KNAUS v. ASTRUE
Filing
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ORDER granting 9 Plaintiff's Motion for Summary Judgment; denying 11 Defendant's Motion for Summary Judgment; and this case is REMANDED FORTHWITH for further administrative proceedings. Signed by Judge Cathy Bissoon on 10/9/2012. (acs)
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
RUTH KNAUS,
Plaintiff,
v.
MICHAEL J. ASTRUE,
Commissioner of Social Security,
Defendant.
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Civil Action No. 11-1387
Judge Cathy Bissoon
MEMORANDUM AND ORDER
I. MEMORANDUM
Plaintiff Ruth Knaus (“Plaintiff” or “Claimant”), has filed this social security appeal
pursuant to 42 U.S.C. § 405(g) for judicial review of the final decision of the Commissioner of
Social Security (“Defendant”) denying her application for disability insurance benefits (“DIB”)
under Title II of the Social Security Act, 42 U.S.C. Sections 401-403. (Doc. No. 3).
The parties have filed cross motions for summary judgment. (Doc. Nos. 9, 11). Plaintiff
argues that the administrative decision is not supported by substantial evidence in the record and,
therefore, must be remanded. More specifically, Plaintiff argues that ALJ William E. Kenworthy
(“ALJ Kenworthy” or the “ALJ”) erred in failing to evaluate her alleged mental impairment of
conversion disorder at Step Two of his Five Step analysis. Plaintiff also argues that such failure
resulted in a Residual Functional Capacity (“RFC”) finding at levels above Plaintiff’s proven
ability. (Doc. No. 10). Defendant argues that substantial evidence exists to support the ALJ’s
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findings and no definitive diagnosis for conversion disorder exists in the record. Therefore, there
is no need to evaluate the impairment under Step Two (or any subsequent step). (Doc. No. 12)
Background
Plaintiff applied for DIB on September 29, 2009.1 In her application, Plaintiff claimed an
initial onset date of May 16, 2009, and disability due to right side weakness and numbness and
lower back pain (all of which resulted in a gait dysfunction). (R. at 210). Plaintiff was found not
disabled and her application initially denied on February 4, 2010. (R. at 132). Thereafter,
Plaintiff filed a written request for hearing before an ALJ, which took place on March 1, 2011.
(R. at 152).
By decision dated March 3, 2011, the ALJ denied Plaintiff’s claim for DIB, finding that
she was not disabled from May 16, 2009, through March 13, 2011 (the date of her hearing) as
defined in the Social Security Act. (R. at 22). At the time of her hearing, Plaintiff was a fortyone year old woman who graduated from high school through an assisted learning program.
(R. 106-07). As determined by the ALJ, Plaintiff lives independently with her husband and two
small children and provides for the daily needs of her children as well as her own personal needs.
(R. at 18). Her past work experience included employment as a certified nursing assistant for
seven years. Plaintiff stopped working following the birth of her first child in August 2005. At
that time, Plaintiff began to see a series of doctors regarding complaints of right side weakness
and numbness in her legs, lower back pain, as well as difficulty walking. (R. at 16).
The ALJ found that Plaintiff has not engaged in any substantial gainful activity since
May 16, 2009, and that she suffered from the following severe impairments: gait dysfunction,
chronic back pain and a learning disorder. Id. The ALJ assessed Plaintiff’s physical and mental
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Plaintiff initially filed for DIB on December 1, 2006. That application was denied and
ultimately resulted in an unfavorable decision issued by ALJ Kenworthy on May 16, 2009.
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conditions against the criteria in Appendix 1 of the regulations to determine whether she suffered
from an impairment or combination of impairments that meets or medically equals those criteria.
