Lyons v. Commissioner of Social Security Administration
Filing
15
OPINION AND ORDER granting 12 MOTION for Order Reversing the Decision of the Commissioner; denying 13 MOTION for Order Affirming the Decision of the Commissioner. Signed by Judge William K. Sessions III on 10/29/2019. (jam)
UNITED STATES DISTRICT COURT
FOR THE
DISTRICT OF VERMONT
DONNA L.,
Plaintiff,
Case No. 2:18-cv-22
v.
ANDREW SAUL,
Commissioner of the Social
Security Administration,
Defendant.
OPINION AND ORDER
Plaintiff Donna L. brings this action pursuant to 42 U.S.C. § 405(g) of the Social Security
Act requesting review of the Commissioner’s decision to deny her application for disability
insurance benefits. Now before the Court are Plaintiff’s motion for judgment reversing the
decision of the Commissioner, and the Commissioner’s motion for judgment affirming the same.
For the reasons set forth below, Plaintiff’s motion is granted, the Commissioner’s motion is
denied, and the matter is remanded for a calculation of benefits.
BACKGROUND
I.
PROCEDURAL HISTORY
Plaintiff Donna L. filed an application for Title II disability insurance benefits (DIB) on
May 13, 2013, alleging disability as of October 1, 2011. Administrative Record at 589
[hereinafter AR]. The Commissioner denied her application initially and again upon
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reconsideration. Id. Ms. L. then requested an administrative hearing, which was held before
administrative law judge (ALJ) Matthew Levin on March 3, 2015. Id. at 662. The ALJ issued an
opinion on April 3, 2015, concluding that Ms. L. was not disabled within the meaning of the
Social Security Act. Id. at 659–74. Following this decision, Ms. L. requested review by the
Appeals Council. The Appeals Council denied this request. Id. at 1.
Ms. L. then sought judicial review in this Court, claiming that the Appeals Council and
the ALJ made several critical errors in their decision to deny her DIB application. Id. at 692–93.
In an opinion dated October 27, 2016, this Court granted Ms. L.’s motion, reversing and
remanding the matter for further proceedings. Id. at 709. The Court held that the Appeals
Council’s failure to consider the June 2015 opinions of treating primary care physician Dr.
Michael Johnson and treating psychiatrist Dr. Laura Middleton warranted a remand. Id. at 696.
The Court also found that substantial evidence did not support the ALJ’s decision to give Dr.
Johnson’s opinions limited weight. Similarly, the Court held that substantial evidence did not
support the ALJ’s credibility assessment of Ms. L. or his RFC determination regarding her
ability to function socially. Id. at 709. Following this decision, the ALJ held a new hearing on
October 3, 2017 and issued another unfavorable decision on November 16, 2017. Id. at 586–606.
II.
PERSONAL AND MEDICAL HISTORY
A. Medical History
Ms. L. was born on July 12, 1961. Id. at 354. She was 50 years old at the onset of her
disabilities and 53 at her date last insured (DLI). Id. at 592. Ms. L. has struggled with mental
health issues for some time and has seen psychiatrist Dr. Laura Middleton for a panic disorder
and agoraphobia since 1997. Id. at 304. In addition, Ms. L. has complained of chronic pain to Dr.
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Michael Johnson who has acted as her primary care provider since at least 2010. Id. at 354. She
was found to have Patellofemoral Pain Syndrome in May 2013 and Dr. Johnson diagnosed Ms.
L. with fibromyalgia in January 2015. Id. at 366.
In October 2011, Ms. L. began working as a cashier for the Richmond Market. Id. at 266.
She alleges that her disabilities began this same month. Id. at 589. Six months later, Ms. L. left
this job due to conflicts with coworkers and because she felt it exacerbated her physical ailments.
Id. at 267. In October 2012, Ms. L. took a position with the Family Dollar but left this job three
days later because she could not stand for the nine-hour shifts. Id. at 37, 320.
Later that month, Ms. L. met with physician assistant Patrick Kearney for an appointment
regarding her joint pain. Id. at 345. X-rays from this visit showed that Ms. L. had bilateral facet
arthrosis in her L4-5 vertebrae and sacralization of her left L5 transverse process. Id. at 346.
Kearney authorized x-rays of Ms. L.’s feet, which were taken eight days later, revealing mild
degenerative changes in the first metatarsal phalangeal (MTP) joint of the left foot and minimal
degenerative changes in the first MTP joint of the right foot. Id. at 360. Ms. L. also reported at
this appointment that her bilateral knee pain began in October 2012 after standing for nine hours
while working at the Family Dollar. Id. at 372.
In November 2012, Dr. Johnson referred Ms. L. to Long Trail Physical Therapy to work
on her bilateral knee pain. Id. During her treatment, Physical Therapist Richard Tremblay
diagnosed Ms. L. with osteoarthrosis and made objective findings of “dramatic decreased
gastroe[nteritis] flexibility, and associated gait deviations, slight decreased hamstring strength,
[and] moderate levels of LCL laxity.” Id. at 373. Despite her physical therapy, Dr. Johnson
noted “severe worsening knee pain” in February 2013.
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In May 2013, Dr. Johnson reported that Ms. L.’s anxiety had worsened even with a
higher dose of Zoloft. Id. at 336. In addition, he stated that Ms. L. had pain in her left gluteal
region, left hip, and left foot and believed that the pain was radiating from her back to her foot.
Id. Dr. Johnson conducted a physical examination that indicated Ms. L.’s spine was straight and
non-tender but her paraspinal muscles were tight and tender. Id. The examination also
demonstrated that Ms. L. had a limited range of motion due to her pain. Id. This same month, Dr.
Johnson referred Ms. L. to Associates in Orthopedic Surgery to assess her knee pain. Id. at 365.
Nurse Practitioner Carol Blattspieler examined Ms. L. on May 22, 2013, finding that Ms. L.
suffered from Patellofemoral Pain Syndrome. Nurse Blattspieler stated that Ms. L. “should avoid
stairs, squatting, [and] kneeling and should make necessary changes while sitting and driving a
car if appropriate.” Id.
In June 2013, an MRI found a tiny central disc protrusion at L4-L5, facet
osteoarthropathy in the lower lumbar spine, and probable degenerative change at the level of the
left hip. Id. at 358. The remainder of the MRI’s findings were unremarkable. Id. at 357–58. On
June 27, 2013, resident Joshua Carter, M.D., saw Ms. L. regarding her left hip in consultation for
Dr. Johnson. Id. at 432. Dr. Carter observed that Ms. L. “walks with a hunched forward stance.”
