Renee S. Phillips appeals the district court’s decision affirming the Commissioner of Social Security's denial of her disability insurance benefits application under 42 U.S.C. § 405(g). The main issue for the appeal is the conditions under which an Administrative Law Judge (ALJ) can rely on Medical Vocational Guidelines rather than a vocational expert. The ALJ’s authority to do so is influenced by the severity of Phillips's limitations, necessitating a review of her medical history.
Phillips applied for benefits on October 27, 1998, claiming disability since July 31, 1997, due to various medical conditions, including fibromyalgia and depression. An ALJ hearing was held on April 26, 2000, where Phillips provided testimony and her medical records from 1993 to 2000 were reviewed.
During the hearing, Phillips, a 45-year-old high school graduate with vocational training, detailed her 18-year career with the State of Georgia, where she held several positions until retiring due to her alleged disability. She indicated that she did not pursue less demanding work due to financial reasons and concerns about her retirement benefits. Her daily activities included reading, light household chores, shopping, and leisure travel, and she expressed that her emotional state, while moderately depressed, did not independently disable her. However, she acknowledged that stress exacerbated her physical conditions. The court ultimately vacated the district court's order and remanded the case for further review of her application.
In 1993, Phillips began treatment with Dr. Sam Schatten, a rheumatologist, for various symptoms including dryness in the eyes and mouth, memory loss, muscle pain, fatigue, and mitral valve prolapse. Dr. Schatten was her primary physician until her administrative hearing. In July 1995, Dr. William Whaley, an oncology and hematology specialist, suggested that Phillips might have Sjögren’s syndrome and noted her overall health despite a lengthy problem list. In February 1996, endocrinologist Dr. Olivia Mulligan reported normal test results after Phillips complained of night sweats and irritability.
By October 1996, Dr. Amy Lang, a physical medicine and rehabilitation specialist, assessed Phillips for persistent neck and back pain, which affected her daily activities and social life. Dr. Lang identified criteria for fibromyalgia and noted radiology findings of cervical disc herniation. In December 1996, psychologist Mary Melton terminated treatment for Phillips's resolved major depression, stating it was not disabling. Dr. Lang observed improvement in Phillips's neck pain and mobility and diagnosed several conditions, including cervical facet syndrome and regional myofascial pain syndrome.
Dr. Lang also provided heel inserts for a leg length discrepancy. Phillips received epidural steroid injections from Dr. Alfonso Dampog for cervical facet syndrome in late 1996 and early 1997. By February 1997, Dr. Lang noted a reduction in Phillips's fibromyalgia symptoms due to stabilization exercises. In May 1997, Dr. Lang documented ongoing issues, including Sjögren’s syndrome and cervical spondylosis, and mentioned that Phillips had not pursued certain treatments or prescriptions. Dr. Lang indicated Phillips intended to apply for long-term disability due to her inability to keep pace at work.
Dr. Lang reported that Phillips experienced significant pain and feelings of being overwhelmed by chronic pain and depression affecting her daily activities. On June 25, 1997, Dr. Whaley evaluated Phillips and conducted tests to determine if her disability was due to a medical condition (like hypothyroidism or lupus) or psychiatric issues. Following normal test results on July 16, 1997, Dr. Whaley stated there was uncertainty regarding Phillips's disability status, noting it was not due to conditions like anemia or lupus, and referred her to psychiatrist Dr. Gene Abel. On July 22, 1997, Dr. Dreyer diagnosed Phillips with chronic pain related to fibromyalgia and emphasized the need for aerobic exercise and stretching. Radiological assessments showed a normally aligned lumbar spine with mild degenerative changes. By November 5, 1998, Dr. Schatten reported Phillips engaged in water aerobics and walking regularly. On December 21, 1998, Dr. Whaley noted improvements in Phillips's exercise routine compared to previous years. A psychological evaluation on February 24, 1999, by Dr. Bible indicated Phillips managed various daily activities and was capable of simple work tasks but had mild issues with attention and persistence. On March 9, 1999, Dr. Horney diagnosed Phillips with irritable bowel syndrome after her reports of bowel irregularities. In January 1999, Dr. Cowles treated Phillips for urinary tract infections, noting full resolution of symptoms by April 19, 1999. By May 3, 1999, Dr. Schatten observed that while Phillips reported intermittent fatigue and pain, she generally felt better than before.
