WILSON v. COMMISSIONER OF SOCIAL SECURITY
Filing
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ORDER granting in part and denying in part 8 Motion for Summary Judgment; denying 12 Motion for Summary Judgment. It is further ordered that the decision of the Commissioner of Social Security is hereby vacated and the case is remanded for further proceedings consistent with the foregoing opinion. Signed by Judge Donetta W. Ambrose on 12/19/16. (slh)
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
AMY LYNN WILSON,
)
)
)
)
)
)
)
)
)
)
Plaintiff,
-vsCAROLYN W. COLVIN,
COMMISSIONER OF SOCIAL SECURITY,
Defendant.
Civil Action No. 15-1272
AMBROSE, Senior District Judge
OPINION
and
ORDER OF COURT
SYNOPSIS
Pending before the Court are Cross-Motions for Summary Judgment. (ECF Nos. 8 and
12). Both parties have filed Briefs in Support of their Motions. (ECF Nos. 9, 13 and 16). After
careful consideration of the submissions of the parties, and based on my Opinion set forth below,
I am granting Plaintiff=s Motion for Summary Judgment (ECF No. 8) and denying Defendant=s
Motion for Summary Judgment. (ECF No. 12).
I. BACKGROUND
Plaintiff brought this action for review of the final decision of the Commissioner of Social
Security (ACommissioner@) denying her applications for disability insurance benefits and
supplemental security income pursuant to the Social Security Act (AAct@). Plaintiff filed her
applications for benefits alleging she had been disabled since February 28, 2008. (ECF No. 4-5,
pp. 8, 15).
Administrative Law Judge (“ALJ”) William E. Kenworthy held a hearing on October 9,
2012. (ECF No. 4-2, pp. 42-47). On October 23, 2012, the ALJ found that Plaintiff was not
disabled under the Social Security Act.
(ECF No. 4-2, pp. 30-37).
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After exhausting all
administrative remedies thereafter, Plaintiff filed an action in this court.
After review, this court remanded the case on September 29, 2014. (ECF No. 6-14, pp.
2-9). On remand, ALJ Kenworthy held another hearing. (ECF No. 6-13, pp. 20-38). On July
24, 2014, the ALJ found that Plaintiff was not disabled under the Act. (ECF No. 6-13, pp. 5-14).
After exhausting all administrative remedies thereafter, Plaintiff filed an action in this court.
The parties have filed Cross-Motions. (Docket No. 8 and 12). The issues are now ripe for
review.
II. LEGAL ANALYSIS
A.
Standard of Review
The standard of review in social security cases is whether substantial evidence exists in
the record to support the Commissioner=s decision. Allen v. Bowen, 881 F.2d 37, 39 (3d Cir.
1989). Substantial evidence has been defined as Amore than a mere scintilla. It means such
relevant evidence as a reasonable mind might accept as adequate.@ Ventura v. Shalala, 55 F.3d
900, 901 (3d Cir. 1995), quoting Richardson v. Perales, 402 U.S. 389, 401 (1971). Additionally,
the Commissioner=s findings of fact, if supported by substantial evidence, are conclusive. 42
U.S.C. '405(g); Dobrowolsky v. Califano, 606 F.2d 403, 406 (3d Cir. 1979). A district court
cannot conduct a de novo review of the Commissioner=s decision or re-weigh the evidence of
record. Palmer v. Apfel, 995 F.Supp. 549, 552 (E.D. Pa. 1998). Where the ALJ's findings of fact
are supported by substantial evidence, a court is bound by those findings, even if the court would
have decided the factual inquiry differently. Hartranft v. Apfel, 181 F.3d 358, 360 (3d Cir. 1999).
To determine whether a finding is supported by substantial evidence, however, the district court
must review the record as a whole. See, 5 U.S.C. '706.
To be eligible for social security benefits, the plaintiff must demonstrate that he 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
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last for a continuous period of at least 12 months. 42 U.S.C. '423(d)(1)(A); Brewster v. Heckler,
786 F.2d 581, 583 (3d Cir. 1986).
The Commissioner has provided the ALJ with a five-step sequential analysis to use when
evaluating the disabled status of each claimant.