Id. at 433. He also found that Ms. L. exhibited “tenderness to palpation around her iliac crest
with worsening pain as palpation is performed more posteriorly toward her posterior gluteal
musculature and SI [sacroiliac] joint.” Id. Dr. Carter opined that “[m]uch of her problems appear
more muscular tenderness in its origin and . . . may be related to her SI joint or some other
etiology.” Id. at 434. Other results from this exam were normal. Id. at 433. Dr. Jennifer Lisle
examined Ms. L. with Dr. Carter and agreed with his findings. Id. at 434.
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In September 2013, Dr. Scott Benjamin examined Ms. L. regarding her chronic pain. Id.
at 535. He stated that Ms. L. “presents with significant musculoskeletal tightness and
inflexibilities, [and] quite a bit of myofascial pain associated with this.” Id. at 537. He remarked
that Ms. L. had “tenderness throughout the trapezius, rhomboids, thoracic and lumbar
paraspinals” and that “trigger points [were] all noted.” Id. He observed significant tightness in
Ms. L.’s ankles and significant limitations in her ability to lean and flex her trunk rightward. Id.
He also noted that Ms. L. “presents with quite a bit of fear about her ongoing pain issues” and
that she hoped he would put her on disability that day. Id. Dr. Benjamin advised against
disability because he believed it would not be beneficial for her physically and recommended
gradually progressive aquatic-based physical therapy instead. Id.
Ms. L. began aquatic therapy with the RehabGym in October 2013 and continued with
treatment until December 2013. Id. at 449–67. The record indicates that she was seen by
RehabGym around 12 times during this period. Id. RehabGym’s initial assessment of Ms. L.
states that: “P[atien]t presents on this day with decreased lumbar and hip range of motion,
decreased core and lower extremity strength, impaired ambulation, generalized tightness, poor
posture, and decreased overall endurance.” Id. at 467. RehabGym’s progress notes for Ms. L.
indicate that she continued to have joint pain despite physical therapy and reflect her frustration
with the lack of progress. Id. at 449–67. In November 2013, Dr. Benjamin wrote a letter to Dr.
Johnson acknowledging the lack of improvement with Ms. L.’s chronic joint pain. Id. at 506. He
stated that he encouraged Ms. L. to continue with her physical therapy and noted that “while [he]
thinks she has real causes for pain in her body . . . her anxiety about her situation certainly can
add to that situation, and she needs to address her pain . . . both from her body and from her
mind.” Id. The following month, Ms. L. met with Dr. Johnson and reported drastically worse
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activity levels due to her hip and knee pain. Id. at 488. She expressed that she “[did not] know
how much was fatigue and how much was pain.” Id.
In February 2014, during a follow-up appointment with Dr. Lisle, Ms. L. reported that
her pain “certainly had not improved.” Id. at 422. Ms. L. also described “occasional tingling and
numbness in her feet.” Id. Dr. Lisle concluded that Ms. L.’s “symptoms [were] mostly
paraspinous and gluteal pain.” Id. Dr. Lisle’s physical examination of Ms. L. produced relatively
unremarkable results. Id. In this same month, Dr. Lisle referred Ms. L. to Dr. Robert Hemond
regarding her back pain. Id. at 440. He noted that Ms. L.’s “back pain is constant, vacillating in
intensity, [and] exacerbated by standing, sitting, walking and lying down.” Id. at 441. His review
of Ms. L.’s symptoms states that she was positive for back pain and joint swelling and his
assessment of Ms. L. reports that she suffers from musculoskeletal low back pain. Id. at 441. Dr.
Hemond remarked that his physical examination of Ms. L. did not show any “signs of nerve root
impingement.” Id. at 443. He also reviewed the MRI taken in June 2013 and stated that Ms. L.
has “mild facet arthropathy in the lumbar spine at 4-5” but opined that the “MRI [was] quite
good . . . with minimal degenerative changes.” Id.
Dr. Johnson continued to see Ms. L. on a regular basis throughout 2014. Id. at 471–87.
His treatment notes from March 2014 show that he prescribed Ms. L. morphine to combat her
ongoing chronic joint pain. Id. at 484. The following month, Ms. L. reported severe hip pain
even with reduced activity levels, stating that she could only work for 15 minutes before having
to stop for 30 minutes. Id. Dr. Johnson increased Ms. L.’s Gabapentin prescription in a continued
effort to ease her symptoms. Id. In May 2014, Ms. L. reported an acute exacerbation of her pain
and stated that she increased her intake of Gabapentin and Robaxin in response. Id. at 480. At her
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next visit in August 2014, Ms. L. reported napping 4 to 5 hours at a time due to her pain. Id. at
478.
In September 2014, Dr. Johnson sent Ms. L. to Dr. Thomas Zweber for an EMG and
nerve conduction study. Id. at 502. Dr. Zweber’s studies produced normal results. Id. at 503. He
found no evidence of a neurotic condition, peripheral neuropathy, lumbar radiculopathy, or tarsal
tunnel syndrome. Id. However, he did opine that Ms. L. “may have some element of peripheral
artery disease affecting her ambulation ability” and stated that “some element of facet syndrome”
is likely causing her chronic pain. Id.
In October 2014, Ms. L. met with Dr. Jonathan Fenton regarding her history of gluteal
pain. Id. at 552. Dr. Fenton’s physical examination showed that Ms. L. had: reduced lumbar
flexion; midline spinal tenderness at L4-5 and L5-S1; para facet tenderness at L3-4, L4-5, L5-S1;
para facet tenderness in all sections of her SI joint; gluteal tenderness; hip scour on her left side;
anterior hip capsule tenderness; and a positive result during torsional testing of her left side L4S1 lumbar facets. Id. at 554. Dr. Fenton included extreme fatigue in his review of Ms. L.’s
symptoms. Id. at 553. He diagnosed Ms. L. with lumbosacral pain and myofascial pain. Id.
