Opinion
No. CA 98-0747-P-C.
April 18, 2000.
REPORT AND RECOMMENDATION
Plaintiff brings this action pursuant to 42 U.S.C. § 405(g) and 1383(c)(3), seeking judicial review of a final decision of the Commissioner of Social Security denying her claim for disability insurance benefits and supplemental security income. This action has been referred to the Magistrate Judge for report and recommendation pursuant to 28 U.S.C. § 636(b)(1)(B). Upon consideration of the administrative record, plaintiffs statement of issues, the Commissioner's response to the statement of issues, the parties' arguments at the March 3, 2000 hearing before Magistrate Judge Kristi D. Lee, and the post-argument briefs of the parties, the undersigned recommends that the Commissioner's decision denying benefits be reversed and that this cause be remanded for an award of benefits.
Plaintiff alleges disability due to Cushing's syndrome, hypertension, diabetes mellitus, degenerative disc disease at L5-S1 and depression. The Administrative Law Judge (ALJ) determined that the claimant retains "the residual functional capacity to perform the exertional and nonexertional requirements of work except for mild depression and an inability to engage in work requiring more than lifting 20 pounds occasionally and lifting and/or carrying 10 pounds frequently, standing six hours during a workday and sitting six hours during a workday." (Tr. 240, Finding No. 5) Relying on the vocational expert's testimony, the ALJ further determined that "the claimant's exertional and nonexertional limitations would not prevent her from performing her past relevant work as a fast food worker and as a cashier in a fast food restaurant[,]" and therefore, concluded that she can perform such past relevant work (Tr. 241, Finding No. 6). The Appeals Council affirmed the ALJ's decision (Tr. 222-223) and thus, the hearing decision became the final decision of the Commissioner of Social Security.
DISCUSSION
In all Social Security cases, the claimant bears the burden of proving that she is unable to perform her previous work. Jones v. Bowen, 810 F.2d 1001 (11th Cir. 1986). In evaluating whether the claimant has met this burden, the examiner must consider the following four factors: (1) objective medical facts and clinical findings; (2) diagnoses of examining physicians; (3) evidence of pain; and (4) the claimant's age, education and work history. Id. at 1005. Once the claimant meets this burden it becomes the Commissioner's burden to prove that the claimant is capable, given her age, education and work history, of engaging in another kind of substantial gainful employment which exists in the national economy. Sryock v. Heckler, 764 F.2d 834, 836 (11th Cir. 1985).
The task for the Magistrate Judge is to determine whether the Commissioner's decision to deny claimant benefits, on the basis that she can perform her past relevant work as a fast food worker and cashier in a fast food restaurant, is supported by substantial evidence. Substantial evidence is defined as more than a scintilla and means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Richardson v. Perales, 402 U.S. 389, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971). "In determining whether substantial evidence exists, we must view the record as a whole, taking into account evidence favorable as well as unfavorable to the [Commissioner's] decision." Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986).
This Court's review of the Commissioner's application of legal principles, however, is plenary. Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987).
The plaintiff claims that (1) the ALJ erred in rejecting the opinion of her treating physician, Dr. Kathryn Pitman, (2) failed to comply with the undersigned's February 21, 1997 remand order, and (3) erred in finding that she has the residual functional capacity to perform light work. The undersigned will not address the plaintiffs claims singly. Rather, all of these issues will be touched upon as the undersigned sets out the reasons why the Commissioner's decision denying plaintiff benefits is due to be reversed.
Prior to setting out the reasons for reversal in this case, however, the undersigned discusses in some detail plaintiffs primary impairment upon which she makes her claim of disability, Cushing's syndrome. "Cushings Syndrome is a condition in which the body overproduces cortisol." Tivoli v. United States, 1996 WL 1056005, * 1 (S.D.N Y 1996), aff'd, 164 F.3d 619 (2nd Cir. 1998); see also Tr. 216 ("Cushing syndrome refers to chronic hypercortisolism (excessive levels if circulating cortisol) caused by hyperfunction of the adrenal cortex, with or without pituitary involvement.").
Clinical manifestations include rounded "moon" facies with a plethoric appearance. There is truncal obesity with prominent supraclavicular and dorsal cervical fat pads ("buffalo hump"); the distal extremities and fingers are usually quite slender. Muscle wasting and weakness are present. The skin is thin and atrophic, with poor wound healing and easy bruising. Purple striae may appear on the abdomen. Hypertension, renal calculi, osteoporosis, glucose intolerance, reduced resistance to infection, and psychiatric disturbances are common. . . Females usually have menstrual irregularities.
