Opinion
C.A. No. 04-2068.
March 21, 2005
MEMORANDUM OPINION AND ORDER
Plaintiff Ronald S. Honig ("Honig") seeks judicial review under 42 U.S.C. § 405(g) and 42 U.S.C. § 1383 of the decision of the Commissioner of Social Security, who found that plaintiff was not entitled to Disability Insurance ("DIB") and Supplemental Security Income Disability ("SSI") under titles II and XVI of the Social Security Act ("Act"), 42 U.S.C. §§ 401- 433, 1381-1383(f). Presently before the court are the parties' cross-motions for summary judgment and the plaintiff's reply brief. For the reasons which follow, we find the Administrative Law Judge ("ALJ") was not supported by substantial evidence when he concluded the benefits should be denied. Accordingly, the motion of the defendant will be denied, the motion for the plaintiff will be granted and the case will be remanded for further proceedings.
STANDARD OF REVIEW
When reviewing a denial of a claimant's application, a reviewing court applies the "substantial evidence" standard.See 42 U.S.C. § 405(g); Burns v. Barnhart, 312 F.3d 113 (3d Cir. 2002). "Substantial evidence is `more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate'." Ventura v. Shalala, 55 F.3d 900, 901 (3d Cir. 1995) (quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)). This court is not empowered to weigh the evidence or substitute its conclusions for those of the fact-finder."Williams v. Sullivan, 970 F.2d 1178, 1182 (3d Cir. 1992).PROCEDURAL HISTORY
Honig protectively filed an application for DIB and SSI on September 7, 2001, R-15, alleging the onset of permanent disability as of August 30, 2000 due to pains in his left leg.Id. After his application was initially denied, Honig requested and was granted a hearing before an ALJ, which was held on September 4, 2002. Id. A decision was issued on December 14, 2002, denying benefits. R-22.
The Social Security Administration applies a five-step evaluation process to determine if a claimant is disabled for purposes of qualifying for disability benefits and supplemental security income. The ALJ considers, in sequence, whether a claimant: 1) worked during the period of alleged disability; 2) had a severe impairment; 3) had an impairment that meets or equals the requirements of a listed impairment; 4) could return to his past relevant work; and 5) if not, whether he could perform other work in the national economy.See 20 C.F.R. § 416.920 (2002); see also Burns, 312 F.3d at 118-19. If the ALJ finds that the claimant is disabled or not disabled at any point in the analysis, the ALJ does not review the claim further. See 20 C.F.R. § 416.920 (2002).
After reviewing the evidence, including that submitted post-hearing, and hearing the testimony from Honig and a vocation expert ("VE"), the ALJ determined that Honig was not eligible for benefits at step four in the process. R-21-22. The ALJ found that while Honig's mental impairments were severe in satisfying step two of the analysis, they did not meet a disability listing and did not preclude the plaintiff from returning to past relevant work as a laborer. R-21-22.
It is unclear whether the plaintiff's experience as a laborer qualifies as past relevant work. Rather, it seems that this was an unsuccessful work attempt. However, the record is not fully developed as to exactly what job this was, the duration of the employment, and the circumstances under which it was terminated.
At his hearing before the ALJ, Honig testified to seeing a psychiatrist regularly. R-534-535. The plaintiff testified that he has a driver's license, but never drives. R-529. Further, although he lives near a train station, the plaintiff testified that he takes the bus on a regular basis since he has never been on a train nor a subway. R-530-532. The plaintiff is 44 years old and testified that he still lives with his father, having never moved out of his parent's home. R-523-524, 557. He testified to being fired from some jobs for not working fast enough and from a restaurant job for eating the food without permission. R-532-33. He recounted being fired from yet another position as a machine operator for what was deemed an unsafe practice of sticking his arm in the machinery. R-534-535. The plaintiff testified that he only talks to people on the Internet and through phone chat rooms but does not have any "live" friends. R-540. He further testified to having strained relationships with his family, including his father. R-542.
