Opinion
2:24-CV-133-JEM
12-20-2024
WILLIAM CALDWELL, Plaintiff, v. CAROLYN W. COLVIN, Acting Commissioner of the Social Security Administration[1], Defendant.
OPINION AND ORDER
JOHN E. MARTIN, MAGISTRATE JUDGE
This matter is before the Court on a Complaint [DE 1] filed by Plaintiff William Campbell on April 15, 2024, and Plaintiff's Social Security Motion to Reverse and Remand the Decision Subject to Review [DE 12], filed July 10, 2024. Plaintiff requests that the decision of the Administrative Law Judge be reversed and remanded for further proceedings. On October 31, 2024, the Commissioner filed a response, and Plaintiff filed a reply on November 13, 2024. For the following reasons, the Court remands the Commissioner's decision.
I. Background
On December 23, 2021, Plaintiff filed an application for benefits alleging that he became disabled on August 1, 2019. Plaintiff's application was denied initially and upon consideration. On May 31, 2023, Administrative Law Judge (“ALJ”) Earl Ashford held a telephonic hearing at which Plaintiff, along with an attorney, and a vocational expert (“VE”), testified. On June 29, 2023, the ALJ issued a decision finding that Plaintiff was not disabled.
The ALJ made the following findings under the required five-step analysis:
1. The claimant met the insured status requirements of the Social Security Act through December 31, 2023.
2. The claimant has not engaged in substantial gainful activity since August 1, 2019, the alleged onset date.
3. The claimant has the following severe impairments: obesity, lumbar radiculopathy with a history of lumbar injury, and osteoarthritis of the right shoulder, resulting in mild subacromial impingement of the rotator cuff, edema, tendinitis, a cyst, and focal articular surface partial thickness tear at the footprint of the supra spinatus tendon (20 CFR 404.1520(c) and 416.920(c)).
4. The claimant does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1.
5. The claimant has the residual functional capacity (“RFC”) to perform light work except: postural limitations of occasional climbing of ladders, ropes, or scaffolds, frequent climbing of ramps and stairs, frequent balancing, stooping, kneeling, and crouching, occasional crawling, and occasional use of the bilateral lower extremities for operation of foot controls. Manipulative limitations of occasional use of the bilateral upper extremities for overhead reaching, and frequent use of the left upper extremity for other reaching, handling, and fingering. Environmental limitations to avoid more than occasional, concentrated exposure to moving mechanical parts and high exposed places.
6. The claimant is unable to perform any relevant past work.
7. The claimant was a younger individual age 18-49 on alleged disability onset date. The claimant subsequently changed age category to closely approaching advanced age.
8. The claimant has a high school education.
9. Transferability of job skills is not an issue in this case because using the Medical-Vocational Rules as a framework supports a finding that the claimant is “not disabled,” whether or not the claimant has transferable job skills.
10. Considering the claimant's age, education, work experience, and residual
functional capacity, there are jobs that exist in significant numbers in the national economy that the claimant can perform.
11. The claimant has not been under a disability, as defined in the Social Security Act, from August 1, 2019, through the date of the decision.
The Appeals Council denied Plaintiff's request for review, leaving the ALJ's decision the final decision of the Commissioner.
The parties filed forms of consent to have this case assigned to a United States Magistrate Judge to conduct all further proceedings and to order the entry of a final judgment in this case. [DE 9]. Therefore, this Court has jurisdiction to decide this case pursuant to 28 U.S.C. § 636(c) and 42 U.S.C. § 405(g).
II. Standard of Review
The Social Security Act authorizes judicial review of the final decision of the agency and indicates that the Commissioner's factual findings must be accepted as conclusive if supported by substantial evidence. 42 U.S.C. § 405(g). Thus, a court reviewing the findings of an ALJ “will reverse an ALJ's decision only if it is the result of an error of law or if it is unsupported by substantial evidence.” Tutwiler v. Kijakazi, 87 F.4th 853, 857 (7th Cir. 2023). “A reversal and remand may be required, however, if the ALJ committed an error of law, or if the ALJ based the decision on serious factual mistakes or omissions.” Beardsley v. Colvin, 758 F.3d 834, 837 (7th Cir. 2014). At a minimum, “[a]n ALJ must provide an adequate ‘logical bridge' connecting the evidence and [the] conclusions, but an ALJ's opinion need not specifically address every single piece of evidence.” Tutwiler v. Kijakazi, 87 F.4th 853, 857 (7th Cir. 2023) (quoting O'Connor-Spinner v. Astrue, 627 F.3d 614, 618 (7th Cir. 2010)).