Dr. Schatten evaluated Phillips, diagnosing her with stable primary Sjögren’s syndrome, stable cervical myofascial pain syndrome, effectively treated urinary tract symptoms, osteoporosis, intermittent myalgias of the lower back and lower extremities with an unclear cause, and allergic sinusitis. In a functional capacities evaluation dated January 24, 2000, Dr. Schatten indicated that Phillips could work for three hours in an eight-hour day, sit for up to 30 minutes intermittently, and stand or walk for up to 30 minutes. She required to lie down three to four times daily for 30 minutes to an hour, could never lift more than ten pounds but could occasionally lift up to that weight, and could perform repetitive hand and foot actions. She could not crawl or climb, could occasionally bend, squat, or reach, and had mild restrictions with unprotected heights and climate changes, moderate restrictions with dust and fumes, but no restrictions with machinery or driving. Dr. Schatten's rationale included the diagnoses of Sjögren’s syndrome, fibromyalgia, myofascial pain, sleep disorder, cervical facet syndrome, and frequent urinary tract infections.
The excerpt outlines the five-step process an Administrative Law Judge (ALJ) follows in evaluating social security disability claims as per 20 C.F.R. § 404.1520, which includes assessing if the claimant is engaged in substantial gainful activity, determining the severity of impairments, checking if impairments meet specific listings, evaluating past relevant work capacity, and assessing the ability to perform other work in the national economy.
In Step One, the ALJ found that Phillips had not engaged in substantial gainful activity since July 31, 1997, confirming that she met the first step. In Step Two, the ALJ assessed the medical severity of Phillips' impairments, concluding that her Sjögren’s syndrome and fibromyalgia were "severe" impairments, allowing progression to Step Three.
At Step Three, the ALJ evaluates whether the claimant’s impairments meet or equal a listed disability as per 20 C.F.R. § 404.1520(a)(4)(iii). The listings are designed to expedite the decision-making process for severely impaired claimants who would likely be deemed disabled regardless of their work history. If the impairments meet the criteria and duration requirements, the claimant is found disabled. In Phillips's case, the ALJ determined her depression was not severe and concluded that her impairments did not meet or equal any listed impairments, leading to a transition to Step Four.
At Step Four, the ALJ assesses the claimant’s residual functional capacity (RFC) and ability to return to past relevant work, as per 20 C.F.R. § 404.1520(a)(4)(iv). RFC is defined as what an individual can still do despite their impairments (20 C.F.R. § 404.1545(a)). The ALJ evaluates all relevant medical evidence to determine the RFC, which informs the ability to return to past work or adjust to other work. If the claimant can return to previous work, they are not considered disabled. In Phillips's evaluation, the ALJ concluded that she has the RFC for limited entry-level sedentary work, citing her pain and fatigue as limitations, along with her need to handle tasks one at a time to manage stress.
The ALJ assigned minimal weight to Dr. Schatten's assessment of Phillips due to inconsistencies with his treatment notes and Phillips's own testimony regarding her daily activities. Conversely, the ALJ dismissed the findings of DDS consultative physicians regarding Phillips's ability to perform light work. Ultimately, the ALJ determined that Phillips could not return to her past relevant work but was capable of performing simple work, despite it being less desirable financially and in terms of job satisfaction.
The ALJ found that Phillips had a Residual Functional Capacity (RFC) for sedentary work and proceeded to step five of the disability evaluation process. At this stage, the ALJ evaluated Phillips's RFC, age, education, and work experience to determine her ability to adjust to other work in the national economy, as outlined in 20 C.F.R. § 404.1520(a)(4)(v). The ALJ noted that if a claimant cannot perform past relevant work due to severe impairments, a combination of RFC and vocational factors is assessed to determine if the claimant can adjust to other work.