. . .
Bilateral adrenalectomy is reserved for patients with pituitary hyperadrenocorticism who do not respond to both pituitary exploration (with possible adenomectomy) and irradiation, which usually restore pituitary function to normal. Adrenalectomy requires steroid replacement for the remainder of the patient's life, in the same pattern as is required for primary adrenal failure.
. . .
Even after a presumed total adrenalectomy, functional regrowth occurs in about a third of patients.
THE MERCK MANUAL, 106, 108 109 (17th ed. 1999); see also Tr. 216 218 ("Most of the clinical signs and symptoms of Cushing syndrome are caused by hypercortisolism. . . . Weight gain is the most common feature and results from the accumulation of adipose tissue in the trunk, facial and cervical areas. These characteristic patterns of fat deposition have been described as `truncal obesity,' `moon face,' and `buffalo hump[.]'. . . Overt diabetes mellitus develops in approximately 20% of individuals with hypercortisolism. . . . Protein wasting is commonly observed in hypercortisolism and is caused by the catabolic effects of cortisol on peripheral tissues. Muscle wasting, especially obvious in the muscles of the extremities, leads to muscle weakness. In bone, loss of the protein matrix leads to osteoporosis, with pathologic fractures, vertebral compression fractures, bone and back pain, kyphosis, and reduced height. Bone disease may contribute to hypercalsuria and resulting renal stones, which are experienced by approximately 20% of individuals with disease. Loss of collagen also leads to thin, weakened integumentary tissues through which capillaries are more visible and which are easily stretched by adipose deposits. Together, these changes account for the characteristic purple striae most frequently observed in the trunk area. Loss of collagenous support around small vessels makes them susceptible to rupture, leading to easy bruising, even with minor trauma. Thin, atrophic skin is also easily damaged, leading to skin breaks and ulcerations. Hyperpigmentation in Cushing syndrome is associated with very high serum levels of ACTH. . . . Elevated blood pressure occurs in most individuals with Cushing syndrome. Chronically elevated cortisol levels also cause suppression of the immune system, so that individuals with Cushing syndrome have an increased susceptibility to infections. Approximately 50% of individuals with Cushing syndrome experience alterations in their mental status. These may range from irritability and depression to severe psychiatric disturbances such as schizophrenia. . . . Females may experience symptoms of increased adrenal androgen levels, increased hair growth (especially facial hair), acne, and oligoamenorrhea. . . Without treatment, approximately 50% of individuals with Cushing syndrome die within 5 years of onset. Major causes of death are overwhelming infection, suicide, complications from generalized arteriosclerosis, and hypertensive disease.").
Against this background, the undersigned discusses the medical evidence in this case and the decision of the Commissioner denying plaintiff benefits. The medical record reveals evidence of a history of Cushing's syndrome back to 1983 (Tr. 177 ("P[atien]t d[iagnose]d [with] Cushings 1983 [secondary] to bilat[eral] adrenal hyperplasia. P[atien]t had bilat[eral] adrenalectomy at that time [and] was placed on Cortisol replacement t[reatment]."); see Tr. 119 ("There is some accumulation of fat in the midline over the upper thoracic spine giv[ing] a "buffalo hump' type appearance that one sees quite often with Cushing's syndrome."); Tr. 120 ("She has been treated for Cushing disease in the past with a bilateral adrenalectomy.")), well before plaintiffs applications for benefits and alleged onset date of June, 1993 (Tr. 15 ("Prior to the [June 28, 1994] hearing, the claimant submitted a written request to change her alleged date of disability onset from January 1, 1993, to June n/f, 1993, due to her work activity through late June, 1993[.]")). It is clear that in 1994, however, that plaintiff had a severe recurrence of Cushing's syndrome and began making regular visits to the Stanton Road Clinic, the Mobile County Health Center and the University of South Alabama Medical Center. (Tr. 140-177)
