Court: District Court, S.D. Iowa; June 2, 2014; Federal District Court
Scott V. Spillers filed a Complaint on September 10, 2013, to review the Commissioner’s denial of his Social Security benefits claim under Title II of the Social Security Act. The Court has the authority to review the Commissioner’s final decisions as per 42 U.S.C. 405(g). Spillers applied for benefits on December 10, 2010, and was 48 years old at the hearing on June 5, 2012, before ALJ Tom Morris. The ALJ issued an unfavorable decision on July 3, 2012, which the Appeals Council declined to review on July 16, 2013, making it the Commissioner’s final decision.
In the sequential evaluation, the ALJ determined that Spillers had not engaged in substantial gainful activity since May 22, 2010, the alleged onset date of his disability. The ALJ identified severe impairments including potential learning disabilities and a psychotic disorder, but concluded these did not meet the severity required for benefits. At the fourth step, the ALJ assessed Spillers' residual functional capacity, concluding he could perform a full range of work with specific nonexertional limitations such as performing simple, routine tasks without close attention to detail and requiring a low-stress environment with verbal instructions. The ALJ found Spillers unable to perform his past relevant work but capable of performing a significant number of jobs, including industrial cleaner and collator operator.
Evidence reviewed included Spillers' hospitalization from May 27 to June 2, 2010, due to anxiety following a failed commercial driver’s license test. His psychiatrist, Dr. Mark A. Preston, noted a history of recurrent paranoid psychosis and concerns about an impending psychotic episode. Despite his claims regarding a prior truck accident, police reports indicated his vehicle crossed the center line. Dr. Preston treated Spillers regularly in 2010, 2011, and 2012, and Spillers was not cleared to return to work upon discharge from the hospital. His medications included Lexapro and Geodon.
Following the hospital stay, the doctor prioritized the Plaintiff's need to retake his driving test. On July 14, 2010, the doctor expressed uncertainty about the Plaintiff's ability to hold a job but remained optimistic. By August 4, 2010, the Plaintiff showed slight improvement, including spontaneous smiling and reduced feelings of hopelessness. On August 20, 2010, Dr. Preston noted the Plaintiff was awaiting results regarding his driver's license appeal.
On June 18, 2010, at Dr. Preston's request, Plaintiff was evaluated by DeAnn L. Nerem, Psy.D., to assess potential learning disabilities affecting his ability to pass the written driver's license test. He had failed the personal driving test twice and was concerned about his commercial driver's license (CDL). The evaluation revealed borderline intellectual functioning, particularly in verbal comprehension and abstract reasoning, with visual-organizational abilities in the average range. Dr. Nerem recommended that the Plaintiff's driving ability be assessed through a road test rather than a written test, suggesting that the written test be administered verbally if possible.
The Plaintiff's primary care physician, Kim Countryman, D.O., noted on December 6, 2010, that the Plaintiff was unable to drive due to severe anxiety stemming from a fatal accident and recommended applying for disability. On March 14, 2011, Dr. Countryman classified the Plaintiff as disabled due to schizophrenia, and on January 7, 2011, Dr. Preston supported the disability claim, citing the Plaintiff's anxiety and indecisiveness. On June 11, 2011, Dr. Preston stated that anxiety and dyslexia prevented the Plaintiff from working, and by May 30, 2012, he completed a mental residual functional capacity questionnaire detailing numerous symptoms, including decreased energy, persistent anxiety, difficulties in concentration, memory impairment, and emotional withdrawal, among others.
The doctor assessed the Plaintiff's abilities across various work-related domains, utilizing a rating scale that included levels from "unable to meet competitive standards" to "very good." Key findings indicated that the Plaintiff was unable to meet competitive standards in remembering work-like procedures, understanding and following simple instructions, maintaining attention, making decisions, completing a workday without interruptions, and managing normal work stresses. Domains rated as "seriously limited but not precluded" included following very short instructions, interacting with the public, and using public transportation. Domains rated as "limited but satisfactory" included maintaining attendance and punctuality, sustaining routine without supervision, and adhering to cleanliness standards. The doctor concluded that the Plaintiff would likely be absent from work more than four days per month and confirmed that the Plaintiff was not a malingerer.