Two methods exist for this determination: applying the Medical Vocational Guidelines or consulting a vocational expert. In Phillips's case, the ALJ exclusively used the Medical Vocational Guidelines, considering her ability to perform entry-level sedentary work, her age (45), her educational qualifications (high school diploma and one year of secretarial school), and her prior work experience. This analysis led to the conclusion that Phillips was not disabled.
Phillips appeals the ALJ's decision, arguing that the ALJ improperly dismissed the medical conclusions of Dr. Schatten regarding her residual functional capacity (RFC) and failed to consult a vocational expert. The court examines whether the ALJ erred in rejecting Dr. Schatten's opinion, which should be given substantial weight unless “good cause” is shown. Good cause exists if the treating physician's opinion lacks support from the evidence, contradicts other findings, or is inconsistent with the physician's own records. The ALJ provided legitimate reasons for minimizing Dr. Schatten's opinion, noting discrepancies between his restrictive assessment and prior treatment notes as well as Phillips's own testimony about her daily activities. Specifically, Dr. Schatten's restrictive assessment from January 2000 conflicted with his earlier observations from May 1999, which indicated that Phillips generally felt well aside from intermittent issues. Additionally, while Dr. Schatten suggested a sleep disorder contributed to Phillips’s disability, she reported sleeping well most nights. Furthermore, a consulting physician indicated that Phillips's urinary tract symptoms had resolved, contradicting her claims of daily issues. Consequently, the ALJ's decision to assign little weight to Dr. Schatten's opinion and to classify Phillips's work capacity as sedentary is supported by substantial evidence. The discussion also touches upon the ALJ's application of the five-step process for determining disability, particularly regarding when reliance on the grids is appropriate versus when a vocational expert is needed.
After assessing a claimant's Residual Functional Capacity (RFC) and ability to return to past relevant work, an Administrative Law Judge (ALJ) may utilize the grids to identify available jobs in the national economy. However, exclusive reliance on the grids is inappropriate if the claimant cannot perform a full range of work at a specific RFC level or has non-exertional impairments that significantly impede basic work skills.
The first condition requiring a consultation with a vocational expert arises when the claimant's exertional limitations restrict them from performing a full range of employment, defined as the ability to engage in unlimited work at the designated exertional level. If the ALJ finds that the claimant, in this case, Phillips, cannot perform such a full range at the sedentary level due to exertional limitations, a vocational expert must be consulted. Conversely, if Phillips is deemed capable of performing a full range of sedentary work despite exertional limitations, the ALJ must then evaluate the impact of her nonexertional limitations.
When assessing nonexertional limitations, the ALJ must determine whether these impairments significantly restrict Phillips's basic work skills, which is interpreted as preventing her from performing a wide range of work at the specified level. Should the ALJ conclude that these limitations do not significantly hinder her basic work skills, reliance on the grids is permissible to ascertain her disability status. If the limitations are found to significantly restrict her basic work skills, consulting a vocational expert becomes necessary.
The ALJ did not determine whether Phillips's exertional limitations prevented her from performing a full range of sedentary work, despite recognizing her Sjögren’s syndrome and fibromyalgia as severe impairments. There is uncertainty about whether these conditions significantly impact her exertional capabilities at the sedentary level. The ALJ also noted a nonexertional limitation, restricting Phillips to entry-level work due to her claim of needing to handle one task at a time to avoid stress. The ALJ must first assess whether this nonexertional limitation significantly restricts Phillips’s basic work skills and whether there are sufficient sedentary jobs that do not require multitasking. Since the ALJ failed to address these issues, the case is remanded to the Commissioner for reconsideration of Phillips’s disability insurance benefits application, emphasizing the need for the ALJ to conduct a thorough analysis before relying on vocational grids. The district court's order affirming the denial of benefits is vacated, but this opinion does not imply that Phillips is entitled to benefits.