(Id. at 18). In doing so, he reviewed Plaintiff’s allegations, along with all of Plaintiff’s medical
records, including records from Dr. Paul Fox, Dr. Barbara Swan, Dr. Hassouri, Dr. Robert Baraff
and Dr. Haranath Parepally.2 (Id.). Based on his review of the record evidence and the
testimony at the hearing, the ALJ determined that Plaintiff’s impairments did not meet or
medically equal the criteria of any impairment listed in Appendix 1. (Id. at 17).
The ALJ went on to find that the claimant’s impairments have not resulted in major
disorganization of motor function, and that she retains the ability for effective ambulation. (R. at
18). The ALJ further determined that in the current record, the claimant failed to produce any
additional evidence relating to her allegation of mental impairment and that her activities of daily
living are no more than mildly restricted. Id. With regard to concentration, persistence or pace,
the ALJ determined that Plaintiff has only moderate difficulties, and Plaintiff successfully
completed the test for her Certified Nursing Assistant certificate and typically spends one to two
hours on the computer engaging in social activities such as Facebook. Id.
Based on the above-outlined evaluation, the ALJ determined that although Plaintiff
suffers from the severe impairments of gait dysfunction, chronic back pain and a learning
disability, these impairments, whether singularly or in combination, do not meet or equal an
impairment listed is 20 C.F.R. Par 404, Subpart P. and that Plaintiff is unable to perform any past
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With regard to the review of medical records, ALJ Kenworthy wrote: “At the hearing, the
claimant has presented additional evidence that is cumulative concerning the same
impairments that were considered in a previous decision. No evidence of additional
impairments has been presented. In connection with the current claim, consideration has
been given to all of the evidence, including that prior to May 15, 2009, so as to obtain a
longitudinal view of the claimant’s impairments.” (R. at 14).
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relevant work. (R. at 18). The ALJ found that the Plaintiff retains the Residual Functional
Capacity (RFC) to:
Perform sedentary work as defined in 20 CFR 404.1567(a) except
with the sit/stand option at intervals of about 30 minutes. The
Claimant can perform simple repetitive tasks that would not involve
exposure to heights or hazardous operations. She should not be
required to perform tasks that would be dangerous of a person with
balance impairment. She could not perform tasks that require literacy
about a third grade level.
(Id. at 19).
Analysis
To be eligible for disability insurance benefits under the Act, a claimant must
demonstrate to the Commissioner that he or she cannot engage in substantial gainful activity
because of a medically determinable physical or mental impairment, which can be expected to
result in death or which has lasted or can be expected to last for a continuous period of at least
twelve months. 42 U.S.C. § 423(d)(1) (A); Brewster v. Heckler, 786 F.2d 581, 583 (3d Cir.
1986). When reviewing a claim, the Commissioner must utilize a five-step sequential analysis to
evaluate whether a claimant has met the requirements for disability. 20 C.F.R. §§ 404.1520,
416.920.
At Step One, the Commissioner determines whether the claimant has engaged in
substantial gainful activity since the onset date of the alleged disability. Id. §§ 404.1520(b),
416.920(b). If not, the Commissioner moves to Step Two to determine if the claimant's alleged
impairments qualify as “severe.” Id. §§ 404.1520(c), 416.920(c). If the claimant has a severe
impairment or impairments, the Commissioner inquires at Step Three as to whether the
impairment or impairments meet (or equal) the criteria of any impairment found in the Listing of
Impairments. 20 C.F.R. Part 404, Subpart P, Appendix 1, Part A. If so, the claimant is
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automatically eligible to receive benefits (and the analysis ends); if not, the Commissioner moves
on to Step Four. Id. §§ 404.1520(d), 416.920(d). At Step Four, the Commissioner decides
whether, despite any severe impairment(s), the claimant retains the Residual Functional Capacity
(“RFC”) to perform past relevant work. Id. §§ 404.1520(e)-(f), 416.920(e)-(f). The claimant
bears the burden of proof at each of these first four steps. At Step Five, the burden shifts to the
Social Security Administration to demonstrate that the claimant is capable of performing other
jobs that exist in significant numbers in the national economy in light of the claimant's age,
education, work experience and RFC. 20 C.F.R. §§ 404.1520(g), 416.920(g).
