Lightle v. Commissioner of Social Security Administration
Filing
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OPINION AND ORDER RULING ON REPORT AND RECOMMENDATION declining to adopt 16 Report and Recommendation, reversing the decision of the Commissioner pursuant to sentence four of 42 U.S.C. § 405(g) and remanding the action for further evaluation. Signed by Honorable Donald C. Coggins, Jr. on 09/10/2018. (bshr, )
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF SOUTH CAROLINA
Vickie Lightle,
)
)
Plaintiff,
)
)
v.
)
)
Nancy A. Berryhill, Acting
)
Commissioner of Social Security,
)
)
Defendant. )
________________________________ )
C/A No. 0:17-1009-DCC
OPINION AND ORDER
Plaintiff brings this action pursuant to 42 U.S.C. § 405(g) seeking judicial review of
the final decision of the Commissioner of Social Security (“Commissioner”) denying her
claim for Disability Insurance Benefits (“DIB”). In accordance with 28 U.S.C. § 636(b) and
Local Civil Rule 73.02 (D.S.C.), this matter was referred to a United States Magistrate
Judge for pre-trial handling. On April 19, 2018, Magistrate Judge Paige J. Gossett issued
a Report and Recommendation (“Report”), recommending that the decision of the
Commissioner be affirmed. ECF No. 16. On May 11, 2018, Plaintiff filed objections to
the Report, and the Commissioner filed a reply on May 23, 2018. ECF Nos. 20, 22.
The Magistrate Judge makes only a recommendation to this Court.
The
recommendation has no presumptive weight, and the responsibility to make a final
determination remains with this Court. Mathews v. Weber, 423 U.S. 261, 270–71. The
Court is charged with making a de novo determination of only those portions of the Report
that have been specifically objected to, and the Court may accept, reject, or modify the
Report, in whole or in part. 28 U.S.C. § 636(b)(1).
The role of the federal judiciary in the administrative scheme established by the
Social Security Act (“the Act”) is a limited one. Section 205(g) of the Act provides, “[t]he
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findings of the Secretary as to any fact, if supported by substantial evidence, shall be
conclusive . . . .”
42 U.S.C. § 405(g).
“Substantial evidence has been defined
innumerable times as more than a scintilla, but less than preponderance.” Thomas v.
Celebreeze, 331 F.2d 541, 543 (4th Cir. 1964). This standard precludes a de novo review
of the factual circumstances that substitutes the court’s findings for those of the
Commissioner. Vitek v. Finch, 438 F.2d 1157 (4th Cir. 1971). The court must uphold the
Commissioner’s decision as long as it was supported by substantial evidence and
reached through the application of the correct legal standard. Johnson v. Barnhart, 434
F.3d 650 (4th Cir. 2005). “From this it does not follow, however, that the findings of the
administrative agency are to be mechanically accepted. The statutorily granted right of
review contemplates more than an uncritical rubber stamping of the administrative
action.” Flack v. Cohen, 413 F.2d 278, 279 (4th Cir. 1969). “[T]he courts must not
abdicate their responsibility to give careful scrutiny to the whole record to assure that
there is a sound foundation for the [Commissioner’s] findings, and that his conclusion is
rational.” Vitek, 438 F.2d at 1157–58.
BACKGROUND
Plaintiff applied for DIB in March 2013, alleging that she has been disabled since
February 28, 2012, due to an injury to her neck and left shoulder,1 chronic obstructive
pulmonary disease, high blood pressure, acid reflux, and depression. Plaintiff’s claims
were denied initially and upon reconsideration. Plaintiff requested a hearing before an
Administrative Law Judge (“ALJ), which was held on August 13, 2015. The ALJ denied
1
Plaintiff suffered an injury to her left shoulder at work and filed a claim with the South
Carolina Workers’ Compensation Commission.
2
Plaintiff’s claims in a decision issued on October 27, 2015. Plaintiff submitted additional
evidence to the Appeals Council, which denied Plaintiff’s request for review on March 2,
2017, making the determination of the ALJ the final decision of the Commissioner.
DISCUSSION
The Magistrate Judge recommends that the Court affirm the Commissioner’s
decision because it is supported by substantial evidence and the proper legal standards
were applied.
Plaintiff objects to the Report, raising three objections, claiming the
Magistrate Judge erred in: (1) failing to afford great weight to Plaintiff’s treating physicians
but giving great weight to the opinions of the state agency medical consultants; (2) failing
to address the vocational assessment of Dr. Hecker; and (3) finding there is substantial
evidence to support the ALJ’s finding that Plaintiff could perform her past relevant work.
The Court finds the first issue dispositive of this appeal and needs not reach the remaining
issues.
Under the regulations of the Social Security Administration,2 the Commissioner is
obligated to consider all medical evidence presented, including the opinions of medical
sources. 20 C.F.R. § 1527(c). The regulations require ALJs to “give more weight to
medical opinions from [a plaintiff’s] treating sources, since these sources are likely to be
the medical professionals most able to provide a detailed, longitudinal picture of [a
plaintiff’s] medical impairment(s) and may bring a unique perspective to the medical
evidence that cannot be obtained from the objective medical findings alone or from
2
As the Magistrate Judge correctly notes, numerous social security regulations and
rulings have changed effective March 27, 2017. However, these changes only apply to
claims filed on or after March 27, 2017. Therefore, all references in this Order are to the
prior versions of the regulations that were in effect at the time Plaintiff’s application was
filed, unless otherwise specified.