20 C.F.R. '404.1520(a).
The ALJ must
determine: (1) whether the claimant is currently engaged in substantial gainful activity; (2) if not,
whether the claimant has a severe impairment; (3) if the claimant has a severe impairment,
whether it meets or equals the criteria listed in 20 C.F.R., pt. 404, subpt. P., appx. 1; (4) if the
impairment does not satisfy one of the impairment listings, whether the claimant=s impairments
prevent him from performing his past relevant work; and (5) if the claimant is incapable of
performing his past relevant work, whether he can perform any other work which exists in the
national economy, in light of his age, education, work experience and residual functional capacity.
20 C.F.R. '404.1520.
The claimant carries the initial burden of demonstrating by medical
evidence that he is unable to return to his previous employment (steps 1-4). Dobrowolsky, 606
F.2d at 406.
Once the claimant meets this burden, the burden of proof shifts to the
Commissioner to show that the claimant can engage in alternative substantial gainful activity
(step 5). Id.
A district court, after reviewing the entire record may affirm, modify, or reverse the decision
with or without remand to the Commissioner for rehearing. Podedworny v. Harris, 745 F.2d 210,
221 (3d Cir. 1984).
B.
Opinion Evidence
Plaintiff submits that remand is warranted because the ALJ erred in failing to consider
medical opinion evidence consistent with the regulations. (ECF No. 9, pp. 5-10, No. 16, p. 1-2).
After a careful review, I agree with Plaintiff’s position, in part.
While the ALJ need only discuss the most pertinent, relevant evidence bearing upon a
claimant’s disability status, he must provide sufficient discussion to allow the court to determine
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whether any rejection of potentially pertinent, relevant evidence was proper. Johnson v. Comm’r
of SS, 529 F.3d 198, 203-04 (3d Cir. 2008). To that end, an ALJ must provide sufficient
explanation of his or her final determination to provide a reviewing court with the benefit of the
factual basis underlying the ultimate disability finding. Cotter v. Harris, 642 F.2d 700, 705 (3d Cir.
1981). “’In the absence of such an indication, the reviewing court cannot tell if significant
probative evidence was not credited or simply ignored.’” Burnett v. Comm’r of SS, 220 F.3d 112,
121-22 (3d Cir. 2000), quoting Cotter v. Harris, 642 F.2d 700, 705 (3d Cir. 1981); Fargnoli v.
Massanari, 247 F.3d 34, 44 (3d Cir. 2001). An ALJ’s findings should be as “comprehensive and
analytical as feasible,” so that the reviewing court may properly exercise its duties under 42
U.S.C. §405(g). Cotter, 642 F.2d at 705.
In the present case, I find the ALJ failed to meet this standard. With regard to Drs.
Wyszomierski, Brentzel and Kaufman, the ALJ gives absolutely no valid reason for giving them
substantial weight. (ECF No. 6-13, p. 12). The ALJ states their opinions and that he agrees
with them, but does not say why or what his agreement is based upon. Id. As a result, I am
unable to tell if the ALJ’s agreement is supported by substantial evidence. Thus, I am prohibited
from conducting a meaningful review in this regard. Therefore, remand is warranted on this
basis.1
With regard to Dr. Bernstein, the ALJ stated that he gave his opinion very little weight
because it is a conclusory opinion. (ECF No. 6-13, p. 12). Plaintiff agrees that Dr. Bernstein’s
opinion is “rather conclusory” and, as such, his statement that Plaintiff is disabled is not entitled to
any significance. (ECF No. 9, p. 11). Nevertheless, Plaintiff submits that there was more to Dr.
Berstein’s report and the ALJ was still required to consider the rest of Dr. Berstein’s report. After
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Plaintiff argues that the ALJ erred in failing to incorporate Dr. Brentzel’s conclusion that Plaintiff was
limited to 1-2 step tasks and that the ALJ erred in failing to account for Plaintiff’s moderate limitation in
concentration, persistence and/or pace. (ECF No. 9, pp. 15-18; No, 16, p. 4). Since I am remanding this
case, I decline to consider these issues as they must be reconsidered, de novo, on remand.
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a review of the record, I find the ALJ considered the entirety report of Dr. Bernstein. (ECF No.
6-13, pp. 9, 12). Thus, I find no merit to this argument.
