Snyder v. Colvin
Filing
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MEMORANDUM (Order to follow as separate docket entry). Signed by Honorable Matthew W. Brann on 3/22/2017. (jn)
UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF PENNSYLVANIA
____________________________________
:
WENDY SNYDER,
:
:
Plaintiff,
:
Civil No. 3:16-CV-01689
:
v.
:
:
(Judge Brann)
CAROLYN W. COLVIN,
:
Acting Commissioner of
:
Social Security
:
:
Defendant.
:
____________________________________:
MEMORANDUM
March 22, 2017
The above-captioned action is one seeking review of a decision of the Acting
Commissioner of Social Security (“Commissioner”)1, denying Plaintiff Wendy Snyder’s
(Snyder”) application for Supplemental Security Income (“SSI”) under Title XVI. For the
reasons set forth below, the Court will vacate and remand the Commissioner’s denial of SSI.
I. BACKGROUND
SSI is a federal income supplement program funded by general tax revenues (not social
security taxes). It is designed to help aged, blind or other disabled individuals who have little or
no income. Insured status is irrelevant in determining a claimant’s eligibility for supplemental
security income benefits.
1
Nancy A. Berryhill is now the Acting Commissioner of Social Security. Pursuant to Federal Rule of Civil
Procedure 25(d), Nancy A. Berryhill is substituted for Carolyn W. Colvin, Acting Commissioner of Social Security
as the defendant in this suit.
1
Snyder applied protectively for SSI on November 7, 2012, alleging disability beginning
January 1, 2010. (Tr. 102).2 She later amended the alleged onset date to December 19, 2012.
(Id.). Her claim was initially denied on May 10, 2013. (Tr. 102, 181-85). Snyder requested a
hearing before the Administrative Law Judge (“ALJ”) Office of Disability and Adjudication and
Review of the Social Security Administration, and one was held on October 9, 2014. (Tr.102).
At the hearing, Snyder was represented by counsel, and a vocational expert testified. (Tr. 12039). On October 20, 2014, the ALJ issued a decision denying Snyder’s application. (Tr. 10211). Snyder’s subsequent request for review with the Appeals Council was denied. (Tr. 1-8).
Thus, the ALJ’s decision stood as the final decision of the Commissioner.
Snyder filed a complaint in this Court on August 12, 2016. (Doc. 1). The Commissioner
filed an answer on October 13, 2016. (Doc. 8). After supporting and opposing briefs were
submitted (Docs. 10 -12), the appeal3 became ripe for disposition.
Snyder was born on July 9, 1979, has a limited education, and is able to communicate in
English. (Tr. 109). She has not engaged in substantial gainful activity since the alleged
amended onset date of December 19, 2012. (Tr. 104). Snyder has the following severe
impairments: panic disorder, multiple sclerosis, tremor and obesity. (Id.).
II. STANDARD OF REVIEW
When considering a social security appeal, the Court has plenary review of all legal
issues decided by the Commissioner. See Poulos v. Comm’r of Soc. Sec., 474 F.3d 88, 91 (3d
2
References to “Tr. __” are to pages of the administrative record filed by the Defendant as part of
the Answer (Docs. 8 and 9) on October 13, 2016.
3
Under the Local Rules of Court, “[a] civil action brought to review a decision of the Social
Security Administration denying a claim for social security disability benefits” is “adjudicated as an
appeal.” M.D. Pa. Local Rule 83.40.1.
2
Cir. 2007); Johnson v. Comm’r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008). However, my
review of the Commissioner’s findings of fact pursuant to 42 U.S.C. § 405(g) is to determine
whether those findings are supported by “substantial evidence.” Id. The factual findings of the
Commissioner, “if supported by substantial evidence, shall be conclusive . . . .” 42 U.S.C.