Judicial review of the Commissioner's final decisions is plenary as to all legal issues. 42
U.S.C. § 405(g). A district court must determine whether substantial evidence existed in the
record to support the Commissioner's findings of fact. Burns v. Barnhart, 312 F.3d 113, 118 (3d
Cir. 2002). Substantial evidence is “more than a mere scintilla of evidence but may be less than
a preponderance,” and is evidence which “a reasonable mind might accept as adequate to support
a conclusion.” Johnson v. Com m'r of Soc. Sec., 529 F.3d 198, 200 (3d Cir. 2008).
The focus of Plaintiff’s challenge relates to the ALJ’s analysis of her impairment of
conversion disorder.3
More specifically, Plaintiff argues that the ALJ erred in finding no
definitive diagnosis of conversion disorder and, therefore, erroneously failed to evaluate whether
the impairment was severe under Step Two and failed to evaluate the impairment in determining
Plaintiff’s residual functional capacity.4
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Having carefully reviewed the record, the Court
The essential feature of a conversion disorder is the presence of symptoms or deficits
affecting voluntary motor or sensory function that suggests a neurological or other general
medical condition. http://www.mayoclinic.com/health/conversion-disorder/DS00877 (last
visited 10/4/2012).
The Court notes that the ALJ ruled against Plaintiff at Step Five of his analysis, not Step
Two, after concluding that her RFC was sufficient to enable her to perform jobs that exist in
significant numbers in the national economy. The ALJ moved past Step Two after
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concludes that the manner in which the ALJ treated Plaintiff’s conversion disorder impairment
was not supported by substantial evidence and remand is appropriate. Accordingly, the Court
will limit its discussion to the point of error alleged by Plaintiff.
Plaintiff argues that the ALJ ignored the diagnosis of conversion disorder given by
Dr. Haranath Parepally and the consultative evaluation offered by Dr. Emanuel Schnepp. (Doc.
No. 10). The Court examines both in turn.
On August 31, 2005, Plaintiff was admitted to UPMC Passavant for rehabilitation of her
left leg after complaining of difficulty walking and electrical sensation radiating down her leg.
(R. at 309). After a physical evaluation on September 1, 2005, Plaintiff underwent a psychiatric
evaluation by Dr. Parepally on September 4, 2005. Id. Dr. Parepally noted that Plaintiff was
conscious and alert with no increased or decreased psychomotor activity. (R. at 315).
Dr. Parepally then opined an AXIS I diagnosis of conversion order with motor symptoms, noting
Plaintiff’s history of pseudoseizures and sexual trauma. (R. at 316).
On February 3, 2010, Emanuel Schnepp, Ph.D conducted a consultative examination of
Plaintiff’s medical records. In his report, Dr. Schepp notes medically determinable impairments
of conversion disorder, major depressive disorder (by history), and mild mental retardation.
Dr. Schnepp found that as a whole, Plaintiff’s medical records do not demonstrate the presence
of “C” criteria and furthermore, Plaintiff’s mental disorders indicate a mild to moderate impact
on Plaintiff’s functional limitations. (R. at 418, 420).
concluding that Plaintiff’s gait dysfunction, chronic back pain and learning disorder were
severe. Before the Court, however, Plaintiff has contended that the ALJ should have found
that her conversion disorder was severe as well. Plaintiff claims that the failure to find a
severe impairment due to conversion disorder at Step Two tainted the rest of the ALJ's
analysis.
