Opinion
7:20-CV-114 (WLS)
08-05-2021
L.W., Plaintiff, v. Commissioner of Social Security, Defendant.
RECOMMENDATION
THOMAS Q. LANGSTAFF UNITED STATES MAGISTRATE JUDGE
Plaintiff filed this Social Security appeal on June 11, 2020, challenging the Commissioner's final decision denying her application for disability benefits, finding her not disabled within the meaning of the Social Security Act and Regulations. Jurisdiction arises under 42 U.S.C. § 405(g) and 42 U.S.C. § 1383(c). All administrative remedies have been exhausted.
Legal Standards
In reviewing the final decision of the Commissioner, this Court must evaluate both whether the Commissioner's decision is supported by substantial evidence and whether the Commissioner applied the correct legal standards to the evidence. Boyd v. Heckler, 704 F.2d 1207, 1209 (11th Cir. 1983); Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983). The Commissioner's factual findings are deemed conclusive if supported by substantial evidence, defined as more than a scintilla, such that a reasonable person would accept the evidence as adequate to support the conclusion at issue. Richardson v. Perales, 402 U.S. 389, 401 (1971); Cornelius v. Sullivan, 936 F.2d 1143, 1145 (11th Cir. 1991). In reviewing the ALJ's decision for support by substantial evidence, this Court may not reweigh the evidence or substitute its judgment for that of the Commissioner. "Even if we find that the evidence preponderates against the [Commissioner's] decision, we must affirm if the decision is supported by substantial evidence." Bloodsworth, 703 F.2d at 1239. "In contrast, the [Commissioner's] conclusions of law are not presumed valid....The [Commissioner's] failure to apply the correct law or to provide the reviewing court with sufficient reasoning for determining that the proper legal analysis has been conducted mandates reversal." Cornelius, 936 F.2d at 1145-1146.
Administrative Proceedings
Plaintiff filed an application for disability benefits in October 2016, alleging disability since September 13, 2016. (T-160-161). Her claim was denied initially and upon reconsideration. (T-91-99, 101-104). A hearing was held before an ALJ in January 2019. (T-31-53). Thereafter, the ALJ determined that the Plaintiff was not disabled, and the Appeals Council denied review. (T-12-30, 1-6). The ALJ's April 12, 2019 decision thereby became the final decision of the Commissioner. Plaintiff last met the insured status requirements for disability benefits on December 31, 2016. (T-17). The ALJ thus considered whether Plaintiff was disabled between her alleged onset date of September 13, 2016 and her date last insured of December 31, 2016. Id.
Statement of Facts and Evidence
Born on May 27, 1979, Plaintiff was 39 years of age at the time of the ALJ's April 12, 2019 decision. (T-195). Plaintiff alleges she is disabled due to psoriatic arthritis, high blood pressure, and anxiety. (T-206). Plaintiff completed four or more years of college, and has past relevant work experience as a math teacher. (T-207). As determined by the ALJ, Plaintiff suffers from severe impairments in the form of obesity, psoriasis with arthropathy including degenerative disc disease and degenerative joint disease of the hip, hands, knees, and foot. (T-18). The ALJ found that the Plaintiff did not have an impairment or combination thereof that met or medically equaled a listed impairment, and remained capable of performing work activity at the light level with certain restrictions. (T-19-20). The ALJ determined that Plaintiff was unable to perform her past relevant work. (T-23). Based on the testimony of a Vocational Expert and the Medical-Vocational Guidelines, the ALJ found that Plaintiff was capable of making a successful adjustment to other work existing in significant numbers in the national economy, and thus was not disabled. (T-25).
DISCUSSION
Plaintiff asserts that the ALJ erred in her consideration of the opinions of her treating physicians, Dr. James Mossell and Dr. Graham.
Treating physicians' opinion
Pursuant to 20 C.F.R. § 404.1527(e)(2), the Commissioner will “consider opinions from treating and examining sources on issues such as . . . your residual functional capacity . . . [although] the final responsibility for deciding these issues is reserved to the Commissioner.” “A statement by a medical source that you are ‘disabled' - or unable to work- does not mean that we will determine that you are disabled.” 20 C.F.R. § 404.1527(e)(1). Good cause to discount the opinion of a physician has been found to exist “where the doctor's opinion was not bolstered by the evidence, or where the evidence supported a contrary finding. We have also found good cause where the doctors' opinions were conclusory or inconsistent with their own medical records.” Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997) (internal citations omitted). As the Lewis court noted, “[w]e are concerned here with the doctors' evaluations of [the plaintiff's] condition and the medical consequences thereof, not their opinions of the legal consequences of [her] condition.” Id.