Dr. Johnson then requested that Dr. Carol Talley see Ms. L. to review options for
addressing fibromyalgia. Id. at 509. At this appointment in December 2014, Ms. L. expressed an
increase in shoulder pain and reported needing assistance with washing her hair over the past
month. Id. Dr. Talley’s evaluation of Ms. L.’s right shoulder demonstrated significant active and
passive restrictions in her range of motion. Id. Additionally, Dr. Talley’s physical examination
identified general tenderness throughout all muscles in her extremities. Id. It also showed that
Ms. L. has local areas of “increased tender points in her bilateral upper trapezii, bilateral deltoid
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insertion, bilateral lumbar paraspinals, bilateral medial knees and at her lateral elbows.” Id. at
510. Ms. L. met with Dr. Johnson within weeks of her appointment with Dr. Talley and reported
that her pain had worsened to the point of debilitation. Id. at 471. She stated that she could no
longer do household chores, needed her husband’s assistance to get down the stairs, and had
trouble getting out of bed at times. Id. The following month, Dr. Johnson officially diagnosed
Ms. L. with fibromyalgia, noting that she exhibited 18 out of 18 fibromyalgia tender points. Id. at
532.
On April 22, 2015, Dr. Narandra Bethina conducted a rheumatological evaluation of Ms.
L. at Dr. Johnson’s request. Id. at 86. Dr. Bethina recorded fibromyalgia, other malaise, fatigue,
and sleep disturbance as Ms. L.’s diagnoses. Id. at 82. Her physical examinations revealed that
Ms. L. had paraspinal tenderness at the cervical and lumbar region and multiple symmetrical
tender points. Id. at 89. Dr. Bethina concluded that Ms. L.’s “overall symptoms [were] from
Fibromyalgia” and suggested that Ms. L. discuss with Dr. Middleton the possibility of adding
Amltriptyline or Savella to her medications. Id. at 86.
In November 2016, rheumatologist Dr. Chi Chi Lau began treating Ms. L. for her
fibromyalgia. Dr. Lau’s physical examination found several abnormalities including: decreased
cervical spine rotation, lumbar spine flexion to 80 degrees with discomfort, decreased bilateral
shoulder rotation to 30 degrees with discomfort, tender lower lumbar and SI area, tender bilateral
trochanteric bursae, bilateral mid-feet tenderness, and bilateral metatarsal phalangeal tenderness.
Id. at 984. Dr. Lau diagnosed Ms. L. with fibromyalgia and osteoarthritis in her lumbar spine’s
facet joint. Id. at 985. He also noted that Ms. L. struggles with generalized anxiety despite her
chronic narcotic use. Id.
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In April 2017, state agency consultant Timothy Cook examined Ms. L. at the
Commissioner’s request. Id. at 985. Dr. Cook’s physical examination showed that Ms. L. had a
limited range of motion in both of her shoulders and both of her hips. Id. at 912. He also elicited
trigger point tenderness with palpation of her back. Id. Dr. Cook noted that Ms. L. was able to
perform the finger-to-nose test but observed that her hand shook during the test. Id. at 913.
Ultimately, he concluded that the physical exam was “chiefly remarkable for extensive trigger
point tenderness, . . . weakness in the upper and lower extremities, some restricted range of
motion at the hips bilaterally, . . . unsteadiness with performing the squat maneuver, . . . inability
to raise on the toes, and unsteadiness in the gait.” Id. at 914.
B. Opinion Evidence
Dr. Johnson submitted a Medical Source Statement in February 2015. Id. at 555–60. He
opined that Ms. L.’s impairments extremely limited her ability to concentrate and would reduce
her pace in performing work-related activities more than 20%. Id. at 555. He stated that Ms. L.
would need more than ordinary breaks during a workday and could not lift or carry more than 10
pounds. Id. at 555, 557. He wrote that Ms. L. could only stand or walk for less than 2 hours in an
8-hour workday, could only sit for 15 minutes before having to stand and walk around for 15
minutes, and would have to lie down for 4 hours during the course of the day. Id. at 557–58. He
noted that both Ms. L.’s upper and lower extremities were extremely limited in their ability to
push and pull and that she could only perform manipulative activities 1 for less than 1/3 of the
workday. Id. at 558. He indicated that Ms. L.’s medications have side effects that adversely
affect her ability to perform work-related activities, including sedation and an inability to
1
The Medical Source Statement form defines manipulative activities as reaching, handling, fingering, and feeling.
Id.
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concentrate and think clearly. Id. at 559. Dr. Johnson supported his assessments by stating that
medical and clinical findings show that Ms. L. suffers from “constant pain, fatigue, [and]
anxiety.” Id. He also noted that Ms. L.’s “symptoms have continually worsened over the last 3
years despite adjusting medical therapies and multiple specialist consultations.” Id. at 560.
Dr. Middleton completed a mental health Medical Source Statement in February 2015.
Id. at 580–85. She stated that Ms. L. has a generalized persistent anxiety accompanied by motor
tension, autonomic hyperactivity, apprehensive expectation, and vigilance and scanning. Id. at
580. She indicated that Ms. L. has “[a] persistent irrational fear of a specific object, activity, or
situation which results in a compelling desire to avoid the dreaded object, activity, or situation.”
Id. Dr. Middleton emphasized that Ms. L. “has adapted her lifestyle to her agoraphobia and has
never since I’ve known her NOT been severely anxious or agoraphobic.” Id. at 582 (capitals in
original). In addition, she opined that Ms. L. has difficulty completing tasks in a timely fashion
and that she has marked limitations in activities of daily living, maintaining social functioning,
and maintaining concentration, persistence, and pace. Id. at 582. Highlighting Ms. L.’s conflicts
with management at the Richmond Market, Dr. Middleton indicated that she would expect Ms.
L. to have difficulty responding appropriately to coworkers, supervisors, and changes in a routine
work setting. Id. at 583. She expressed her belief that Ms. L.’s physical limitations prevent her
from working and noted that she “has deteriorated in terms of her physical functioning since
2011.” Id. at 585.
Dr. Johnson submitted a supplemental Medical Source Statement on June 5, 2015 that
reported that Ms. L.’s symptoms had worsened since his first Medical Source Statement. Id. at
873. He stated that Ms. L.’s general symptoms had intensified and that she now requires a cane
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in the morning because of her elevated morning stiffness and pain. Id. He explained that Ms. L.
experiences flare-ups of her fibromyalgia symptoms everyday “throughout the day and night”
and indicated that some days the flare-ups are continuous. Id. at 873. Dr. Johnson opined: “I
don’t think that [Ms. L.] is currently capable of working. She is disabled even on ‘good’ days.”