III. Analysis
Plaintiff argues that the ALJ failed to consider whether Plaintiff's impairments met Listing 1.18 and failed to request an updated medical expert review incorporating all of the results of a May 2018 right shoulder MRI and an August 2019 Functional Capacity Assessment, which he argues were not considered by the medical expert review panel in preparing its August 2022 review. The Commissioner argues that the opinion is supported by substantial evidence and that the right shoulder MRI results and August 2019 FCA analysis were considered by the medical expert review panel in August 2022 so there was no need for an updated medical expert review. The Commissioner does not respond to the argument that Listing 1.18 should have been considered.
The Commissioner follows a five-step inquiry in evaluating claims for disability benefits under the Social Security Act:
(1) Whether the claimant is currently employed; (2) whether the claimant has a severe impairment; (3) whether the claimant's impairment is one that the Commissioner considers conclusively disabling; (4) if the claimant does not have a conclusively disabling impairment, whether she can perform her past relevant work; and (5) whether the claimant is capable of performing any work in the national economy.Kastner v. Astrue, 697 F.3d 642, 646 (7th Cir. 2012). The claimant bears the burden of proof at every step except step five. Clifford v. Apfel, 227 F.3d 863, 868 (7th Cir. 2000). The determination of whether a claimant suffers from a listed impairment occurs at steps two and three of the ALJ's analysis. At step three, the ALJ must determine whether the claimant's impairments meet an impairment listed in the appendix to the social security regulations. See 20 C.F.R. §§ 404.1520(a)(4)(iii), 416.920(a)(4)(iii). An individual suffering from an impairment that meets the description of a listing or its equivalent is conclusively presumed disabled. See Bowen v. Yuckert, 482 U.S. 137, 141 (1987). The claimant “has the burden of showing that his impairments meet a listing, and he must show that his impairments satisfy all of the various criteria specified in the 4 listing.” Ribaudo v. Barnhart, 458 F.3d 580, 583 (7th Cir. 2006); see also Sullivan v. Zebley, 493 U.S. 521, 530 (1990) (“For a claimant to show that his impairment matches a listing, it must meet all of the specified medical criteria.”); Filus v. Astrue, 694 F.3d 863, 868 (7th Cir. 2012) (claimant “had the burden of establishing that he met all of the requirements of a listed impairment”).
A. Step 3 Analysis
Plaintiff argues that the ALJ failed to consider Listing 1.18 for Plaintiff and remand is therefore required. Although the Commissioner did not respond to this argument, the Court will nonetheless consider it.
“At step three the ALJ decides whether the claimant has an impairment that meets or equals one of the categories listed in the agency's Listing of Impairments at 20 C.F.R. pt. 404, subpt. P, app. 1.” Zellweger v. Saul, 984 F.3d 1251, 1253 (7th Cir. 2021). If the criteria for a Listing are satisfied or medically equaled, then the claimant is determined to be disabled.
Plaintiff argues that the ALJ erred by not considering Listing 1.18, abnormality of a major joint(s) in any extremity. The applicable section provides, that an abnormality of a major joint must be documents by chronic pain or stiffness, and abnormal motion or immobility and anatomical abnormality with limitations lasting more than twelve months, and medical documentation of at least one of the following:
2. An inability to use one upper extremity or independently initiate, sustain, and complete work-related activities involving fine and gross movements [], and a documented medical need [] for a one-handed, hand-held assistive device [] that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand []; or
3. An inability to use both upper extremities to the extent that neither can be used to independently initiate, sustain, and complete work-related activities involving fine and gross movement [].
20 C.F.R. Pt. 404, Subpt. P, App. 1 § 1.18. Plaintiff argues that the ALJ failed to adequately analyze the Listing and Assessment.
The ALJ stated that Plaintiff has a severe impairment of “osteoarthritis of the right shoulder, resulting in mild subacromial impingement of the rotator cuff, edema, tendinitis, a cyst, and focal articular surface partial thickness tear at the footprint of the supra spinatus tendon.” There is no mention of Listing 1.18. The ALJ explicitly considered Listing 1.15, disorders of the skeletal spine resulting in compromise of a nerve root. The impairment related physical limitations and need for a medically necessary assistive device are the same for both Listing 1.15 and 1.18.
At Step 3 of the sequential process, Plaintiff bears the burden of proof. In his brief, Plaintiff has not identified evidence showing that he has:
2. An inability to use one upper extremity or independently initiate, sustain, and complete work-related activities involving fine and gross movements [], and a documented medical need [] for a one-handed, hand-held assistive device [] that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand []; or
3. An inability to use both upper extremities to the extent that neither can be used to independently initiate, sustain, and complete work-related activities involving fine and gross movement [].