§ 405(g). “Substantial evidence does not mean a large or considerable amount of evidence, but
rather such relevant evidence as a reasonable mind might accept as adequate to support a
conclusion.” Johnson, 529 F.3d at 200 (3d Cir. 2008) (quoting Hartranft v. Apfel, 181 F.3d 358,
360 (3d Cir. 1999)) (internal quotations and citations omitted). Substantial evidence has been
described as more than a mere scintilla of evidence but less than a preponderance. Brown v.
Bowen, 845 F.2d 1211, 1213 (3d Cir. 1988). “It means such relevant evidence as a reasonable
mind might accept as adequate to support a conclusion.” Plummer v. Apfel, 186 F.3d 422, 427
(3d Cir. 1999) (citing Ventura v. Shalala, 55 F.3d 900, 901 (3d Cir. 1995)) (quoting Richardson
v. Perales, 402 U.S. 389, 401 (1971) (internal citations omitted)). The United States Court of
Appeals for the Third Circuit has stated,
[O]ur decisions make clear that determination of the existence vel non of substantial
evidence is not merely a quantitative exercise. A single piece of evidence will not
satisfy the substantiality test if the [Commissioner] ignores, or fails to resolve, a
conflict created by countervailing evidence. Nor is evidence substantial if it is
overwhelmed by other evidence – particularly certain types of evidence (e.g., that
offered by treating physicians) – or if it really constitutes not evidence but mere
conclusion.
Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000) (citing Kent v. Schweiker, 710 F.2d 110, 114
(3d Cir. 1983); Gilliland v. Heckler, 786 F.2d 178, 183 (3d Cir. 1986)). Therefore, a court
reviewing the decision of the Commissioner must scrutinize the record as a whole. Id. (citing
Smith v. Califano, 637 F.2d 968, 970 (3d Cir. 1981)).
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III. SEQUENTIAL EVALUATION PROCESS
The plaintiff must establish that there is some “medically determinable basis for an
impairment that prevents him from engaging in any substantial gainful activity for a statutory
twelve-month period.” Fargnoli v. Massanari, 247 F.3d 34, 38-39 (3d Cir. 2001) (quoting
Plummer, 186 F.3d at 427) (internal quotations omitted). “A claimant is considered unable to
engage in any substantial gainful activity ‘only if his physical or mental impairment or
impairments are of such severity that he is not only unable to do his previous work but cannot,
considering his age, education, and work experience, engage in any other kind of substantial
gainful work which exists in the national economy . . . .’” Fargnoli, 247 F.3d at 39 (quoting 42
U.S.C. § 423(d)(2)(A)). The Commissioner follows a five-step inquiry pursuant to 20 C.F.R. §
404.1520 to determine whether the claimant is disabled. In Plummer, the Third Circuit set out
the five-steps:
In step one, the Commissioner must determine whether the claimant is currently
engaging in substantial gainful activity. 20 C.F.R. § [404.]1520(a). If a claimant is
found to be engaged in substantial activity, the disability claim will be denied.
Bowen v. Yuckert, 482 U.S. 137, 140 (1987) . . . . In step two, the Commissioner
must determine whether the claimant is suffering from a severe impairment. 20
C.F.R. § 404.1520(c). If the claimant fails to show that her impairments are
“severe,” she is ineligible for disability benefits.
In step three, the Commissioner compares the medical evidence of the claimant’s
impairment to a list of impairments presumed severe enough to preclude any gainful
work. 20 C.F.R. § 404.1520(d). If a claimant does not suffer from a listed
impairment or its equivalent, the analysis proceeds to steps four and five. Step four
requires the ALJ to consider whether the claimant retains the residual functional
capacity to perform her past relevant work. 20 C.F.R. § 404.1520(d). The claimant
bears the burden of demonstrating an inability to return to her past relevant work.
Adorno v. Shalala, 40 F.3d 43, 46 (3d Cir. 1994).