On March 6, 1994, plaintiff presented to the University of South Alabama Medical Center complaining of a severe headache and expressing the opinion that she thought her blood pressure was high. (Tr. 151) Blood pressure readings were high and plaintiff stayed at the hospital until some control was obtained over her hypertension. (Tr. 149) On discharge, plaintiff was instructed to make an appointment at the Board of Health within the week so that her medication could be adjusted and a thyroid function test could be performed. (Tr. 15) On March 8, 1994, plaintiff visited the Mobile County Health Department. (Tr. 141) Her blood pressure was 130/90; Dr. Eichold told her to continue her medications. ( Id.) Laboratory testing of a sample of plaintiffs blood revealed several high readings. (Tr. 143-144) Approximately one month later on April 19, 1994, Dr. Eichold noted that plaintiffs diabetes mellitus was "poor[.]" (Tr. 140)
Plaintiff began seeing various physicians at Stanton Road Clinic, primarily Drs. William Davidson and Gail Tolbert, on a regular basis beginning on August 31, 1994. (Tr. 169; see also Tr. 167-168, 171-172, 178-191) On August 31. 1994, Dr. Davidson noted the following characteristics: facial hirsutism and acne, buffalo hump, increased pigmentation over the upper back and central obesity. (Tr. 169) Davidson's assessment/plan on this date reads in pertinent part as follows:
On recent Hosp (8/94) at USAMC for syncope pt was noted to have [increase]d urinary free cortisol [with] [decreased] ACTH levels. High dose Dex suppression test on 8/5/94 revealed cortisol level of 21.1. Has some sort of non-ACTH dependent process, most likely an adrenal adenoma. As Pt has already had NL head CT pituitary MRI done 8/94. Will schedule outpt CT of adrenal glands bilat [with and without] contrast. Will also collect 24 urine for free cortisol cretine.
The CT scan of plaintiffs adrenal glands and the testing of plaintiffs urine on this date are not evident in the record.
(Tr. 177 (footnote added)) Approximately one week later Kirksey returned to Stanton Road Clinic and was examined by Dr. Gail Tolbert. (Tr. 167) Tolbert noted that plaintiffs hypertension and diabetes mellitus were poorly controlled and also took note of Kirksey's complaints of persistent episodes of weakness, weight gain and prolonged menses. (Tr. 167) Tolbert ordered cretine and free cortisol testing and a CT scan of the abdomen. (Id.) The free cortisol urine test was out of range with a reading of 109.4 H (the reference range being 20 to 90) (Tr. 160) and the CT scan of the abdomen revealed probable right-sided nephrolithiasis and post-surgical changes bilaterally in the renal hila (Tr. 168). Following all testing and having seen plaintiff for numerous months for her Cushing's syndrome and associated uncontrolled hypertension and diabetes, Drs. Tolbert and Davidson determined that the best mode of treatment was for plaintiff to undergo an adrenalectomy. ( See Tr. 174) Plaintiff was hospitalized from December 4, 1994 to December 15, 1994, during which time either a left adrenalectomy or a bilateral adrenalectomy was performed ( compare Tr. 174 with Tr. 184); an adrenal adenoma was found (Tr. 174). Kirksey's hospital course was described by her surgeon, Dr. Dana Keiss, as follows: "The patient is a 41 year old black female who presented for adrenalectomy secondary to recurrence of Cushing's syndrome. The patient was complaining of increased blood pressure, back pain, headache with menstrual cycle. The patient was also complaining of ascites. The patient has a history of bilateral adrenalectomies in 1983. . . Physical examination was notable for hirsutism, trunk obesity and acne. . . . The final pathology was black adenoma on the adrenal adenoma. Postoperatively, the patient continued to have hypertension and hyperglycemia. . . . At the time of discharge, the patient was doing well except for increased blood pressure of 160s over 100s and hyperglycemia." (Tr. 174)
Plaintiff's blood pressure was elevated to 160/110 on this first visit to Davidson. (Tr. 169) Some time was spent in the doctor's office getting Kirksey's blood pressure regulated. (Id.)
