Coy v. Colvin
Filing
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ORDER GRANTING 20 Plaintiff's Motion for Judgment on the Pleadings, and DENYING 24 Defendant's Motion for Judgment on the Pleadings. This matter is remanded to the Commissioner for further proceedings. Signed by US District Judge Terrence W. Boyle on 1/28/2015. (Fisher, M.)
IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF NORTH CAROLINA
WESTERN DIVISION
No. 5:13-CV-770-BO
ANNETTE R. COY,
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Plaintiff,
v.
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CAROLYN COLVIN,
Acting Commissioner of Social Security,
Defendant.
ORDER
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This matter is before the Court on the parties' cross-motions for judgment on the
pleadings. [DE 20, 24]. A hearing on this matter was held in Elizabeth City, North Carolina on
January 13, 2015. For the reasons discussed below, this matter is REMANDED for further
consideration by the Commissioner.
BACKGROUND
Plaintiff applied for Title II disability insurance benefits and Title XVI supplemental
security income on January 4, 2010, alleging disability beginning January 1, 2007 [Tr. 116, 202].
Her date last insured was December 31,2010. [Tr. 16]. These applications were denied initially
and upon reconsideration. An Administrative Law Judge (ALJ) held a hearing on April4, 2012,
at which Ms. Coy appeared pro se. The ALJ rendered an unfavorable decision and the Appeals
Council denied Ms. Coy's request for review, rendering the ALI's decision the final decision of
the Commissioner. Ms. Coy now seeks judicial review of the Commissioner's final decision
pursuant to 42 U.S.C. § 405(g).
Ms. Coy was 47 years old as of her alleged onset date and 53 at the time of the ALI's
decision. [Tr. 23, 52]. She has a bachelor's degree and past work experience as a teacher. [Tr. 23,
53-62]. She takes daily medications for several impairments and wears braces on her arms. [Tr.
18]. At the time of the hearing, plaintiff had a Veteran's Administration (VA) disability rating of
70% due to post-traumatic stress disorder (PTSD). [Tr. 221-22]. At the hearing, plaintiffs
counsel informed the Court that plaintiff was awarded a 100% VA disability rating shortly after
the instant claim was denied.
DISCUSSION
When a social security claimant appeals a final decision of the Commissioner, the Court's
review is limited to the determination of whether, based on the entire administrative record, there
is substantial evidence to support the Commissioner's findings. 42 U.S.C. § 405(g); Richardson
v. Perales, 402 U.S. 389, 401 (1971). Substantial evidence is defined as "evidence which a
reasoning mind would accept as sufficient to support a particular conclusion." Shively v. Heckler,
739 F.2d 987, 989 (4th Cir. 1984) (quoting Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir.
1966)). If the Commissioner's decision is supported by such evidence, it must be affirmed. Smith
v. Chafer, 99 F.3d 635, 638 (4th Cir. 1996).
In evaluating whether a claimant is disabled, an ALJ uses a multi-step process. First, a
claimant must not be able to work in a substantial gainful activity. 20 C.F.R. § 404.1520.
Second, a claimant must have a severe impairment that significantly limits his or her physical or
mental ability to do basic work activities. !d. Third, to be found disabled, without considering a
claimant's age, education, and work experience, a claimant's impairment must be of sufficient
duration and must either meet or equal an impairment listed by the regulations. !d. Fourth, in the
alternative, a claimant may be disabled if his or her impairment prevents the claimant from doing
past relevant work and, fifth, if the impairment prevents the claimant from doing other work. !d.
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The claimant bears the burden of proof at steps one through four, but the burden shifts to the
Commissioner at step five. Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987).
At step one, the ALJ determined that plaintiff met the insured status requirements and
had not engaged in substantial gainful activity from her alleged onset date through her date last
insured. [Tr. 16]. Ms. Coy's diabetes mellitus, hypertension, migraine headaches, chronic back
pain, cervical disc disease, history of transient ischemic attack, carpal tunnel syndrome, joint
pains, post-traumatic stress disorder (PTSD) and depression qualified as severe impairments at
step two but were not found to meet or equal a Listing at step three. [Tr. 16-17]. The ALJ
concluded that plaintiff had the residual functional capacity (RFC) to perform a limited range of
light work. [Tr. 18]. The ALJ limited Ms. Coy to no more than occasional climbing oframps or
stairs, occasional postural activities, and simple, routine, repetitive tasks in a low-stress work
setting. [Id.]. She was restricted to no production-pace work, no more than frequent social
interaction with supervisors and coworkers, and no work with public other than incidental
contact, and avoiding even moderate exposure to workplace hazards. [/d.]. The ALJ
correspondingly found at step four that Ms. Coy was no longer capable of performing her past
relevant work as a pre-school teacher. [Tr. 23]. At step five, the ALJ determined that Ms. Coy
was still capable of performing the jobs of photocopy machine operator, folder and potato chip
sorter and correspondingly concluded that she was not disabled within the meaning of the Act.