If the claimant is unable to resume her former occupation, the evaluation moves to
the final step. At this stage, the burden of production shifts to the Commissioner,
who must demonstrate the claimant is capable of performing other available work
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in order to deny a claim of disability. 20 C.F.R. § 404.1520(f). The ALJ must show
there are other jobs existing in significant numbers in the national economy which
the claimant can perform, consistent with her medical impairments, age, education,
past work experience, and residual functional capacity. The ALJ must analyze the
cumulative effect of all the claimant’s impairments in determining whether she is
capable of performing work and is not disabled. See 20 C.F.R. § 404.1523. The ALJ
will often seek the assistance of a vocational expert at this fifth step. See, [sic]
Podedworny v. Harris, 745 F.2d 210, 218 (3d Cir. 1984).
Plummer, 186 F.3d at 428.
IV. DISCUSSION
Snyder appeals the ALJ’s determination on three grounds: (1) substantial evidence does
not support the ALJ’s residual functional capacity (“RFC”) finding; (2) the ALJ did not properly
weigh the medical opinion evidence; and (3) substantial evidence does not support the ALJ’s
credibility assessment.
The ALJ went through each step of the sequential evaluation process and (1) found that
Snyder had not engaged in substantial gainful activity since December 19, 2012, the alleged
amended onset date; (2) found that Snyder had the severe impairments of panic disorder,
multiple sclerosis, tremor and obesity; (3) found that Snyder’s impairments did not meet or equal
a listed impairment; and (4) concluded that while Snyder does not have past relevant work, she
could perform light work with several limitations. (Tr. 102-11). Specifically, in addressing
Snyder’s RFC, the ALJ found that:
[she could only occasionally] climb stairs, balanc[e], stoop[], kneel[],
crouch[], and crawl[] ... [she] needs to avoid concentrated exposure to
hazards as well as climbing ladders and frequent fine manipulation ...
[she] retains the mental capacity for simple, routine, repetitive tasks in
a work environment free form fast-paced production involving only
simple work-related decision with few, if any, work place changes, and
no interaction with the public.
(Tr. 106).
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The Court will initially address Snyder’s first and second arguments together because
they are interrelated. The ALJ must consider all of the relevant evidence and give a clear
explanation to support his findings when determining the RFC. Fargnoli, 247 F.3d at 40, 41
(quoting Burnett v. Comm’r of Soc. Sec. Admin., 220 F.3d 112, 121 (3d Cir. 2000)). A treating
physician’s opinion is entitled to 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 claimant’s] case record . . . .” Johnson, 529 F.3d at 202 (quoting
Fargnoli, 247 F.3d at 43 (quoting 20 C.F.R. § 404.1527(d)(2))) (internal quotations omitted). If
a treating physician’s opinion conflicts with an opinion of a non-treating physician, the ALJ may
reject the treating physician’s opinion “ ‘only on the basis of contradictory medical evidence’
and not due to his or her own credibility judgments, speculation or lay opinion.” Id. (quoting
Plummer, 186 F.3d at 429). The ALJ determines what weight to give a medical opinion by
considering factors such as the examining relationship, the length of the treatment relationship
and frequency of visits, nature and extent of the treatment relationship, whether the medical
source supports the opinion with medical evidence, whether the opinion is consistent with the
record as a whole, and the medical source’s specialization. 20 C.F.R. § 404.1527(c)(1-5). If the
ALJ discounts certain evidence, he must give some indication of the reasons for discounting that
evidence. Fargnoli, 247 F.3d at 43.
The record in this case contains three medical opinions, the first from Mahmood Nasir,
M.D. who performed a consultative exam on April 15, 2013 (Tr. 452-60); the second from a
psychological consultative examination with Michael Keil, Ph.D. on April 29, 2013 (Tr. 46272); and finally one from Snyder’s family practitioner, David Wampler, M.D. on September 15,
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2014 (Tr. 562-67). In his decision, the ALJ accorded little weight to the opinion of Dr. Nasir,
partial weight to Dr. Keil’s opinion, and limited weight to Dr. Wampler’s opinion. (Tr. 108-09).
The significance of this weighing of the medical opinions is that the ALJ made a determination
of Snyder’s RFC without relying on the medical opinions of any of the medical doctors who
provided a medical opinion.