Id. He explained that if Ms. L. tries to lift anything over 5 pounds then her muscles fatigue and
hurt. Id. at 874. Similarly, if she stands, walks, or sits for more than 15 minutes, then she
develops worsening pain in her trigger points and has to rest. Id. He remarked that if Ms. L.
reaches, handles, fingers, or feels objects repetitively, then she develops fatigue and pain. Id. He
noted that her medications provide “some limited improvement in her symptoms” but they
impair her ability to think clearly and to concentrate. Id. at 875. He expressed that he “ha[d] no
reason to expect that she could perform even light tasks outside of the home without suffering an
exacerbation of her fatigue and pain” when “she can not even compete light tasks in her own
home where she can rest as much as needed.” Id. at 874. Dr. Johnson stated that he based his
assessment of Ms. L.’s condition on over 20 office visits and his review of recommendations
from multiple specialists, including rheumatologists and psychiatrists. Id. at 877.
Dr. Middleton also submitted a supplemental Medical Source Statement in June 2015. Id.
at 899–902. She agreed with Dr. Johnson, stating that Ms. L.’s conditions had worsened since
February 2015. Id. Dr. Middleton stated that Ms. L. requires more medication to function and
that she is unable to perform routine household tasks at a rate that was previously easy for her.
Id. at 899–900. She also noted that Ms. L. had “marked agoraphobia” and that she does not leave
the house without her husband. Id. at 900.
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Dr. Cook completed a Medical Source Statement following his examination of Ms. L. in
April 2017. Id. at 916–21. He remarked that Ms. L. could lift and carry: up to 10 pounds for over
two-thirds of the time; 11 to 20 pounds between one-third and two-thirds of the time; and 21 to
50 pounds up to one-third of the time. Id. at 916. He opined that Ms. L. could, without
interruption, sit for six hours, stand for four hours, and walk for four hours of an eight-hour
workday. Id. at 917. He also stated that Ms. L. could reach, handle, finger, feel, and push and
pull for up to one-third of the workday. Id. at 918.
Psychiatrist Dr. Stuart Gitlow testified as a medical expert at the second hearing. Id. at
626–42. He acknowledged that Ms. L. has an anxiety disorder but criticized her prescription
regimen and suggested that her medications may be the cause of some of her limitations. Id. at
627, 632. He felt that Ms. L. had a moderate limitation in her ability to adapt and likely had a
moderate limitation in her social functioning. Id. at 629. Dr. Gitlow opined that Ms. L. would
require limited interactions with the general public and only occasional interaction with
coworkers. Id. at 630. He indicated that Ms. L. would likely require “an extra few weeks in order
to come up to the processing pace and speed that would normally be expected more rapidly.” Id.
He also stated that the longer the commute, the more anxiety Ms. L. would experience and the
longer her transition period would take. Id. at 631. Ultimately, Dr. Gitlow concluded that Ms. L.
“falls into the anxiety paradigm, but does not meet[] B or C criteria.” Id. at 629.
III.
THE ALJ’S DECISION
A. Overview of the Five-Step Sequential Evaluation Process
The ALJ applied the five-step sequential process set forth in 20 C.F.R § 404.1520 to
evaluate Ms. L.’s disability claim. See Butts v. Barnhart, 388 F.3d 377, 380-81 (2d Cir. 2004).
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The first step of this process requires the ALJ to determine whether the claimant is presently
engaging in “substantial gainful activity.” 20 C.F.R. §§ 404.1520(b), 416.920(b) (2017). If the
claimant is not engaging in such activity, then step two requires the ALJ to determine whether
the claimant has a “severe impairment.” 20 C.F.R. §§ 404.1520(c), 416.920(c). If the ALJ finds
that the claimant has a severe impairment, then the third step requires the ALJ to determine
whether that impairment “meets or equals” an impairment listed in 20 C.F.R. Part 404, Subpart
P, Appendix 1 (“the Listings”). §§ 404.1520(d), 416.920(d). The claimant is presumptively
disabled if his or her impairment meets or equals a listed impairment. Ferraris v. Heckler, 728
F.2d 582, 584 (2d Cir. 1984).
If the claimant is not presumptively disabled, the ALJ must proceed to the fourth step.
The ALJ begins this step by determining the claimant’s residual functional capacity (RFC). An
individual’s RFC equals that person’s ability to perform physical and mental work activities on a
sustained basis despite limitations from an impairment. 20 C.F.R. §§ 404.1520(e),
404.1545(a)(1), 416.920(e), 416.945(a)(1). To make RFC determinations, ALJs must consider all
of the claimant’s impairments—including those that are not severe—and must base their findings
on all the relevant medical and other evidence in the record. 20 C.F.R. §§ 404.1520(e),
404.1545(a)(1), 416.920(e), 416.945(a)(1). Then, the fourth step requires ALJs to consider
whether the claimant’s RFC precludes the performance of his or her past relevant work. 20
C.F.R. §§ 404.1520(f), 416.920(f). Finally, at the fifth step, the ALJ determines whether the
claimant can do “any other work.” 20 C.F.R. §§ 404.1520(g), 416.920(g).
Claimants bear the burden of proving their case at steps one through four. Butts, 388 F.3d
at 383. At step five there is a “limited burden shift to the Commissioner” to provide evidence
demonstrating that other work exists in significant numbers in the national economy that the
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claimant can perform. Poupore v. Astrue, 566 F.3d 303, 306 (2d Cir. 2009) (clarifying that the
burden shift to the Commissioner at step five is limited, and the Commissioner “need not provide
additional evidence of the claimant’s [RFC]”).
B. The ALJ’s Analysis of Ms. L.’s Case
In this case, the ALJ found at step one that Ms. L. had worked since the alleged disability
onset date of October 1, 2011, but that her work activity did not rise to the level of substantial
gainful activity. Id. at 592. Then, at step two, the ALJ determined that Ms. L. suffered from “the
following severe impairments: an anxiety disorder, fibromyalgia and patellofemoral arthritis.”
Id. Additionally, the ALJ concluded that Ms. L.’s degenerative disc disease did not qualify as
severe but stated that he considered the condition when determining Ms. L.’s Residual
Functioning Capacity. Id.