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The ALJ's discussion of Plaintiff's conversion disorder is limited. In his opinion, the ALJ
found that “[i]n passing, it is noted that some physicians have suggested after examination that
the claimant may have a conversion disorder. However, the record does not contain a definitive
diagnosis of a conversion disorder by any examining medical source.” (R. at 19). The ALJ
offers no additional discussion or analysis of Plaintiff’s conversion disorder diagnosis. In
reaching his finding, the ALJ does not mention Dr. Parepally’s examination or Dr. Schnepp’s
report, nor does he assess their credibility or the weight given to their treatment notes and/or
opinions. In Cotter, the Court held that “[t]he ALJ has a duty to hear and evaluate all relevant
evidence in order to determine whether an applicant is entitled to disability benefits.” Cotter v.
Harris, 642 F.2d 700, 704 (3d Cir. 1981). “Although the ALJ may weigh the credibility of the
evidence, he must give some indication of the evidence he rejects and his reason(s) for
discounting that evidence.” Fargnoli v. Halter, 247 F.3d 34, 43 (3d Cir. 2001). The ALJ must
make enough factual findings so that the reviewing court has the ability to determine if
“significant probative evidence was not credited or simply ignored.” Id. at 42.
Despite Dr. Parepally’s diagnosis of conversion disorder (following an examination of
Plaintiff), along with Dr. Schnepp’s confirmation and consideration of a diagnosis of conversion
disorder, the ALJ writes that no diagnosis from an “examining medical” source exists, and did
not evaluate the disorder under Step Two of his analysis. Defendant argues that Dr. Parepally’s
notes and diagnosis were not conclusive, and his “differential diagnosis, more than three years
before the relevant time period of Plaintiff’s claim, does not support a finding of a severe
impairment.” (Doc. 12). The Court notes that upon review, the ALJ has the discretion to reject
or adopt Dr. Parepally’s diagnosis or Dr. Schnepp’s report; the Court does not give direction on
that matter. It is the lack of analysis of his findings that leaves the Court wondering if “he
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considered and rejected” the diagnosis and report, “considered and discounted them, or failed to
consider them at all.” Fargnoli, 247 F.3d at 43–44.
In light of Dr. Parepally’s diagnosis and Dr. Schnepp’s report, the Court finds it difficult
to find substantial evidence for the ALJ’s conclusion that no definitive diagnosis of conversion
disorder by any examining medical source exists in the record. It is impossible for the Court to
determine if the ALJ weighed Dr. Parepally’s and Dr. Schnepp’s reports or if the reports were
ignored, or worse, missed altogether. The regulations clearly require the Commissioner to
consider all of a claimant's severe and non-severe impairments. 20 C.F.R. §§ 404.1545(a)(2),
416.945(a) (2); see also Lambert v. Astrue 2009 WL 425603, *13 (W.D.Pa. 2009). “Although
the ALJ may weigh the credibility of the evidence, he must give some indication of the evidence
which he rejects and his reason(s) for discounting such evidence ... [i]n the absence of such an
indication, the reviewing court cannot tell if significant probative evidence was not credited or
simply ignored.” Burnett v. Commissioner, 220 F.3d 112, 121 (3d Cir. 2000) (citations omitted).
Therefore, on remand, the ALJ shall address Plaintiff’s diagnosis of conversion disorder and the
extent to which the impairment creates vocational limitations.
Conclusion
For all of the reasons stated above, Defendant’s Motion for Summary Judgment is
DENIED, and Plaintiff’s Motion for Summary Judgment is GRANTED insofar as it seeks a
remand for further administrative proceedings. This case is REMANDED for further
proceedings before the Commissioner as outlined in the following Order:
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II. ORDER
For the reasons stated above, the Court hereby ORDERS that Defendant’s Motion for
Summary Judgment (Doc. 11) is DENIED; and Plaintiff’s Motion for Summary Judgment (Doc.
9) is GRANTED; and this case is REMANDED FORTHWITH for further administrative
proceedings consistent with the Court’s Memorandum and Order.
IT IS SO ORDERED.
s/ Cathy Bissoon
Cathy Bissoon
United States District Judge
October 9, 2012
cc (via ECF):
All counsel of record.
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