Plaintiff's Cushing's syndrome continued to be monitored by either Dr. Tolbert or Dr. Davidson once to twice monthly throughout 1995. ( See Tr. 171-172 178-191) On January 25, 1995, Dr. Tolbert, one of plaintiffs treating physicians, noted on a Social Security disability questionnaire that Kirksey was presently disabled due to the Cushing's syndrome and associated hypertension, diabetes, muscle wasting and psychosis; however, Tolbert was only able to state that the estimated length of disability was unknown. (Tr. 171-172) Tolbert noted that plaintiff's problems were severe and that those problems were being treated monthly with steroids, blood pressure medication and insulin. ( See id.) Finally, Tolbert noted that plaintiffs compliance with treatment was excellent. (Tr. 172) The remaining evidence from 1995 reveals that it was not until mid-August that the signs of hyperadrenalism (i.e., hirsutism, buffalo hump, etc.) were no longer present (Tr. 184-191); nevertheless, plaintiff continued to see the internists at Stanton Road Clinic throughout the remaining months of 1995 for follow-up on the Cushing's syndrome and monitoring of her steroid medication and other medications (Tr. 178-1 83)
On that date, Tolbert examined plaintiff, finding her anxious, generalized weakness in the extremities, and noting the buffalo hump, hirsutism and pigmented lesions over her back. (Tr. 154) Kirksey was also seen by Tolbert on January 18, 1995; plaintiff related weakness and fatigue since her discharge from the hospital. (Tr. 156) Tolbert found decreased spontaneity on examination. ( Id.)
X-rays of plaintiffs lumbar spine on February 22, 1995 revealed degenerative disc disease of L5-S1 (Tr. 213), while x-rays of her cervical spine and thoracic spine on April 5, 1995, revealed possible left C4-C5 neural foramen narrowing and degenerative changes in thoracic vertebrae (Tr. 212).
In light of the medical evidence of record relating to plaintiffs Cushing's syndrome from the spring and summer of 1994 up to the date of the Commissioner's July 25, 1995 administrative decision and Dr. Gail Tolbert's January 25, 1995 indeterminate disability opinion, which the Commissioner accepted as true in his July 27, 1995 decision ( see Tr. 23), this Court, on February 21, 1997, remanded this case to the Commissioner of Social Security, explaining that "[w]here, as here, the record contains an indeterminate disability opinion from a treating opinion, which is accepted by the ALJ, but no subsequent physical capacities evaluation establishing the claimant's residual functional capacity, an ALJ's decision that the claimant retains the residual functional capacity to perform her prior work is not supported by substantial evidence." (Tr. 353) Clearly implicit within this finding is that the Commissioner had no evidence before him when he entered his initial decision on July 27, 1995 with which to overcome Tolbert's January 25, 1995 disability determination and thereby establish any support for the determination that plaintiff could perform her prior relevant work. In other words, the evidence of record from at least July of 1994 ( see Tr. 177) (and very possibly from March of 1994) forward to the entry of the Commissioner's first decision clearly established that plaintiff could not perform her past relevant work. Therefore, the Court remanded this case so that the Commissioner could address this identified deficiency and "revisit the issue of whether the evidence establishes at least a closed period of disability with respect to the Cushing syndrome." (Tr. 354)
In the July 27, 1995 denial of benefits decision, the Commissioner noted Tolbert's indeterminate disability opinion (Tr. 19 ("On January 25, 1995, claimant's treating physician, Dr. Gail Tolbert, indicated she had first treated the claimant on August 31, 1994, and had been treating her monthly since then. She indicated the claimant's impairments were severe, adversely affected her ability to work, that the issue of pain was not applicable, that the claimant was disabled `at the present time' and the estimated length of disability was unknown. She indicated the claimant exercised excellent compliance with her medications, that her multiple health problems had adversely affected her daily functioning, and that any stressful situation would likely provoke an undesirable situation[.]")) but did not reject this opinion. Rather, the Commissioner analyzed Tolbert's indeterminate disability opinion and plaintiffs Cushing's syndrome as follows: "Although the claimant experienced an exacerbation of her hypertension in early 1994, her condition was stabilized by treatment in the emergency room and subsequent examinations were within normal limits, although her blood sugar was slightly elevated. Her medication controlled her symptomotology until September, 1994 when she experienced a reoccurrence of Cushing's disease which resulted in surgery. At the same time, her diabetes and hypertension were adversely affected, however, these impairments were brought under control subsequent to her surgery and, by January 18, 1995, she was in no apparent distress with no complaints of dyspnea, headaches or pain. The claimant's reoccurrence of Cushing's and exacerbation of her hypertension and diabetes was of short duration and resolved by surgery and medication. Although her treating physician considered her disabled at that time, she also indicated that the claimant exercised excellent compliance with her medications and the length of disability was unknown. Consequently, it is reasonable to conclude that the claimant's impairment, while temporarily disabling, would not remain so severe as to prohibit work activity for a period of not less than twelve consecutive calendar months." (Tr. 20-21) Clearly, therefore, under Eleventh Circuit case law, the Commissioner accepted Tolbert's indeterminate disability opinion as true. MacGregor v. Bowen, 786 F.2d 1050, 1053 (11th Cir. 1986) ("The testimony of a treating physician must ordinarily be given substantial or considerable weight unless good cause is shown to the contrary. The Secretary must specify what weight is given to a treating physician's opinion and any reason for giving it no weight, and failure to do so is reversible error. . . Where the Secretary has ignored or failed properly to refute a treating physician's testimony, we hold as a matter of law that he has accepted it as true.").