In his motion for summary judgment, Honig argues that the ALJ erred by (1) rejecting his treating psychiatrist's opinion; (2) discounting plaintiff's credibility without allowing the plaintiff a full opportunity to testify; (3) accepting plaintiff's experiences as a laborer to constitute past relevant work; and, (4) failing to incorporate all of the plaintiff's limitations in they hypothetical question presented to the VE. Because we find the ALJ failed to adequately credit the treating psychiatrist's opinion, we need not consider the other claims.
DISCUSSION
A treating physician's opinion will be given controlling weight when it is "well supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record." 20 C.F.R. § 416.927(d)(2). An ALJ may reject a treating physician's opinion outright only on the basis of contradictory medical evidence and it is an error of law to do so without an adequate explanation.Plummer v. Apfel, 186 F.3d 422, 429 (3d Cir. 1999); Allen v. Bowen, 881 F.2d 37, 42 (3d Cir. 1989). Final determinations of the ultimate issue of a claimant's disability are reserved to the Commissioner. See 20 C.F.R. § 416.927.
Dr. London-Barrett listed as plaintiff's symptoms: poor memory, sleep disturbance, mood disturbance, delusions or hallucinations, and social withdrawal or isolation. R. 465-470. The doctor assessed as "fair", the claimant's ability to carry out very short and simple instructions, to ask simple questions or request assistance, and to get along with co-workers or peers with undue distraction or exhibiting behavioral extremes. Id. The claimant was rated as having "good" ability to be aware of normal hazards and take appropriate precautions. Id. However, in all other areas assessed by Dr. London-Barrett, the claimant's abilities were rated as poor to none at all. Id. In addition, the claimant's functional limitations were characterized as "moderate" in daily living, as "marked" in maintaining social functioning, and as "marked" in concentration. Id. Dr. London-Barrett also reported "three or more" episodes of deterioration or decompensation.Id.
Not only does the ALJ fail to adequately explain the decision to disregard Dr. London-Barrett's opinion, but the two opinions the ALJ does credit appear to actually support rather then contradict Dr. London-Barrett's assessment. The ALJ's statement that Dr. London-Barrett's assessment is inconsistent with those of John D. Rosella, Ph.D., and Kal Weidenfeld, a licensed psychologist R-17, without more, falls far short of the explanation needed to sustain a rejection of a treating psychiatrist's opinion. Here, the ALJ simply summarized Dr. London-Barrett's findings, declared them inconsistent with other medical evidence, went on to summarize Dr. Rosella's and Dr. Weidenfeld's findings, and never indicated what differences she found between the opinions. While "an ALJ is not required to supply a comprehensive explanation," more then a declarative statement that the evidence is inconsistent is necessary to reject otherwise probative evidence. Cotter v. Harris, 650 F.2d 481, 482 (3d Cir. 1981).
A cursory reading of the three relevant opinions fails to disclose what inconsistencies exist. A more careful reading of the two non-treating opinions show that they are not only consistent with Dr. London-Barrett's opinion, but supporting. Dr. Rosella's assessment, to which the ALJ gave significant weight, seems to go even further than Dr. London-Barrett in limiting the plaintiff's abilities. As discussed in more detail below, the three doctor's opinions were consistent in the areas of diagnosis, social functioning, psychotic symptoms, inappropriate behaviors, concentration and memory.
The only substantive difference between the opinions was the purpose for their creation and thus their relative bearing on a disability hearing. Dr. Weidenfeld's analysis did not extend to the plaintiff's ability to work, but rather whether he presented a risk to the community. While, Dr. Rosella's opinion did not squarely address the plaintiff's ability to work, the purpose of the assessment was to determine the plaintiff's ability to enter a vocational rehabilitation program. R-379-385. Specifically, the stated reason for Dr. Rosella's evaluation was to "determine [Honig's] cognitive and emotional dysfunction and potential assets that he could bring to an employment situation." R-379. It is important to note that among other things, Dr. Rosella found that the plaintiff is not capable of entering a vocational rehabilitation program. R-385. Dr. Rosella stated that psychiatric/psychological intervention was necessary before allowing the plaintiff to enter such a program. Id. Dr. London-Barrett was the only doctor to directly consider the plaintiff's conditions in relation to the requirements of a disability listing. R-17-18, 465-470. Therefore, to the extent that other differences exist because a physician failed to report on one element or another of the plaintiff's condition, a comparison is colored by the different stated purposes of the reports.