20 C.F.R. Pt. 404, Subpt. P, App. 1 § 1.18. The lack of this also prevents Listing 1.18 being met.
The ALJ addressed Plaintiff's shoulder impairment in the RFC determination but did not mention Listing 1.18. However, the ALJ did discuss Plaintiff's shoulder impairment, and the evidence supports the ALJ's finding that Plaintiff's shoulder impairment limited his ability to use it frequently. Plaintiff adduced no evidence of his having a documented medical need for an assistive device. Therefore, any potential error in failing to discuss Listing 1.18 is harmless. Schomas v. Colvin, 732 F.3d 702, 707-08 (7th Cir. 2013) (“[W]e will not remand a case to the ALJ for further explanation if we can predict with great confidence that the result on remand would be the same”). Since the ALJ discussed Plaintiff's shoulder impairment and there was no evidence of 6 an assistive device, it is clear that the ALJ would not find that Plaintiff meets the requirements for Listing 1.18.
Plaintiff has not presented a fully supported argument that would show the ALJ's Step 3 determination to be erroneous regarding Listing 1.18. The Court will not order remand on this basis.
B. Updated Medical Review
Plaintiff also argues that the ALJ failed to request an updated medical expert review incorporating all of the results of a May 2018 right shoulder MRI and an August 2019 Functional Capacity Assessment, which he argues were not considered by the medical expert review panel in preparing its August 2022 review. The Commissioner argues that the was considered by the medical expert review panel in August 2022 and Plaintiff has not articulated how the MRI from May 2018, over a year before the alleged onset date, constituted “new and potentially decisive evidence” so as to require an updated medical expert review. See Goins v. Colvin, 764 F.3d 677, 680 (7th Cir. 2014). The Commissioner argues that Plaintiff has therefore forfeited this argument.
The ALJ considered the May 2018 right shoulder MRI and referenced the findings from that MRI in the RFC analysis. R. p. 22. The ALJ also referenced the August,2019 FCA and incorporated its noted restrictions in the RFC. The August 2022 medical review list of data received does not appear to reference the May 2018 right shoulder MRI as one of documents received by the medical expert panel. R. 66-79. The medical panel does seem to have considered the FCA, as, as the Commissioner pointed out, the FCA was submitted via fax on March 17, 2022, and the review reports indicate that documents received from counsel on that date were reviewed. R. 53, 68.
Neither the ALJ nor this Court are qualified to interpret the May 2018 MRI report. “ALJs are not qualified to evaluate medical records themselves, but must rely on expert opinions.” Moreno v. Berryhill, 882 F.3d 722, 729 (7th Cir. 2018)) (citing Meuser v. Colvin, 838 F.3d 905, 911 (7th Cir. 2016) (remanding because the ALJ improperly “played doctor”); see also Childress v. Colvin, 845 F.3d 789, 792 (7th Cir. 2017) (describing the evidence of non-treating physicians who had not had access to the full medical record as “worthless”). Rather, the reports should be interpreted by an expert and only then should the ALJ rely on them in forming Plaintiff's RFC. See Goins v. Colvin, 764 F.3d 677, 680 (7th Cir. 2014) (“Fatally, the administrative law judge failed to submit that MRI to medical scrutiny, as she should have done since it was new and potentially decisive medical evidence.”). After all, this evidence undermines the ALJ's reasoning that “however, the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms are not entirely consistent with the medical evidence and other evidence.” R. at 17. See Goins, 764 F.3d at 680; cf. Arnold v. Kijakazi, No. 19-3040, 2022 WL 409685, at *3 (C.D. Ill. Feb. 9, 2022) (“While the ALJ did not assess or analyze the results of the MRI as in McHenry, the ALJ failed to consider those opinions which resulted in a de facto medical judgment, thereby violating the principle of Goins and McHenry. . . It is speculation to presume that the opinions of Dr. DeBartolo and the state agency reconsideration physician, Dr. Hinchen, would not have changed if they had been aware of the additional medical imaging.”). Insofar as “Social Security proceedings are inquisitorial rather than adversarial,” see Sims v. Apfel, 530 U.S. 103, 110-11 (2000), and “[i]t is the ALJ's duty to investigate the facts and develop the arguments both for and against granting benefits,” Id. at 111, the ALJ should have submitted the 2018 MRI for expert review and thus completed the record.
IV. Conclusion
For the foregoing reasons, the Court hereby GRANTS the relief requested in the Plaintiff's Social Security Motion to Reverse and Remand the Decision Subject to Review [DE 12] and REMANDS this matter for further proceedings consistent with this opinion.
SO ORDERED.