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reports of individual examinations, such as consultative examinations or brief
hospitalizations.” Id. § 416.1527(c)(2). If the ALJ “find[s] that a treating source’s medical
opinion on the issue(s) of the nature and severity of [a plaintiff’s] impairment(s) is wellsupported by medically acceptable clinical and laboratory diagnostic techniques and is
not inconsistent with the other substantial evidence in [a plaintiff’s] case record, [the ALJ]
will give it controlling weight.” Id. When, however, the ALJ does not give a treating
physician’s opinion controlling weight, the ALJ must consider a number of factors
including: (1) the length of the treatment relationship and the frequency of examination;
(2) the nature and extent of the treatment relationship; (3) the supportability of the
physician’s opinion; (4) the consistency of the opinion with the medical records; (5)
whether the physician is a specialist; and (6) any other relevant factors. Id. § 416.927(c).
The ALJ began its discussion of Plaintiff’s treating physicians by stating “[a]
claimant’s treating physician in the context of a workers compensation claim often serves
as an advocate for the claimant and may describe excessive limitations to enhance the
claimant’s financial recovery.” R. 40–41. The ALJ then gives partial weight to the
opinions of Dr. Allan Posta, Plaintiff’s surgeon; some, limited weight to the opinion of Dr.
James Behr, Plaintiff’s pain specialist; partial, limited weight to the opinion of Dr. Stefan
Tolan, Plaintiff’s surgeon; and appears to give limited weight to the opinions of Dr. Charles
Kanos, Plaintiff’s surgeon, though the ALJ does not elaborate on this issue. R. 41–43.
In contrast, the ALJ gave great weight to the opinions of the State agency psychological
and medical consultants. R. 42–43.
The Court has reviewed the medical records and finds that they generally support
the opinions of Plaintiff’s treating physicians that she is disabled. However, the Court
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need not delve into the minutia of the medical records in this case, for the Court
determines that the ALJ’s opinion is infected with an error of law warranting remand.
The
ALJ
fundamentally
misunderstands
the
South
Carolina
Workers’
Compensation system, and that misunderstanding makes his evaluation of Plaintiff’s
treating physicians’ opinions impossible to properly evaluate on appellate review.
Employers, not employees, choose treating physicians in the Workers’ Compensation
system. See S.C. Code Ann. § 42-15-60(A) (“The employer shall provide medical,
surgical, hospital, and other treatment, including medical and surgical supplies as
reasonably may be required . . . to effect a cure or give relief . . . .”); see also Clark v.
Aiken Cty. Gov’t, 620 S.E.2d 99, 104 (S.C. Ct. App. 2005) (“The Workers’ Compensation
Act provides that the employer retains the right to name the authorized treating physician
once a case has been accepted. Refusal by the claimant to accept treatment generally
bars further compensation”). Yet, the ALJ’s decision is clearly influenced by an erroneous
belief that the physicians treating Plaintiff for her Workers’ Compensation claim were
biased in her favor and had incentive to exaggerate her disability.
Specifically, the ALJ writes in his decision that, “[a] claimant’s treating physician in
the context of a workers compensation claim often serves as an advocate for the claimant
and may describe excessive limitations to enhance the claimant’s financial recovery.” R.
40–41. This statement clearly evidences the ALJ’s apparent ignorance of the fact that
the employer’s insurance carrier selects and pays the treating physician in the workers’
compensation context. Accordingly, if there is any bias based upon financial incentive,
or otherwise, it is for the physician to minimize the claimant’s impairments and certify a
return to work as soon as possible. While the ALJ notes that “nevertheless, the potential
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conflict of interest that inherently arises for a treating source in a workers compensation
case may necessarily reflect on the supportability and consistency of his opinion,” the
actual potential for conflict of interest is against the claimant, not in her favor. R. 41.
After these misguided musings on the apparent claimant-favored bias inherent in
the South Carolina Workers’ Compensation system, the ALJ then transitions to his
evaluation of the opinion evidence by stating, “[w]ith all of these thoughts in mind, the
undersigned turns to the sizeable amount of opinion evidence present in the claimant’s
case that was generated by her workers compensation claim.” Id. The Social Security
Regulations allow ALJs to consider factors other than those specifically set forth in 20
C.F.R. § 404.1527 in evaluating medical evidence. However, the Regulations do not
permit an ALJ to assume bias based on a fundamental legal error about how the South
Carolina Workers’ Compensation system works.
Of course, the Social Security Regulations do not require an ALJ to accept the
finding of any other governmental agency, including the South Carolina Workers’
Compensation Commission. See 20 CFR § 404.1504. Therefore, analyzing the opinion
evidence in the context of the applicable Workers’ Compensation regulations would be
appropriate. Erroneously assuming bias without any basis in fact, however, is not. The
ALJ’s opinion analysis is tainted, and a remand is warranted for an ALJ to objectively
evaluate the opinion evidence in this case consistent with the applicable law and
regulations.
CONCLUSION
For the reasons set forth above, the Court respectfully DECLINES to adopt the
Report, REVERSES the decision of the Commissioner, and REMANDS pursuant to
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sentence four of 42 U.S.C. § 405(g) for further evaluation of Plaintiff’s claim as indicated
above.
IT IS SO ORDERED.
s/ Donald C. Coggins, Jr.
United States District Judge
September 10, 2018
Spartanburg, South Carolina
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