During the administrative hearing, the Plaintiff, who had been under Dr. Preston's care for 12 years, reported ongoing anxiety, confusion, depression, and side effects from medication (Geodon) that caused drowsiness. He expressed doubts about his ability to drive or perform previous factory jobs due to these issues. The ALJ called a vocational expert (Carma Mitchell) to testify, who responded to a hypothetical scenario based on the Plaintiff's age, education, and limitations. The expert determined that the Plaintiff could not perform any of his past relevant work but identified alternative jobs suitable for the Plaintiff, including marker, collator operator, inserting machine operator, and packaging machine tender.
The vocational expert indicated that an individual limited to daily interactions with a supervisor could still perform certain previously identified jobs. A subsequent hypothetical involving limitations to simple, routine tasks with low stress and no requirement for detailed attention or computer work also supported the feasibility of those jobs. However, if the individual could not maintain a production pace, roles such as production machine or packaging machine tender would be unfeasible, though the job of industrial cleaner remained possible. If the individual were off-task for up to one-eighth of a workday or required daily re-instruction, competitive work would not be achievable. Unscheduled breaks due to mental health issues would similarly preclude competitive employment. Missing work two days per month would also eliminate the possibility of full-time competitive work.
The ALJ's decision included a rejection of Dr. Preston’s opinion, citing inconsistencies with treatment notes that indicated anxiety and low self-esteem without psychotic symptoms, alongside the claimant's ability to engage in social and physical activities. The ALJ also dismissed Dr. Countryman’s disability assessment due to the use of "schizophrenia" in the diagnosis, which was not supported by other medical opinions. In contrast, the ALJ gave significant weight to the state agency doctors’ opinions, as they aligned with the overall evidence.
The decision to affirm the ALJ's ruling hinges on whether the findings are backed by substantial evidence, defined as enough to support the decision from a reasonable perspective. The court will uphold the ALJ's denial of benefits unless the decision falls outside the permissible range of choices, acknowledging that differing conclusions could be drawn from the evidence, as long as one aligns with the ALJ’s findings.
A reviewing court must carefully analyze the entire record without considering a claim de novo. The plaintiff contends that the ALJ erred by not giving controlling or great weight to Dr. Preston's opinion and failing to evaluate his complaints according to established standards. A treating physician's opinion is typically given controlling weight if it is well-supported by clinical evidence and consistent with other substantial evidence. However, conclusory statements lacking such support can be discounted. The ALJ's decision to disregard a treating physician's opinion must be based on good reasons, especially if other medical assessments provide better evidence.
Dr. Preston, who treated the plaintiff for twelve years, never released him to work following hospitalization in May 2010 and expressed skepticism about his ability to work, ultimately stating on January 7, 2011, that the plaintiff was too disabled to work. This assessment aligns with another long-term provider, Dr. Countryman, who also determined the plaintiff was too disabled, despite using the term "schizophrenia." The ALJ’s reliance on assessments from non-examining state agency physicians was deemed erroneous, as such opinions do not constitute substantial evidence against a claim of disability. The court emphasized that Dr. Preston's opinion should not have been disregarded in the absence of contradictory evidence.
Statements from physicians who did not personally examine the claimant but only reviewed reports from examining physicians are not considered substantial evidence, as established in Van Horn v. Heckler and Singh v. Apfel. Only Dr. Preston and Dr. Countryman provided substantial evidence regarding the Plaintiff's work ability. The ALJ noted that the Plaintiff had worked for many years despite his medical condition, highlighting that employment alone does not negate a finding of disability, referencing Wilder v. Chater. The Plaintiff's condition significantly deteriorated after an accident, with no evidence of regaining work capability post-incident. The ALJ's observation of the Plaintiff engaging in daily activities like walking, biking, and household chores does not equate to the ability to perform substantial gainful activity.
Legal precedents emphasize that a claimant is not required to prove they are bedridden to be deemed disabled, but must demonstrate the ability to perform necessary tasks consistently in competitive environments. The ability to engage in light activities is insufficient to establish functional capacity for work. The court found a lack of substantial evidence supporting the Plaintiff's ability to meet employer expectations regarding capacity, stability, and attendance.
Consequently, the Commissioner’s final decision is deemed unsupported by substantial evidence and is reversed, remanding the case for an award of benefits. The judgment will also start the timeline for filing attorney fee applications under the Equal Access to Justice Act. Counsel is reminded to identify the government's positions in the EAJA application as per local rules.