At step three, the ALJ found that none of Ms. L.’s impairments, alone or in combination,
met or medically equaled a listed impairment. Id. In making this determination, the ALJ
considered whether Ms. L.’s patellofemoral arthritis met or equaled the criteria of listing 1.02
(major dysfunction of a joint due to any cause). Id. He found that it did not because the record
shows that the claimant is able to ambulate effectively. Id. The ALJ also considered Ms. L.’s
fibromyalgia in the context of listing 14.06 (undifferentiated and mixed connective tissue
disease). Id. at 593. He found that her fibromyalgia did not meet or medically equal this listing
because Ms. L. “does not have at least two of the constitutional symptoms or signs, defined as
severe fatigue, fever, malaise, or involuntary weight loss, nor does she have a marked level of
limitation in daily activities, social functioning, or concentration, persistence, and pace.” Id.
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The ALJ also considered “paragraph B” criteria to assess Ms. L.’s anxiety disorder. Id. In
doing so, the ALJ determined whether Ms. L.’s mental impairments resulted in one extreme or
two marked limitations in her ability to: 1) understand, remember, or apply information; 2)
interact with others; 3) concentrate, persist, or maintain pace; or 4) adapt and manage herself. Id.
The ALJ found that Ms. L. had no limitation in her ability to understand, remember, and apply
information and in her ability to concentrate, persist, and maintain pace. Id. He determined that
Ms. L. had a moderate limitation in her ability to interact with others and in her ability to adapt
and manage herself. Id. at 593–94. The ALJ concluded that “[b]ecause the claimant’s mental
impairment did not cause at least two ‘marked’ limitations or one ‘extreme’ limitation, the
‘paragraph B’ criteria were not satisfied.” Id. at 594.
During this assessment, the ALJ noted that Ms. L.’s treating psychiatrist Dr. Middleton
opined that Ms. L. had marked limitations in daily activities, maintaining social functioning, and
maintaining concentration, persistence, and pace. Id. He also acknowledged that Ms. L.’s treating
physician Dr. Johnson similarly opined that Ms. L. had extreme limitations in daily activities,
maintaining social functioning, and maintaining concentration, persistence, and pace. Id. at 594–
95. However, the ALJ attributed little weight to these opinions, citing state agency consultant Dr.
Gitlow’s testimony as support for his conclusions. Id. at 595.
The ALJ then determined Mr. L.’s residual functional capacity. In making this
determination, the ALJ followed a two-step process to assess Ms. L.’s alleged symptoms. Id.
First, the ALJ determined whether Ms. L. had an underlying medically determinable
impairment 2 that could reasonably be expected to produce her symptoms. Id. Second, the ALJ
2
To be medically determinable, an impairment must be able to be shown by medically acceptable clinical or
laboratory diagnostic techniques. 20 C.F.R. § 404.1529(b).
15
“evaluate[d] the intensity, persistence, and limiting effects of [Ms. L.’s] symptoms to determine
the extent to which they limit” her ability to perform work-related activities. Id. Ms. L. claimed
to suffer from numerous symptoms that she linked to both her mental and physical impairments.
Id. at 596. She testified that, because of these symptoms, “she is unable to manage the demands
of work on a regular and full time basis.” Id. The ALJ concluded that Ms. L. does have
“medically determinable impairments [that] could reasonably be expected to produce the above
alleged symptoms.” Id. However, the ALJ found that the objective evidence in the record did not
support reducing Ms. L.’s RFC to the extent alleged.
Instead, the ALJ determined that Ms. L.’s RFC allows her to work at medium exertional
levels with multiple limitations. Id. at 595. First, Ms. L. can “sit for 6 hours, stand for 5 hours,
and walk for 5 hours in an 8-hour workday.” Id. Second, she “can occasionally reach overhead
and occasionally push and pull bilaterally.” Id. Third, Ms. L. “should avoid work requiring
ladders, climbing stairs, and unprotected heights, hazards, and balancing.” Id. Fourth, she “can
occasionally stoop, kneel, crouch, and crawl.” Id. Fifth, Ms. L. “should have only limited social
interaction with the general public, meaning that she should avoid crowds.” Id. Sixth, she
“should have occasional interaction with coworkers and supervisors, defined as work requiring
no tandem tasks or team work.” Id. Finally, the ALJ stated that Ms. L. “will require supportive
supervision at a new job over the first few weeks, but would be within the acceptable tolerances
for new employees.” Id.
At step four, the ALJ determined that Ms. L.’s RFC prevents her from performing past
relevant work. Id. at 604. Moving to step five, the ALJ assessed Ms. L.’s age, education, work
experience, and residual functional capacity and concluded that there were other jobs that exist in
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significant numbers in the national economy that Ms. L. could perform. Id. at 605–06. The ALJ
consulted the vocational expert in coming to this conclusion. Id. The vocational expert testified
that Ms. L. could perform the requirements of representative occupations such as: dispatcher,
sorter, and checker. Id. at 605. These occupations combined present an estimated 63,000 jobs in
the national economy. Id.
STANDARD OF REVIEW
In considering a Commissioner’s disability decision, the Court “review[s] the
administrative record de novo to determine whether there is substantial evidence supporting
the . . . decision and whether the Commissioner applied the correct legal standard.” Machadio v.
Apfel, 276 F.3d 103, 108 (2d Cir. 2002) (citing Shaw v. Chater, 221 F.3d 126, 131 (2d Cir.
2000)); see 42 U.S.C. § 405(g). Substantial evidence is “more than a mere scintilla. It means
such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”
Richardson v. Perales, 402 U.S. 389, 401 (1971); Poupore, 566 F.3d at 305. In its deliberations,
a court should bear in mind that the Social Security Act is “a remedial statute to be broadly
construed and liberally applied.” Dousewicz v. Harris, 646 F.2d 771, 773 (2d Cir. 1981).
DISCUSSION
I.
THE ALJ ERRED BY ATTRIBUTING LITTLE WEIGHT TO DR. JOHNSON’S
OPINIONS
Ms. L. claims that the ALJ erred by affording her treating physician Dr. Johnson’s
opinion little weight. Under the SSA’s treating physician rule, “a treating source’s opinion on the
nature and severity of a claimant’s condition is entitled to ‘controlling weight’ if it is: [1] ‘wellsupported by medically acceptable clinical and laboratory diagnostic techniques and [2] not
17
inconsistent with the other substantial evidence in [the] record.’” Green-Younger v. Barnhart,
335 F.3d 99, 106 (2d Cir. 2003); 20 C.F.R. § 404.1527(d)(2).
If a treating source’s opinion does not receive controlling weight, then the ALJ should
consider the following factors to determine what weight to give the opinion: (1) the length of the
treatment relationship and frequency of examination; (2) the nature and extent of the treatment
relationship; (3) whether the opinions are supported by relevant medical evidence or explanation;
(4) whether the opinions are consistent with the record as a whole; (5) the specialization of the
treating source with respect to the condition being treated; and (6) any other factors that may be
significant. 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2); see also Halloran v. Barnhart, 362 F.3d
28, 32 (2d Cir. 2004). ALJs do not have to recite each factor in their decisions, but they must
“always give good reasons” for the weight they assign to a treating source’s opinion. See Schaal
v. Apfel, 134 F.3d 496, 505 (2d Cir.1998); 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2). Failure to
do so is grounds for remand. Halloran, 362 F.3d at 33.