The plaintiff pled guilty and was convicted of some criminal misdemeanors in 2001. R-222-224. Following the legal proceedings, the plaintiff was referred to Dr. Weidenfeld, by his psychiatrist, for further evaluation and treatment. Id. Specifically, Dr. Weidenfled opined as to whether the plaintiff presented a current threat or danger to the community. Id.
The ALJ noted that if Dr. London-Barrett's opinion was credited, it would follow that the "claimant's mental impairment is attendant with the degree of severity" to meet the listing in section 12.04. R-17.
The long list of compliments and similarities in the three opinions makes it difficult to understand what inconsistencies the ALJ was referring to. Dr. London-Barrett and Dr. Rosella both diagnosed the plaintiff with schizotypal personality disorder, while calling attention to other mood disorders such as major depressive disorder and psychotic features including schizoid/schizotypal traits. R-462-465, 380-384. This diagnosis seems to be accepted by the ALJ, who refers to it at step two of the process: "[t]he medical evidence of record establishes that the claimant has been diagnosed with a mood disorder . . . and schizoid/schizotypical traits." R-16. The finding of psychotic symptoms was supported by the existence of delusions, hallucinations, and paranoia as reported by Dr. London-Barrett. R.465-66. Dr. Rosella's conclusion to this point was supported by the findings of Plaintiff's Minnesota Multi-Phasic Personality Inventory, one of ten tests run by Dr. Rosella. R-379-80, 384. Dr. Weidenfeld did not reach a diagnosis, but did note psychological impairments characterized by social and psychological avoidance. R-222-223.
All three doctors note problems in social functioning including withdrawal, isolation, and marginal social adjustment. R-222, 382, 384, 465. The doctors suggest that this failure to function extends beyond normal social interactions into family relationships. R-222-223, 380. Further, each doctor recorded evidence of odd, eccentric or socially inappropriate behavior. Dr. London-Barrett noted oddities in thought perception, speech and behavior as well as vague thought processes. R-465-66. Dr. Weidenfeld noted that the Plaintiff's conviction for indecent exposure was attention-seeking not sexually driven and was entirely consistent with his psychological profile. R-222-223. Dr. Rosella commented on the plaintiff's impulse control problems in that while sitting in the waiting room, the plaintiff was observed having a tendancy to steal small items such as magazines. R-380.
The ALJ did not allow the plaintiff to fully develop the testimony concerning deficits in social functioning, however it is clearly documented in other parts of the record. R-222, 382, 384, 465, 530-32, 536-38, 542-43, 545-46.
Both Dr. London-Barrett and Dr. Rosella made considerable comments concerning extensive impairments in the plaintiff's concentration and memory. Presumably because concentration and memory has no bearing on an individual's danger to the community, Dr. Weidenfeld did not address this area. Dr. London-Barrett assessed marked impairments in concentration, persistence and pace, noting that plaintiff is easily confused with minor details, has no ability to remember work-like procedures, understand and remember very short and simple instructions, maintain attention for two hour segments, and maintain regular attendance and be punctual. R-468. Dr. Rosella performed extensive testing in this area and found that the plaintiff's memory and concentration were very impaired. Specifically, Dr. Rosella characterized Honig's visual memory as poor, his short term memory as impaired, and his ability to remember words on a list as poor.
Finally, both Dr. Rosella and Dr. London-Barrett gave the plaintiff a Global Assessment of Functioning (GAF) score at 50 or below. The definition of such a score includes "serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational or school functioning (e.g., no friends, unable to keep a job)." DSM-IV at 32. Again, Dr. Weidenfeld did not assign a GAF number.
The ALJ's rejection of Dr. London-Barrett's opinion because of inconsistencies and without appropriate explanation was in error. Given this error, the ALJ's decision is not based on substantial evidence. Therefore, the case is remanded for further consideration consistent with this opinion.
ORDER
The motion of the plaintiff for summary judgment is GRANTED.The motion of the defendant for summary judgment is DENIED.
Judgment is ENTERED in favor of the plaintiff and against the defendant.
The action is REMANDED to the Commissioner for further proceedings consistent with this Opinion.
IT IS SO ORDERED.