In remanding this case on February 21, 1997, the Court had hopes that the Commissioner would contact Dr. Tolbert and garner an opinion from her about when plaintiffs disability due to Cushing's syndrome had ended or if it could ever be expected to end. Alternatively, the undersigned thought that the Commissioner might obtain a consultative evaluation and an opinion from that consultant regarding the likely length of plaintiffs disability due to Cushing's syndrome and her present condition. Unfortunately, however, these avenues were not pursued. ( See Tr. 229-24 1) In fact, the latest opinion ignores the closed period of disability issue by failing to set forth the entirety of the evidence of record in his decision. ( See Tr. 234-235)
The medical records . . ., reflect that in March 1995 (sic), the claimant was seen at the University of South Alabama Medical Center emergency room with complaints of headaches caused by increased hypertension. She was stabilized and released with the referral to the Mobile County Health Department for adjustment of her medications. She was treated at the Health Department in March and April 1994 with her vital signs within normal limits although her blood sugars were up slightly in April. . . .
In September 1994, the claimant underwent a workup for a persistent Cushing's syndrome and poorly controlled hypertension and diabetes mellitus. She was hospitalized from December 4 through December 15. 1994 at which time she underwent a left adrenalectomy for treatment of her Cushing's syndrome. The hospital records demonstrate that the claimant was diagnosed with Cushing's syndrome in 1983. Dr. Davidson noted that the claimant was placed on Cortisol replacement treatment at that time but she was lost t[o] followup and stopped taking the replacement the year before. While hospitalized, the claimant was also treated for her diabetes and hypertension which were under poor control prior to hospitalization. The followup records demonstrate that by January 18, 1995, she was in no apparent distress, denied headaches, dyspnea or complaints of pain. The records further reflect that the adrenalectomy showed an adrenaladeoma (sic). At discharge the claimant's condition was listed as good with a good prognosis and good rehabilitation capacity.
On January 25, 1995, Gail Tolbert, M.D., completed a Social Security disability questionnaire. On that form[,] Dr. Tolbert recorded that the claimant was treated for Cushing's syndrome with hypertension, diabetes, muscle wasting, and psychosis. She marked that the level of severity of these conditions was "severe". She stated also that the conditions adversely affected the claimant's ability to work but did not state how. On the question regarding if the claimant suffered pain, the doctor put N/A. On the question as to whether the claimant was capable of working, Dr. Tolbert did not answer; however, under the question "If no, please state the reason for you opinion", she stated "Multiple health problems which have adversely affected her daily functioning and stressful situation is likely to produce undesirable situation". Under the question about whether the claimant is disabled, Dr. Tolbert circled yes at the present time and on the question as to the estimated length of disability, she stated unknown. Dr. Tolbert marked that the claimant had shown excellent compliance with medications and the treatment regime. . . .
The records indicate the claimant was next seen after this at the Mobile County Health Department on June 14, 1996 complaining about a growth on her nose.