[Tr. 24].
Here, the ALJ failed to order and review the VA disability determination. The Fourth
Circuit recently held that "in making a disability determination, the SSA must give substantial
weight to a VA disability rating." Bird v. Comm 'r ofSoc. Sec. Admin., 699 F.3d 337, 343 (4th
Cir. 2012). An ALJ can only give less weight to a VA disability rating when the record supports
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that such deviation is appropriate. !d. The ALJ was aware the VA disability determination
existed, and indeed, even referenced a letter submitted by plaintiff that explained she was entitled
to VA disability benefits. The ALJ, however, did not discuss the VA disability determination at
all, but summarily dismissed it, stating that the "record ... supports the claimant's residual
functional capacity, regardless of the VA rating." [Tr. 23]. The lack of explanation of the VA's
disability determination is unsurprising given that the ALJ did not order and review the actual
VA disability determination. Without reviewing the determination, the ALJ had no basis for
assigning it less than substantial weight, nor could he determine that deviation therefrom was
appropriate. Accordingly, the Court finds that it was error for the ALJ not to review the VA
disability determination and explain if and how deviation therefrom was appropriate. Moreover,
the VA determination of 100% disability close in time to the ALJ' s denial implies that plaintiffs
PTSD was causing functional difficulties and underscores the fact that the rationale underlying
the VA disability determination was important to plaintiffs case.
The ALJ' s error was compounded by the fact that Ms. Coy was unrepresented at her
hearing. Where a plaintiff is unrepresented, the plaintiff is entitled to "sympathetic assistance of
the ALJ to develop the record and to 'assume a more active role' and adhere to a 'heightened
duty of care and responsibility.'" Smith v. Barnhart, 395 F. Supp. 2d 298, 301 (E.D.N.C 2005)
(quoting Crider v. Harris, 624 F.2d 15, 16 (4th Cir. 1980).When adjudicating the claims of
unrepresented plaintiffs, an ALJ should "scrupulously and conscientiously probe into, inquire of,
and explore for all the relevant facts." Gold v. Sec 'y of Health, Educ. and Welfare, 463 F.2d 38,
43 (2nd Cir. 1972). An ALJ may not rely solely on the evidence submitted by the plaintiff. See
Cook v. Heckler, 783 F.2d 1168, 1173 (4th Cir. 1986); Marsh v. Harris, 632 F.2d 296, 299 (4th
Cir. 1980). Although the record demonstrates that the ALJ did make a concerted effort to aid
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plaintiff, the fact remains that the VA disability determination was material to plaintiffs case,
the ALJ knew the determination existed, and failed to help plaintiff obtain and/or admit it into
the record.
The decision of whether to reverse and remand for benefits or reverse and remand for a
new hearing is one which "lies within the sound discretion of the district court." Edwards v.
Bowen, 672 F.Supp. 230, 236 (E.D.N.C. 1987). The Fourth Circuit has held that it is appropriate
for a federal court to "reverse without remanding where the record does not contain substantial
evidence to support a decision denying coverage under the correct legal standard and when
reopening the record for more evidence would serve no purpose." Breeden v. Weinberger, 493
F.2d 1002, 1012 (4th Cir. 1974). Remand, rather than reversal, is required when the ALJ fails to
explain his reasoning and there is ambivalence in the medical record, precluding a court from
"meaningful review." Radfordv. Colvin, 734 F.3d 288,296 (4th Cir. 2013) (citing Kastner v.
Astrue, 697 F.3d 642, 648 (7th Cir. 2012)). Here, the appropriate action is to remand the case to
the Commissioner. Meyer v. Astrue, 662 F.3d 700, 707 (4th Cir. 2011). ("assessing the probative
value of competing evidence is quintessentially the role of the fact finder."). Upon remand, the
Commissioner is to obtain the VA disability determination and review it in order to give it
appropriate weight in the SSA disability determination.
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CONCLUSION
For the foregoing reasons, the plaintiffs motion for judgment on the pleadings is
GRANTED, and the matter is REMANDED to the Commissioner for further proceedings
consistent with this decision.
SO ORDERED, this~ day of January, 2015.
Jl~~
UNITED STATES DISTRICT J
6
GE
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