Roberts v. Commissioner of Social Security

Citations: 14 F. Supp. 3d 968; 2014 U.S. Dist. LEXIS 37811Docket: Case No. 3:12cv340

Court: District Court, S.D. Ohio; March 20, 2014; Federal District Court

SummaryOriginalCytator Case TreatmentBackward CitatorAnalysis

EnglishEspañolSimplified EnglishEspañol Fácil

The court adopted the United States Magistrate Judge's Report and Recommendations, overruling the Defendant's objections. The judgment was entered in favor of the Plaintiff, reversing the Defendant Commissioner’s decision that the Plaintiff was not disabled and thus not entitled to benefits under the Social Security Act prior to April 23, 2008. The case has been remanded to the Defendant Commissioner for an immediate award of benefits with an onset date of February 8, 2006. The court conducted a thorough de novo review of the case, confirming that the Commissioner’s decision lacked substantial evidence. The standard for substantial evidence requires that there be adequate relevant evidence for a reasonable mind to accept as supporting a conclusion, ensuring that the decision aligns with legal precedents regarding the review of administrative decisions.

Substantial evidence must exceed mere suspicion and be sufficient to justify a jury's refusal to direct a verdict if the evidence supports a factual conclusion for the jury. The court evaluates the Commissioner’s findings based on the entire record but does not re-try cases, resolve evidentiary conflicts, or assess credibility. The Commissioner’s decisions cannot be reversed solely because there is evidence supporting an alternative conclusion. A court must affirm the Commissioner’s decision if it is backed by substantial evidence, even if the court would have chosen differently.

In this case, the Administrative Law Judge (ALJ) improperly rejected the opinions of the Plaintiff's treating physician in favor of a non-treating source, failing to apply the treating physician Rule and the 'Good Reasons Rule.' The court found the Commissioner’s decision unsupported by substantial evidence and determined that the record clearly established the Plaintiff's entitlement to benefits with an onset date earlier than the one chosen by the ALJ. Therefore, the court remanded the case for immediate benefit payments rather than further administrative proceedings, concluding that the ALJ's selection of April 23, 2008, as the onset date was incorrect. The court adopted the Magistrate Judge's recommendations, overruled the Defendant’s objections, and ordered the case closed after reversing the Commissioner’s decision regarding disability benefits prior to April 23, 2008, with a corrected onset date of February 8, 2006.

A Social Security disability benefits appeal is being considered regarding whether the Administrative Law Judge (ALJ) incorrectly determined that the Plaintiff was not disabled before April 23, 2008, affecting his eligibility for Disability Insurance Benefits (DIB) and Supplemental Security Income (SSI). The Plaintiff initially filed for DIB and SSI on April 7, 2005, claiming a disability onset date of July 20, 2004, due to various impairments including arthritis, knee pain, lower back pain, depression, and anxiety. After initial denials, a hearing was held on March 18, 2008, resulting in ALJ Daniel Shell's decision on August 20, 2008, which concluded that the Plaintiff was not disabled as defined by the Social Security Act. Following unsuccessful appeals, the case was remanded by Judge Timothy S. Black on March 1, 2011, for further evaluation. A new hearing was conducted on November 15, 2011, leading to ALJ Amelia Lombardo's partially favorable decision on December 9, 2011, which set the disability onset date at April 23, 2008. Key findings from ALJ Lombardo included that the Plaintiff met the insured status through March 31, 2005, had not engaged in substantial gainful activity since the alleged onset date, and had severe impairments including knee problems and depression. It was determined that the Plaintiff did not meet the severity of listed impairments and had a residual functional capacity (RFC) for light work with specific limitations. Ultimately, it was found that the Plaintiff could not perform past relevant work since the alleged onset date. The court recommends amending the disability onset date to February 8, 2006.

The claimant was classified as a younger individual (ages 18-44) prior to the established disability onset date, which has remained unchanged. The claimant possesses at least a high school education and can communicate in English. Before April 23, 2008, the transferability of job skills was not relevant to the disability determination, as the Medical-Vocational Rules indicated the claimant was "not disabled." However, from April 23, 2008, the claimant could not transfer job skills to other occupations. Prior to this date, jobs existed in significant numbers that the claimant could perform based on age, education, work experience, and residual functional capacity (RFC). After April 23, 2008, the claimant was unable to perform even sedentary work regularly, with no jobs available in significant numbers in the national economy that the claimant could perform.