In this case, the ALJ attributed “little weight” to the opinions of Ms. L.’s treating primary
care physician Dr. Johnson. AR at 601. Highlighting the dearth of “clinical examinations
documenting deficits consistent with the limitations [Dr. Johnson] identified,” the ALJ found that
Dr. Johnson lacked objective evidence supporting his opinion. Id. He asserted that Dr. Johnson’s
treatment notes “fail to document . . . anatomical and physiological abnormalities on clinical
examination” and criticized his reliance “upon [Ms. L.’s] own description of symptoms and the
impact they have upon her functioning.” 3 Id. In addition, the ALJ claimed that Dr. Johnson’s
3
The ALJ claimed that Dr. Johnson’s reliance on Ms. L.’s reports to form his opinion contravened 20 C.F.R. §
404.1513 and POMS DI 24501.020. These rules and regulations require that abnormalities be identified by
medically acceptable clinical and laboratory diagnostic techniques. Quite tellingly, he neglected to include SSR 122p—the Social Security rule that specifically guides how ALJ’s should evaluate fibromyalgia claims.
18
opinion “is not well supported by or consistent with his own treatment notes or the medical
evidence of record.” Id. Not only are these findings unsupported by substantial evidence, they
largely conflict with this Court’s previous holding. Thus, the ALJ erred in affording Dr.
Johnson’s opinion little weight.
As this Court previously explained, the ALJ’s insistence that Dr. Johnson provide
objective evidence regarding Ms. L.’s fibromyalgia suggests that he misunderstood the nature of
the disease. Id. at 698. He “effectively required ‘objective’ evidence for a disease that eludes
such measurement.” Green-Younger, 335 F.3d at 108. Evaluating whether a patient exhibits
trigger point tenderness is “the primary diagnostic technique for fibromyalgia” and provides the
only objective signs of the disease. Id. at 108 n. 4; Johnson v. Astrue, 597 F.3d 409, 412 (1st Cir.
2009). Because “[t]here is no objective tests which can conclusively confirm [fibromyalgia],” it
must be diagnosed based largely on a claimant’s subjective complaints. Preston v. Sec. of Health
and Human Servs., 854 F.2d 815, 818 (6th Cir. 1988); see also Green-Younger, 335 F.3d at 107
(“[A] patient’s report of complaints, or history, is an essential diagnostic tool” for fibromyalgia
claims); see also SSR 12-2p, No. SSA-2011-0021, 2012 WL 3104869, at *3 (July 25, 2012)
(stating that “[a] history of widespread pain” and “[a]t least 11 tender points on physical
examination” are the two criteria used to evaluate fibromyalgia claims). Thus, “a treating
physician’s reliance on such complaints ‘hardly undermines his opinion as to [the patient’s]
functional limitations.’” Johnson, 597 F.3d at 412 (quoting Green-Younger, 335 F.3d at 107).
Concerning Ms. L.’s physical limitations, Dr. Johnson opined that she could stand or
walk for less than 2 hours in an 8-hour workday, could sit for 15 minutes before having to stand
and walk around for 15 minutes, and would have to lie down for 4 hours during the course of the
19
day. Id. at 557–58. He noted that both Ms. L.’s upper and lower extremities were extremely
limited in their ability to push and pull and that she could only perform manipulative activities
for less than 1/3 of the workday. Id. at 558. He also remarked that Ms. L. suffers from constant
pain and fatigue. Id. at 559.
Contrary to the ALJ’s claims, Dr. Johnson supported this assessment with medically
acceptable clinical techniques, marshalling the only objective evidence available to assess a
patient’s claims of fibromyalgia. He performed a physical examination of Ms. L. that revealed
tenderness in 18 out of 18 trigger points. Id. at 532. Based on this evaluation, Dr. Johnson
diagnosed Ms. L. with fibromyalgia, stating that she “clearly fit this diagnosis and is clearly
debilitated.” Id. Moreover, Dr. Johnson referred Ms. L. to two rheumatologists, both of whom
confirmed Dr. Johnson’s findings after conducting their own physical examinations. Id. at 86,
985.
Not only did Dr. Johnson ground his opinion on the only objective signs of fibromyalgia,
he based it on observations made during his years-long treatment relationship with Ms. L. Dr.
Johnson had over 20 office visits with Ms. L. and his treatment notes extensively document her
long history of widespread chronic pain. See id. at 333, 336, 340, 342, 471, 473, 475, 478, 480,
482, 484, 486, 488, 491. In addition, Dr. Johnson consulted and reviewed the recommendations
of multiple physical therapy facilities, numerous specialists, and Ms. L.’s treating psychiatrist
Dr. Middleton. Id. at 877. His treatment notes illustrate that despite meeting with specialists and
participating in these physical therapy programs, Ms. L. continued to suffer from chronic pain
and that her symptoms worsened within the relevant time period. See id. at 700 (“The record
indicates that [Ms. L.’s] symptoms worsened during the relevant period, despite . . . her
20
attendance at physical therapy sessions, chiropractic and acupuncture treatments, aqua therapy
sessions, and appointments with specialists.”). Most importantly, Dr. Johnson’s notes
demonstrate the limiting effects Ms. L.’s pain has had on her ability to function. Id. at 342
(explaining that a 9-hour work shift caused so much pain she could not stand for a week); id. at
471 (describing her pain as debilitating, stating that it precludes her from doing household
chores, that her husband needs to help her down the stairs, and that it makes it difficult for her to
get out of bed); id. at 478 (stating that her pain forced her to nap 4-5 hours a day); id. at 482
(reporting that she can only work for 15 minutes before having to stop for 30 minutes); id. at 486
(finding that Ms. L.’s “hip pain [is] still severe” and that she “can’t stand for any considerable
length of time” or “sit for any length of time without moving.”).