Specifically, Dr. Nasir assessed Snyder capable of lifting and carrying up to 10 pounds
occasionally, able to sit, stand and walk no more than one hour each in an 8 hour workday,
occasional reaching, handling, fingering, feeling, pushing/pulling, climbing stairs, stooping,
kneeling, crouching and crawling, and no climbing ladders/scaffolds and balancing. (Tr. 108,
455-60). Dr. Nasir also opined that Snyder should avoid exposure to unprotected heights,
moving mechanical parts, extreme cold and heat, and capable of no more than occasionally
operating a motor vehicle, and occasional exposure to humidity and wetness, dust, odors, fumes,
pulmonary irritants, and vibrations. (Tr. 108, 459). Dr. Nasir also noted that “[a]ctivities result
in pain in head, neck, back and also has numbness in hand.” (Tr. 108, 460).
Limited weight was accorded to this medical opinion by the ALJ because he found that
the restrictions were overstated in comparison to the limited examination findings and treatment
required by Snyder, including her treating neurologist. (Tr. 109). Additionally, the ALJ
reasoned that Dr. Nasir appeared to rely on Snyder’s complaints rather than his examination
findings in making the above restrictions. (Id.).
Next, the ALJ gave partial weight to the opinion of Dr. Keil. (Tr. 109). Dr. Keil opined
that Snyder had mild and moderate restrictions in performing work-related tasks, and rated her
with a global assessment of functioning (“GAF”) of 40-50. (Tr. 109, 465). Dr. Keil further
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opined that Snyder “would be expected to be present variably and produce interference in most
work settings in the context of her multiple sclerosis, as is found with most individuals with
diagnosis of MS. Her panic disorder alone would be expected to produce significant interference
with instrumental activities, including vocational activities ....” (Tr. 465). In assigning this
opinion only partial weight, the ALJ reasoned that the GAF score is not supported by the mental
status examination findings, the claimant’s limited need for mental health treatment and the
claimant’s admission that she tries to keep busy most of the time. (Tr. 109).
Finally, the ALJ accorded limited weight to Dr. Wampler, Snyder’s family practitioner.
Dr. Wampler opined that Snyder was incapable of even “low stress” jobs, expected to be absent
from work more than four days per month, was unable to stand/walk or sit longer than 2 hours
each in an 8 hour workday, and has significant and persistent disorganization of motor function
in two extremities and significant reproducible fatigue with muscle weakness on repetitive
activity. (Tr. 109, 564-67). Moreover, Dr. Wampler opined that Snyder was capable of lifting
and carrying less than 10 pounds occasionally, and never lifting or carrying 10 pounds or greater.
(Tr. 566).
In assigning limited weight to this opinion, the ALJ stated that Dr. Wampler’s treatment
and examination notes do not support his conclusions and restrictions and that Dr. Wampler’s
conclusions are “clearly overstated.” (Tr. 109). The ALJ reasoned that Snyder was treated
conservatively, that she declined referral to physical therapy, reported exercising regularly,
presented with appropriate musculoskeletal range of motion and strengths, had normal station
and gait, and normal judgment and orientation. (Tr. 109). The ALJ provides that the above
frequency and degree of treatment is not what “one would expect from an individual with the
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alleged symptoms reported....” (Tr. 108).
I find that substantial evidence does not support the ALJ’s ultimate determination. The
ALJ’s decision to discredit, at least partially, every opinion of every medical doctor’s RFC
assessment of Snyder left the ALJ without a single medical opinion to rely upon in reaching a
RFC determination. “Rarely can a decision be made regarding a claimant’s residual functional
capacity without an assessment from a physician regarding the functional abilities of the
claimant.” Maellaro v. Colvin, Civ. No. 3:12-01560, 2014 WL 2770717, at *11 (M.D. Pa. June
18, 2014); see Doak v. Heckler, 790 F.2d 26, 29 (3d Cir. 1986) (“No physician suggested that
the activity [the claimant] could perform was consistent with the definition of light work set
forth in the regulations, and therefore the ALJ’s conclusion that he could is not supported by
substantial evidence.”). Moreover, an ALJ cannot disregard medical opinion “based solely on
his own amorphous impressions, gleaned from the record and from his evaluation of [the
claimant]’s credibility.” Burns v. Colvin, 156 F. Supp. 3d 579, 595 (M.D. Pa. Jan. 13, 2016)
(quoting Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000)). An “ALJ may not reject a
supported medical opinion based on the ALJ’s lay evaluation of medical evidence.” Burns, 156
