA and for the co-occurring mental disorder(s), we will find that DAA is not material ....
ii. A co-occurring mental disorder may appear to improve because of the structure and support provided in a highly structured treatment setting. As for any mental disorder, we may find that a claimant's co-occurring mental disorder(s) is still disabling even if increased support or a highly structured setting reduce the overt symptoms and signs of the disorder.
iii. Given the foregoing principles, a single hospitalization or other inpatient intervention is not sufficient to establish that DAA is material when there is evidence that a claimant has a disabling co-occurring mental disorder(s). We need evidence from outside of such highly structured treatment settings demonstrating that the claimant's co-occurring mental disorder(s) has improved, or would improve, with abstinence. In addition, a record of multiple hospitalizations, emergency department visits, or other treatment for the co-occurring mental disorder-with or without treatment for DAA-is an indication that DAA may not be material even if the claimant is discharged in improved condition after each intervention.
Id. at *12-13. Plaintiff contends that the Commissioner's January 2015 determination that plaintiff is disabled is evidence that plaintiff's impairment has not improved to the point of nondisability in the absence of substance use. (Pl.'s Reply at 8-9.)
The ALJ attributed "little weight" to the opinions of Michelle Rivera, M.D., and Dr. Gyulai, staff psychiatrists with the VA Medical Center. (R. 1522.) Dr. Gyulai opined on March 10, 2014, that plaintiff "as major depression when drug free" and on March 7, 2014, Dr. Rivera, inter alia, rated as "poor/none" plaintiff's ability to sustain an ordinary routine without special supervision, work in coordination with or proximity of others being unduly distracted, maintain concentration, and make work-related decisions. See R. 1499, 1505.
"A district court, after reviewing the decision of the Secretary may, under
Reference
- Full Case Name
- Thomas BRUCE v. Nancy A. BERRYHILL, Acting Commissioner of Social Security Administration
- Cited By
- 14 cases
- Status
- Published