These findings show that Dr. Johnson appropriately evaluated Ms. L.’s fibromyalgia and
that his assessment is supported by and consistent with his treatment notes. He obtained the only
objective evidence of Ms. L.’s symptoms available and had his findings corroborated by two
rheumatologists. He also based his opinions on Ms. L.’s reports about the limiting effects of her
symptoms. Despite the ALJ’s criticism, considering a patient’s reports of symptoms and their
limiting effects are not only acceptable, but essential in fibromyalgia claims. Thus, the ALJ’s
arguments do not constitute good reasons to discount the weight given to Dr. Johnson’s opinions
because he demanded objective evidence that exceeds current medical capabilities.
The ALJ’s claim that Dr. Johnson’s opinion is not supported by the medical evidence of
record flounders for similar reasons. In his review of the record, the ALJ largely cites the
discrepancy between Ms. L.’s complaints of pain and the relatively normal results of her physical
examinations. Id. at 597–99. However, as the Second Circuit has recognized, “[i]n stark contrast
21
to the unremitting pain of which fibro[myalgia] patients complain, physical examinations will
usually yield normal results—a full range of motion, no joint swelling, as well as normal muscle
strength and neurological reactions.” Green-Younger, 335 F.3d at 108 (quoting Lisa v. Sec. of the
Dep’t of Health and Human Servs., 940 F.2d 40, 45 (2d Cir. 1991)). Thus, the relatively
unremarkable results of other physicians’ examinations do not contradict Dr. Johnson’s opinion.
Rather, they are expected for patients with fibromyalgia. Thus, these results do not warrant
reducing the weight given to Dr. Johnson’s opinions.
Viewed properly, the medical evidence of record supports Dr. Johnson’s opinions
regarding the nature and severity of Ms. L.’s fibromyalgia. As this Court found in its previous
opinion, “the vast majority of Ms. L.’s medical providers do not appear to doubt that she
experiences pain.” AR at 703. For example, as noted above, two rheumatologists confirmed Dr.
Johnson’s fibromyalgia diagnosis and the record is replete with Ms. L.’s complaints of chronic
pain. Id. at 86, 985. Moreover, Dr. Benjamin elicited trigger point tenderness during examination
and stated in his letter to Dr. Johnson, “I think she has real causes for pain in her body.” Id. at
550. Dr. Talley noted “general tenderness to pressure through all muscles in [Ms. L.’s]
extremities” and “local area[s] of increased tender points in her bilateral upper trapezii, bilateral
deltoid insertion, bilateral lumbar paraspinals, bilateral medial knees and at her lateral elbows.”
Id. at 510. RehabGym found that Ms. L. continued to have joint pain despite physical therapy. Id.
at 449–67.
Most importantly, the opinions of Ms. L.’s treating psychiatrist Dr. Middleton support
Dr. Johnson’s assessments. See id. at 304, 567, 580–85. Like Dr. Johnson, Dr. Middleton
extensively documented the effects fibromyalgia has had on Ms. L.’s ability to function in her
22
treatment notes. See id. at 72–73 (stating that Ms. L. is limited by pain and that she cannot
perform household chores); id. at 570 (“[Ms. L.] continues to deal with her multiple pains.”); id.
at 574 (“she continues to have a lot of problems with pain in her shoulder, back, hips, knees, and
feet.”); id. at 576 (“[Ms. L.] is clearly in more pain today. She is squirming in her seat. She states
that pain limits her life.”); id. at 579 (“[Ms. L.] woke up crying from pain”); id. at 585 (opining
that Ms. L.’s physical limitations prevent her from working and noting that her physical
functioning has deteriorated since 2011); id. at 909 (stating that Ms. L.’s “physical deterioration
over the past few years has been quite marked” and that she is “NOT the malingering type.”)
(capitals in original). Viewing the record in its entirety shows that the substantial evidence does
not support the ALJ’s finding that Dr. Johnson’s opinion was inconsistent with the medical
evidence of record. Thus, the ALJ erred in reducing the weight given to Dr. Johnson’s opinions
based on this reasoning.
The only evidence that directly contradicts some of Dr. Johnson’s opinions of Ms. L.’s
physical limitations comes from the Commissioner’s consultant examiner Dr. Cook. Dr. Cook
reached different conclusions than Dr. Johnson over Ms. L.’s ability to sit, stand, walk, and lift
and carry items. Id. at 916–17. He found that Ms. L’s conditions created less limitations for her
in these categories than Dr. Johnson. Id. That said, his opinion does support Dr. Johnson in some
respects. For example, Dr. Cook stated that the “[p]hysical exam [wa]s chiefly remarkable for
extensive trigger point tenderness and weakness in the upper and lower extremities.” Id. at 914.
In addition, Dr. Cook agreed with Dr. Johnson regarding Ms. L.’s ability to perform
manipulative activities, finding that she could only reach, handle, finger, and feel for up to 1/3 of
the workday. Id. at 918. The Court notes, as in did in the previous opinion, that generally “where
there are conflicting opinions between treating and consulting sources, the ‘consulting
23
physician’s opinions or report should be given limited weight.’” Id. at 704 (quoting Cruz v.
Sullivan, 912 F.2d 8, 13 (2d Cir. 1990)); see also 20 C.F.R. § 404.1527(c)(1). However, the
Court does not need to reach a conclusion as to whether a single consultant examiner’s opinion
presents sufficient evidence to obviate controlling weight to Dr. Johnson’s opinions. As
explained more fully below, the limitations that Dr. Cook and Dr. Johnson agreed on show that
Ms. L. is disabled within the meaning of the Social Security Act.
II.
MS. L.’S ABILITY TO PERFORM MANIPULATIVE ACTIVITIES
The record demonstrates that Ms. L. is disabled due to her limited ability to perform
manipulative activities. Manipulative activities include reaching, handling, fingering, and
feeling. At the second hearing, the vocational expert testified that if Ms. L. could only
occasionally reach, handle, finger, or feel, then she would not be able to perform any of the
representative occupations. AR 652, 655. Here, a limitation that allows for “occasional” activity
means that the claimant can perform that activity for 1/3rd of the workday or less. The record
shows that Ms. L.’s limitations allow her to only occasionally perform manipulative activities.