The Appeals Council denied the claimant's request for review, finalizing the ALJ's findings. The legal standard for review involves determining whether the ALJ's non-disability finding is supported by substantial evidence and whether the correct legal criteria were applied. Substantial evidence is defined as evidence that a reasonable mind might accept as adequate to support a conclusion. The ALJ’s decision can be affirmed even if there is contradictory evidence in the record. The second inquiry pertains to the correctness of the legal analysis, which allows for reversal if the ALJ did not follow regulations and such errors prejudiced the claimant. To qualify for SSI, a claimant must demonstrate a "disability" as defined by the Social Security Act, indicating severe physical and/or mental impairments that prevent them from performing past work and engaging in substantial gainful activity available in the economy.

Administrative regulations mandate a five-step sequential evaluation for disability determinations as outlined in 20 C.F.R. 416.920(a)(4). A finding at any step can conclude the ALJ's review process. The five questions involved in this evaluation are: 1) whether the claimant has engaged in substantial gainful activity; 2) whether the claimant has one or more severe impairments; 3) whether these impairments meet or equal the criteria in the Commissioner’s Listing of Impairments; 4) whether the claimant can perform past relevant work considering their residual functional capacity (RFC); and 5) if the claimant cannot perform past work, whether there are significant numbers of other jobs in the national economy they can do, taking into account age, education, past work experience, and RFC. 

A claimant bears the ultimate burden of proving disability under the Social Security Act, specifically during the first four steps, after which the burden shifts to the Commissioner at Step 5. In this case, the plaintiff's initial disability application was denied, leading to an appeal where Judge Black reversed the ALJ's decision and remanded the case for a new hearing due to insufficient medical evidence supporting the RFC finding, particularly the rejection of the treating physician’s opinion. 

On remand, although a new hearing was conducted by ALJ Lombardo, similar errors occurred, notably the incorrect application of the treating physician rule and reliance on a record-reviewing physician instead of granting deference to the treating physician. The treating physician rule necessitates that ALJs give greater weight to treating physicians due to their ability to provide comprehensive insights into a claimant's medical conditions. An ALJ must give controlling weight to a treating physician's opinion if it is well-supported by medical evidence and consistent with other substantial evidence in the record. If the ALJ fails to do so, as highlighted in relevant case law, a reversal of the decision is warranted.

The 'good reasons rule' requires that an Administrative Law Judge (ALJ) provide clear, evidence-supported reasons for the weight given to a claimant's treating physician's opinion in their decision-making process. If an ALJ does not grant controlling weight to a treating physician’s opinion, they must assess the appropriate weight by considering factors such as the length and frequency of the treatment relationship, the opinion's supportability, its consistency with the overall record, and the physician's specialization. A failure to adequately explain the rationale for the weight assigned to a treating physician's opinion indicates a lack of substantial evidence, regardless of the ALJ's conclusion being supported by the record.

The determination of disability is ultimately reserved for the Commissioner of Social Security, and a treating physician’s opinion regarding a patient’s unemployability does not hold special significance in this context. However, there is a rebuttable presumption that the treating physician's opinion should be given significant weight.

Dr. Nenonene, the plaintiff’s primary care internist since January 2006, treated the plaintiff for several pain conditions and opined in February 2006 that the plaintiff was unable to work due to his pain, depression, and anxiety. Imaging results from February 2006 supported Dr. Nenonene's assessment. By August 2006, Dr. Nenonene reported severe limitations on the plaintiff's physical capabilities and labeled him unemployable, basing this on physical examinations and MRI results. In April 2007 and March 2008, Dr. Nenonene continued to assert that the plaintiff was unable to sustain full-time employment, noting a worsening condition.

The plaintiff contests the ALJ's disability onset date of April 23, 2008, arguing that it should be February 8, 2006, in line with Dr. Nenonene’s opinion, a position with which the Court concurs.