Plaintiff maintains that the ALJ improperly rejected the opinions of treating physicians Dr. James Mossell, a rheumatologist, and Dr. James Graham. Dr. Mossell's treatment notes show that he treated Plaintiff for psoriatic arthritis and fibromyalgia between 2016 and 2017. (T-451-557; 671-709). Treatment notes show that Dr. Graham treated Plaintiff for joint pain and various other conditions, including high blood pressure and anxiety, between 2011 and 2018. (T-349-390; 708-718; 725-761; 767-788). In a statement dated October 4, 2016, Dr. Mossell opined that Plaintiff was disabled between September 13, 2016 and December 13, 2016, and that it was unknown as to when Plaintiff would be able to work, based on limitations associated with psoriatic arthropathy. (T-600). In a statement dated July 26, 2017, Dr. Mossell stated that Plaintiff was unable to work and suffered a permanent disability. (T-765-766). In a statement dated December 11, 2017, Dr. Graham opined that Plaintiff suffered from fibromyalgia and psoriatic arthropathy, with constant severe pain, weakness, and fatigue. (T-839-840). Dr. Graham opined that Plaintiff was incapable of even low stress jobs, and that she “is unable to work, severe disability”. (T-840-841, 843).
The ALJ addressed the opinions of Dr. Mossell and Dr. Graham, and stated that
[Dr. Mossell] rendered opinions relative to the claimant's applications for short-term and long-term disability. He opined that the claimant was unable to work due to psoriatic arthropathy, but she did not have any cognitive deficits or psychiatric conditions that impacted her functioning. She could occasionally lift up to 10 pounds, occasionally sit, stand and walk, occasionally push/pull, occasionally perform fine finger movements and hand/eye coordinated movements and she could never climb, twist, stoop, bend, reach above shoulder level or operate heavy machinery. Treatment notes from February 15, 2017, after the date last insured indicate that she would be unable to return to work for the next four months. On July 26, 2017, Dr. Mossell opined that the claimant was permanently unable to work as she could not push, pull, bend, climb, lift less than 10 pounds and she was unable to sit or stand for long periods. However, his findings are inconsistent with the objective evidence from the period under review and with the claimant's reports of her activities. Imaging studies throughout the record show no more than mild abnormalities. An MRI of her lumber (sic) spine showed mild degenerative changes. Nerve conduction testing was negative. I therefore give more weight to the findings of state agency consultants, which are supported by the medical evidence of record.
Little weight is also afforded to the opinions of James L. Graham Jr., M.D. in assessing the claimant's condition prior to her date last insured. He no longer felt that the claimant was able to work and agreed that she needed long-term disability, as she was unable to maintain full-time or part-time employment. The Medical Source Statement dated December 11, 2017 indicates that her symptoms were severe enough to interfere with her attention and concentration constantly, she was unable to perform even low stress jobs, she was unable to push, pull, bend, climb, squat, sit or stand for long periods of time and she could not lift less than 10 pounds. His findings are inconsistent with the activities she describes in the Function Report, which suggests that she is not as limited as she alleges based on these activities. Another example of an inconsistency is his statement regarding her ability to focus or handle low-stress employment, which is not supported by the medical evidence of record during the period under review. It is also notable that he made these statements in 2017, after her symptoms increased in severity following her date last insured.(T-23).
Plaintiff contends that the ALJ's reasons for discounting Dr. Mossell's opinions are not consistent with the evidence of record. Plaintiff points to the treatment notes from Plaintiff's December 5, 2016 visit to Dr. Mossell, which she maintains show positive examination findings consistent with psoriatic arthritis, and show that Plaintiff had difficulty taking medications due to their side effects. Plaintiff also asserts that her reported activities in a December 2016 function report are not inconsistent with Dr. Mossell's opinions and do not support the ALJ's determination to discount Dr. Mossell's disability findings.
As to Dr. Graham, Plaintiff contends that the ALJ improperly relied on Plaintiff's December 2016 function report to discredit Dr. Graham's findings, and failed to acknowledge that Dr. Graham told Plaintiff to stop working in December 2016.
The Eleventh Circuit has clearly stated that the ALJ must state with particularity the weight given to different medical opinions and the reasons therefor....[and] when the ALJ fails [to do so], we will decline to affirm simply because some rationale might have supported the ALJ's conclusion. Winschel v. Commissioner of Social Sec., 631 F.3d 1176, 1179 (11th Cir. 2011) (quoting Owens v. Heckler, 748 F.2d 1511, 1516 (11th Cir. 1984)). Moreover, pursuant to 20 C.F.R. 404.1527(d)(2), [the Social Security Administration] will always give good reasons in our notice of determination or decision for the weight we give your treating source's opinion.