With regard to Dr. Seilhamer, Plaintiff argues that the ALJ erred in failing to recognize that
Dr. Seilhamer is a specialist and that that he was an examining source. (ECF No. 9, pp. 12-13).
Additionally, Plaintiff argues that the reason given by the ALJ for discrediting Dr. Seilhamer is
incorrect. Id. at p. 13. I disagree. The ALJ clearly recognized that Dr. Seilhamer was a
consultative examining source. (ECF No. 6-13, p. 12). Moreover, the ALJ in this case did not
credit Dr. Seilhamer’s opinion that Plaintiff had an extreme impairment in her ability to respond
appropriately to work pressures and a marked impairment in her ability to interact socially in the
workplace because it was internally inconsistent and because Plaintiff “sought only very limited
mental health treatment since September, 2009, except for her drug rehab.” (ECF No. 6-13, p.
12). These are appropriate, valid and acceptable reasons for discounting opinion evidence. See,
20 C.F.R. §§404.1527; 416.927 (Evaluating Opinion Evidence).
I find that that internal
inconsistency reason is supported by substantial evidence. (ECF No. 6-13, p. 12). Therefore, I
find no error in this regard on the part of the ALJ.2
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As mentioned above, the ALJ also questioned Dr. Seilhamer’s conclusions because Plaintiff had “sought
only very limited mental health treatment since September, 2009, except for her drug rehab.” (ECF No.
6-13, p. 12). Plaintiff contends that the ALJ erred in making this reference because the ALJ failed to
address Plaintiff’s inability to afford such treatment due to lack of health insurance. (ECF No. 9, pp. 13-14;
ECF No. 16, p. 3). It is well-established that an “ALJ may rely on lack of treatment, or the conservative
nature of treatment, to make an adverse credibility finding, but only if the ALJ acknowledges and considers
possible explanations for the course of treatment.”
Wilson v. Colvin, No.
3:13-cv-02401-GBC, 2014 WL 4105288, at * 11 (M.D. Pa. Aug. 19, 2014). As set forth in Social Security
Ruling 96-7p, however, “[t]he adjudicator must not draw any inferences about an individual’s symptoms and
their functional effect from a failure to seek or pursue regular medical treatment without first considering any
explanations that the individual may provide, or other information in the case record, that may explain
infrequent or irregular medical visits or failure to seek medical treatment.” S.S.R. 96-7p, 1996 WL 374186,
at **7-8. Possible explanations that may provide insight into an individual’s credibility include the inability to
afford treatment and/or lack of access to free or low-cost medical services. Id. Courts routinely have
remanded cases in which the ALJ’s credibility analysis fails to address evidence that a claimant declined or
failed to pursue more aggressive treatment due to lack of medical insurance. See, e.g., Newell v. Comm’r
of Soc. Sec., 347 F.3d 541, 547 (3d Cir. 2003); Wilson, 2014 WL 4105288, at 11-12; Kinney v. Comm’r of
Soc. Sec., 244 F. App’x 467, 470 (3d Cir. 2007); Sincavage v. Barnhart, 171 F. App’x 924, 927 (3d Cir.
2006); Henderson v. Astrue, 887 F. Supp. 2d 617, 638-39 (W.D. Pa. 2012); Plank v. Colvin, Civ. No.
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An appropriate order shall follow.
12-4144, 2013 WL 6388486, at *8 (E.D. Pa. Dec. 6, 2013). In this case, the ALJ fails to address this issue.
On remand, the ALJ must consider the same.
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IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
AMY LYNN WILSON,
)
)
)
)
)
)
)
)
)
)
Plaintiff,
-vsCAROLYN W. COLVIN,
COMMISSIONER OF SOCIAL SECURITY,
Defendant.
Civil Action No. 15-1272
AMBROSE, Senior District Judge
ORDER OF COURT
THEREFORE, this 19th day of December, 2016, it is ordered that Plaintiff=s Motion for
Summary Judgment (ECF No. 8) is granted in part and denied in part and Defendant=s Motion for
Summary Judgment (Docket No. 12) is denied.
It is further ordered that the decision of the Commissioner of Social Security is hereby
vacated and the case is remanded for further proceedings consistent with the foregoing opinion.
BY THE COURT:
s/ Donetta W. Ambrose
Donetta W. Ambrose
United States Senior District Judge
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