The ALJ erred in rejecting Dr. Nenonene’s opinion by not properly applying the treating physician rule and instead relying excessively on Dr. Newman’s assessment to determine the Plaintiff's residual functional capacity (RFC). The ALJ dismissed Dr. Nenonene’s opinion, stating it lacked "objective support" and was inconsistent with the overall medical record before April 23, 2008. The ALJ favored Dr. Newman’s evaluation, an orthopedic specialist, over Dr. Nenonene, a primary care internist, asserting that the latter's opinion was primarily based on the Plaintiff’s subjective complaints. Dr. Newman concluded that the Plaintiff could perform sedentary work, and his determination relied heavily on a 1999 assessment, which the ALJ considered more valid than Dr. Nenonene's insights from their two-year treatment relationship. Throughout this period, Dr. Nenonene documented multiple conditions affecting the Plaintiff, including knee and shoulder pain, and consistently found the Plaintiff unable to maintain full-time employment based on thorough examinations and MRI results. The ALJ’s rationale for discrediting Dr. Nenonene was insufficient, merely citing inconsistency with Dr. Newman’s assessment. The Sixth Circuit's ruling in Gayheart emphasized that conflicting substantial evidence must extend beyond non-treating and non-examining doctors' opinions; otherwise, the treating physician rule would be undermined. The ALJ's reliance on Dr. Newman’s review, particularly concerning outdated records, was deemed inappropriate and inadequate for dismissing the treating physician’s opinion.

The ALJ's decision found Dr. Nenonene's medical opinion lacking objective support and not consistent with the overall medical record, but failed to apply the "good reasons" factors to the treatment relationship. The primary justification for disregarding Dr. Nenonene’s opinion was the differing opinion of Dr. Newman, without adequately identifying conflicting substantial evidence as required by 20 C.F.R. 416.927(c)(2). This omission hinders meaningful judicial review of the application of the treating-physician rule. The ALJ's established onset date of April 23, 2008, aligns with x-ray findings revealing significant knee conditions that support Dr. Nenonene's assessments. The ALJ did not cite evidence that contradicts Dr. Nenonene’s opinion and incorrectly applied the good reasons requirement. The record indicates that the plaintiff's condition had worsened over 5 to 10 years, reinforcing Dr. Nenonene’s total disability assessment. Given the lack of substantial evidence supporting the non-disability determination, the Court has the authority to reverse and award benefits if the record establishes entitlement. The evidence strongly indicates an earlier onset date of February 8, 2006, correlating with MRI results of disabling knee degeneration, and the ALJ improperly prioritized a non-treating, non-examining source's opinion over that of the treating physician. Thus, the treating physician's opinion should have been given greater weight, as it aligns with the overall medical evidence.

The Court finds that the Plaintiff's assigned error is valid, indicating that the ALJ’s decision lacks substantial evidence. The record demonstrates the Plaintiff's entitlement to Disability Insurance Benefits (DIB) and/or Supplemental Security Income (SSI) with an earlier onset date than determined by ALJ Lombardo. The following recommendations are made: 

1. Reversal of ALJ Lombardo’s disability onset date of April 23, 2008.
2. Remand to the Commissioner under the Fourth Sentence of 42 U.S.C. § 405(g) for an immediate award of DIB and/or SSI benefits, with a revised onset date of February 8, 2006.
3. Closure of the case.

Parties may file written objections to these recommendations within fourteen days, extendable to seventeen days due to the method of service. Objections must specify contested portions and include a supporting legal memorandum. If objections relate to matters from an oral hearing, the objecting party must arrange for the transcription of relevant portions of the record. Responses to objections may be filed within fourteen days, also extendable to seventeen days. Failure to comply may result in forfeiture of appeal rights.

Additionally, the report clarifies that references to the administrative record will be cited only by transcript page numbers. The Plaintiff's medical records are summarized elsewhere, and the Court will identify relevant medical evidence in its decision. The assessment of a claimant’s Residual Functional Capacity (RFC) is defined, detailing the physical exertion levels for various job classifications as established by the Social Security Administration.

Dr. Newman has no familial ties to the undersigned. The Plaintiff argues that the Administrative Law Judge (ALJ) made reversible errors on remand by misanalyzing reports from his treating physician and failing to recognize him as disabled under the Listings. However, the argument regarding the Listings is deemed unnecessary for discussion. Chondrocalcinosis, defined as an arthritis variant, is characterized by calcium pyrophosphate dehydrate crystal deposits in joints leading to joint damage. Joint effusion refers to increased intra-articular fluid causing inflammation, potentially requiring fluid drainage. A popliteal cyst is a swelling behind the knee resulting in stiffness and pain. Osteonecrosis involves the death of bone tissue due to reduced blood flow in joints. There are three categories of medical sources: non-examining, non-treating (but examining), and treating sources. Generally, opinions from treating sources are prioritized, followed by examining sources over non-examining sources. The ALJ must evaluate medical opinions based on the examining relationship, treatment relationship, supportability, consistency with the overall record, the source's specialization, and any other relevant factors, per Ealy v. Comm’r of Soc. Sec. and 20 C.F.R. 416.927(c).