[W]ithout clearly articulated grounds for [the ALJ's decision], [the Court] cannot determine whether the ALJ's conclusions were rational and supported by substantial evidence, requiring that this matter be reversed and remanded. Winschel, 631 F.3d at 1179; see also, Lawton v. Comm'r. of Social Security, 2011 WL 2471475 (M.D.Ga. Docket No. 5: 09-CV-239-MTT) (failure of ALJ to reference and assign weight to treating physicians' opinions, which were contrary to the ALJ's residual functional capacity assessment, required reversal and remand).
The Court finds that although the ALJ provided reasons for discrediting Dr. Mossell's and Dr. Graham's findings, these reasons are not supported by substantial evidence. The ALJ relies on his conclusions that because Plaintiff did not have any cognitive deficits, could engage in occasional physical activity, and had certain mild or negative test findings, Dr. Mossell's conclusions were entitled to less weight. However, an ALJ “may not arbitrarily substitute his own hunch or intuition for the diagnosis of a medical professional.” Marbury v. Sullivan, 957 F.2d 837, 840-41 (11th Cir. 1992). “The law is clear that the ALJ may not substitute his judgment or conclusions for the medical evidence on the record or the diagnosis of a medical professional.” Lake v. Astrue, 2012 WL 3631623, *11 (M.D.Ala. 2012).
Moreover, the ALJ also discounted both Dr. Mossell's and Dr. Graham's opinions based on alleged conflicts with Plaintiff's statement of her activities in a December 2016 Function Report. The ALJ did not provide detail as to the activities described by Plaintiff in her Function Report that allegedly refuted the physicians' findings and opinions of disability. (T-23). In the report, Plaintiff states that if she stands more than 10-15 minutes she is in pain, that she can barely walk some days, only taking her children to school and returning home to rest. (T-213-214). Plaintiff describes helping with some household chores but that her husband and children do the bulk of the work. (T-214). Although she prepares food, it is limited to simple meals, and she states that she does not carry out simple household chores. (T-215). Plaintiff states that she “mostly stay[s] at home and pace[s] [herself].” (T-218). The ALJ's conclusion that these statements are somehow inconsistent with the limitations issued by Drs. Mossell and Graham is not supported by substantial evidence.
The Court notes additionally that although the ALJ mentions the fact that Dr. Graham's residual functional capacity assessment is dated December 11, 2017, the ALJ fails to note that Dr. Graham's assessment is accompanied by his finding that Plaintiff was unable to work as of December 5, 2016, prior to the expiration of Plaintiff's insured status. (T-839-844). Overall, the ALJ's reasons for discrediting Dr. Mossell's and Dr. Graham's opinions are unsupported by the record, and based largely on the ALJ's opinions alone. Accordingly, the ALJ's assignment of “little weight” to Dr. Graham's findings and opinions, as well as apparently implicitly assigning little weight to Dr. Mossell's findings and opinions, is not supported by substantial evidence. Treating physicians' opinions are to be granted substantial or considerable weight unless good cause is shown to the contrary. MacGregor v. Bowen, 786 F.2d 1050, 1053 (11th Cir. 1986); Phillips v. Barnhart, 357 F.3d 1232, 1240 (11th Cir. 2004).
Conclusion
Inasmuch as the Commissioner's final decision in this matter is not supported by substantial evidence, it is the recommendation of the undersigned that the Commissioner's decision be REVERSED and REMANDED pursuant to Sentence Four of § 405(g), for consideration of the record in accordance with the findings herein.
Pursuant to 28 U.S.C. § 636(b)(1), the parties may serve and file written objections to this Recommendation, or seek an extension of time to file objections, WITHIN FOURTEEN (14) DAYS after being served with a copy thereof. The District Judge shall make a de novo determination as to those portions of the Recommendation to which objection is made; all other portions of the Recommendation may be reviewed by the District Judge for clear error.
The parties are hereby notified that, pursuant to Eleventh Circuit Rule 3-1, “[a] party failing to object to a magistrate judge's findings or recommendations contained in a report and recommendation in accordance with the provisions of 28 U.S.C. § 636(b)(1) waives the right to challenge on appeal the district court's order based on unobjected-to factual and legal conclusions if the party was informed of the time period for objecting and the consequences on appeal for failing to object. In the absence of a proper objection, however, the court may review on appeal for plain error if necessary in the interests of justice.”
SO RECOMMENDED.