( Id.) Without giving a reason, this decision fails to mention the medical evidence of record regarding the course of treatment of plaintiffs Cushing's syndrome for the eleven months after January of 1995. ( See Tr. 178-191) This evidence, up to August 16, 1995 (Tr. 184), reveals that plaintiff still had Cushing's characteristics and associated problems (Tr. 186-191). In fact, it was not until December of 1995 that Dr. Davidson determined that plaintiff no longer need to make monthly visits to Stanton Road Clinic for monitoring of the progress of her Cushing's syndrome and medication regimen. ( See Tr. 178)
In consideration of the foregoing, the undersigned finds that the Commissioner's December 9, 1997 decision denying plaintiff disability insurance benefits and supplemental security income is not supported by substantial evidence and further, that this cause should be reversed and remanded for an award of benefits. The undersigned is of the opinion that the medical evidence of record in existence after Tolbert's January 25, 1995 indeterminate disability opinion establishes that Tolbert would not have found Kirksey's disability over until at the very best August 16, 1995 when she no longer had any signs of hyperadrenalism (Tr. 184) but more probably not until December of 1995 when she presented without signs of hyperadrenalism for several months and it was determined she no longer needed to make monthly visits to the Stanton Road Clinic ( see Tr. 178-183). Moreover, as implicitly recognized by the Commissioner in both of his decisions denying benefits, plaintiffs indeterminate disability obviously did not begin on January 25, 1995 but instead began numerous months prior thereto. (Tr. 20 ("Her medication controlled her symptomotology until September, 1994 when she experienced a reoccurrence of Cushing's disease which resulted in surgery."); Tr. 234 ("In September 1994, the claimant underwent a workup for a persistent Cushing's syndrome and poorly controlled hypertension and diabetes mellitus. She was hospitalized from December 4 through December 15, 1994 at which time she underwent a left adrenalectomy for treatment of her Cushing's syndrome. The hospital records demonstrate that the claimant was diagnosed with Cushing's syndrome in 1983.")) By the time plaintiff was first seen at the Stanton Road Clinic on August 31, 1994, it is clear that she had not become cushingoid in appearance (i.e., the presence of facial hirsutism and acne, central obesity, and a buffalo hump and increased pigmentation over the upper back) with uncontrolled blood pressure (160/110) (Tr. 169) overnight inasmuch as the office notes of Dr. Davidson from that visit clearly establish that Kirksey was hospitalized at the University of South Alabama Medical Center in August of 1994 and found to have an elevated urinary free cortisol with decreased ACTH levels (Tr. 177). In fact, a high dose "Dex" suppression test on August 5, 1994 revealed a cortisol level of 21.1. ( Id.) Although the records from this August, 1994 hospitalization are not contained in the present administrative record, in light of plaintiffs March 6, 1994 hospital visit for uncontrolled hypertension (Tr. 150-152) and documented evidence of poorly-controlled diabetes in April of 1994 (Tr. 140), it is clear to the undersigned that plaintiffs cortisol level was no doubt high well before her August hospitalization. Therefore, the undersigned does not hesitate in finding that the evidence of record establishes that plaintiff proved that she was totally disabled for at least a twelve-month period of time between March of 1994 and December of 1995. Because the evidence of record clearly establishes plaintiffs disability, the undersigned need not reach the issue of whether the Commissioner properly rejected the July 15, 1997 disability opinion of Dr. Kathryn Pitman.
It is clear to the undersigned that there is other medical evidence which should have made its way into this record but for whatever reason it did not. For instance, there is nothing in the record which describes in detail plaintiffs actual surgery in December of 1994. Usually, a description of what happened during surgery (i.e., the prepping of the patient, the location of incision, and the size and appearance of anything excised) is contained in the record but that is not the case here. Quite frankly, therefore, the undersigned is unsure whether plaintiff had a bilateral adrenalectomy in December of 1994, as suggested by her treating internists ( see, e.g. Tr. 178) or whether she only had a left adrenalectomy, as suggested by her surgeon (Tr. 174 (describing her principal procedure as being a left adrenalectomy)).
The undersigned would note, however, that there is no evidence of record after December of 1995, either, to support the Commissioner's finding that plaintiff can perform the exertional and non-exertional requirements of work except for mild depression and an inability to engage in work requiring more than lifting 20 pounds occasionally and lifting and/or carrying 10 pounds frequently, standing six hours during a workday and sitting six hours during a workday (i.e., light work). ( See Tr:498-508, 549-553 557-575).
CONCLUSION
The Magistrate Judge recommends that the decision of the Commissioner of Social Security denying plaintiff benefits be reversed and remanded pursuant to sentence four of § 405(g), see Melkonyan v. Sullivan, 501 U.S. 89, 111 S.Ct. 2157, 115 L.Ed.2d 78 (1991), for an award of benefits. The reversal and remand pursuant to sentence four of § 405(g) makes the plaintiff a prevailing party for purposes of the Equal Access to Justice Act, 28 U.S.C. § 2412. Shalala v. Schaefer, 509 U.S. 292, 113 S.Ct. 2625, 125 L.Ed.2d 239 (1993).The attached sheet contains important information regarding objections to the report and recommendation of the Magistrate Judge.
DONE this the 18th day of April, 2000.