F. Supp. 3d at 595.
Here, not one medical opinion proffers that Snyder is capable of light work’s physical
exertion requirements. 20 C.F.R. § 404.1567(b) states that light work “involves lifting no more
than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds.”
Dr. Nasir assessed Snyder capable of lifting and carrying up to 10 pounds occasionally while Dr.
Wampler similarly opined Snyder’s limitation to be less than 10 pounds occasionally. (Tr. 455,
566). No doctor opined that Snyder is capable of lifting up to 20 pounds at a time or frequently
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lifting or carrying weight up to 10 pounds. Similarly, both Dr. Nasir and Dr. Wampler opined
that Snyder is unable to stand/walk more than 1 or 2 hours, respectively, in an 8 hour work day.
(Tr. 456, 565). The ALJ failed to point to any specific medical evidence that would support a
contrary opinion on Snyder’s standing/walking capabilities, and as a result, it appears that the
ALJ was forced to reach a RFC determination without the benefit of any medical opinion.
Accordingly, the ALJ’s conclusion is not supported by substantial evidence.
I also find that the ALJ impermissibly engaged in a lay interpretation of the medical
evidence in stating that the frequency and degree of Snyder’s treatment is not what “one would
expect from an individual with the alleged symptoms reported ...” despite the contrary medical
opinions offered by Doctors Nasir, Keil, and Wampler. As suggested by Plaintiff, if the ALJ
believed that all of the medical opinions were inadequate or inconsistent, rather than engage in
his own lay analysis, the ALJ should have requested a clarification as to the limitations opined
by the medical doctors, rather than engaging in speculation or stating his own lay opinion of the
medical evidence. See Mayes v. Massanari, 276 F.3d 453, 459-60 (9th Cir. 2001) (stating that
the ALJ’s obligation to develop the record is triggered “when there is ambiguous evidence or
when the record is inadequate to allow for proper evaluation of the evidence.”); Burns v. Colvin,
156 F. Supp. 3d 579, 595 (M.D. Pa. Jan. 13, 2016) (An ALJ cannot disregard medical opinion
“based solely on his own amorphous impressions, gleaned from the record and from his
evaluation of [the claimant]’s credibility”) (quoting Morales v. Apfel, 225 F.3d 310, 317 (3d Cir.
2000)). This approach would have been consistent with the ALJ’s duty to investigate the facts
and develop the record, and such a clarification may have produced the substantial evidence
needed to support the ALJ’s decision.
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Therefore, remand on this basis is necessary. I decline to address Snyder’s other
allegations of error, as remand may produce a different result on this claim, making discussion of
them moot. Burns v. Colvin, 156 F. Supp. 3d 579, 598 (M.D. Pa. Jan. 13, 2016); see LaSalle v.
Comm’r of Soc. Sec., Civ. No. 10-1096, 2011 WL 1456166, at *7 (W.D. Pa. Apr. 14, 2011).
V. CONCLUSION
Based upon a review of the record, it is determined that the Commissioner’s decision to
deny Snyder’s SSI claim under Title XVI is not supported by substantial evidence. Therefore,
pursuant to 42 U.S.C. § 405(g), this Court will vacate the Commissioner of Social Security’s
decision and remand this case for further proceedings. An appropriate Order follows.
BY THE COURT:
s/ Matthew W. Brann
Matthew W. Brann
United States District Judge
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