In his February 2015 opinion, Dr. Johnson stated that Ms. L.’s physical conditions
limited her to performing manipulative activities for less than 1/3rd of the workday. Id. at 558.
Dr. Johnson elaborated on this finding in his June 2015 opinion, stating that “if [Ms. L.] reaches,
handles, fingers, or feels objects she is working with on a repetitive basis, then she develops
fatigue and pain.” Id. at 874. As shown above, the ALJ erred in affording Dr. Johnson’s opinion
little weight. If the ALJ attributed the proper weight to Dr. Johnson, then his opinions—viewed
together with the vocational expert’s testimony—would provide strong evidence that Ms. L. is
disabled because of her limited ability to perform manipulative activities.
24
In addition, the opinion of the Commissioner’s consultative examiner Dr. Cook confirms
this conclusion. Following a physical examination of Ms. L., Dr. Cook found that both of her
shoulders had a reduced range of motion. Id. at 912. The normal range of motion for shoulder
flexion and abduction is 150 degrees. Id. Dr. Cook found that the range of motion for Ms. L.’s
shoulders was restricted to 40 degrees. Id. He also found that Ms. L. had reduced motor strength
in all major muscle groups in her upper extremities, marking her deltoid, biceps, and triceps
strength a 3 on a scale to 5. Id. at 913. Following this physical examination, Dr. Cook determined
that Ms. L. could only reach, handle, finger, and feel for up to 1/3rd of the workday. Id. at 918.
Dr. Cook listed “trigger point tenderness and weakness in the upper and lower extremities” as
support for this assessment. Id.
The ALJ afforded this section of Dr. Cook’s opinion little weight and gave the remainder
of his opinion great weight. Id. at 603.The ALJ stated that “Dr. Cook’s assessment of the
claimant’s ability to engage in manipulative activities is not consistent with either his own
evaluation or the remainder of the treatment notes.” Id. He asserted that Dr. Cook “did not
identify any abnormalities or deficits of the hands or fingers” and claimed that “[t]here is no
other objective examination in the record documenting any abnormalities or deficits of the hands
and fingers.” Id.
The ALJ erred in his decision to attribute Dr. Cook’s opinion little weight. Id. To start,
the ALJ failed to provide any medical opinion supporting his claim that Dr. Cook’s opinion was
not consistent with his evaluation. In fact, the record contains no medical opinion showing that
Dr. Cook’s evaluation should have produced different results if Ms. L. was limited to only
occasionally performing manipulative activities. Thus, the ALJ impermissibly substituted his
25
own analysis of raw medical data for that of a trained physician. See Balsamo v. Chater, 142
F.3d 75, 81 (2d Cir. 1998) (quoting McBrayer v. Sec. of Health and Human Servs., 712 F.2d 795,
799 (2d Cir. 1983)) ([I]t is well-settled that the ALJ cannot arbitrarily substitute his own
judgment for competent medical opinion. . . . [W]hile an [ALJ] is free to resolve issues of
credibility as to lay testimony or to choose between properly submitted medical opinions, he is
not free to set his own expertise against that of a physician.”).
In addition, the ALJ stated that “Dr. Cook did not identify any abnormalities of the
hands; he only documented the claimant’s subjective complaints.” Id. at 603. He continued:
“There is no other objective examination in the record documenting any abnormalities or deficits
of the hands and fingers.” Id. These findings do not support reducing the weight given to Dr.
Cook’s opinion for two reasons. First, the ability to perform manipulative activities, particularly
reaching and handling, can be limited by more than abnormalities in the hands or fingers.
Namely, disabilities in a person’s shoulders and arms can prevent them from performing
manipulative activities. Dr. Cook’s physical examination produced evidence of a restricted range
of motion in both Ms. L.’s shoulders and weakness in the major muscle groups of both of her
arms. Moreover, Dr. Talley’s assessment of Ms. L. lends additional support to Dr. Cook’s
findings regarding Ms. L.’s shoulders. Id. at 510 (“Right shoulder evaluation with significant
active and passive range of motion restrictions: abduction 60, external rotation 45, internal
rotation zero.”).
Second, the ALJ again called for objective evidence of a disease that eludes such
measurements and criticized the consideration of Ms. L.’s complaints. As illustrated above, the
only objective signs of fibromyalgia are trigger point tenderness, and a claimant’s reports of
26
symptoms is an essential tool for evaluating this disease. Dr. Cook specifically stated that he
based his opinion regarding Ms. L.’s ability to perform manipulative activities on “trigger point
tenderness.” Id. at 918. He further supported his statement by citing his findings of “weakness in
the upper and lower extremities.” Id. Thus, the ALJ erred in attributing little weight to this
section of Dr. Cook’s opinion because the ALJ impermissibly substituted his medical judgement
for that of a physician’s and called for objective evidence that is impossible to obtain.
The fact that Ms. L.’s long-time treating physician and the Commissioner’s own
consultant examiner reached the same conclusion concerning her ability to perform manipulative
activities presents cogent evidence of her condition. Moreover, the record contains no other
medical provider’s opinion that refutes Dr. Johnson’s and Dr. Cook’s opinions. Rather, it
contains ample findings that support their assessments. In addition, the vocational expert
specifically testified that Ms. L. would not be able to perform any of the representative
occupations if she was limited to occasionally performing manipulative activities. Thus, the
record leads to only one conclusion—Ms. L. is disabled within the meaning of the Social
Security Act and entitled to the benefits thereof. Schaal v. Apfel, 134 F.3d 496, 504 (2d Cir.
1998) (“Where application of the correct legal standard could lead to only one conclusion, [the
Court] need not remand.”); see also Butts v. Barnhart, 388 F.3d 377, 385 (2d Cir. 2004)
(“[W]here this Court has had no apparent basis to conclude that a more complete record might
support the Commissioner’s decision, we have opted simply to remand for a calculation of
benefits.”).
To be clear, the record contains evidence of a variety of impairments effecting more than
just Ms. L.’s ability to perform manipulative activities that could lead the Court to this same
27
conclusion. Ms. L.’s widespread crippling pain precludes her from accomplishing basic life
tasks, much less working full time. Ms. L.’s anxiety and agoraphobia drastically limit her ability
to function normally, illustrated by the fact that she rarely leaves the house without her husband
there as support. In addition, Ms. L. requires a significant amount of medication to address her
symptoms which causes side effects that limit her ability to work on a full-time basis. However,
the Court declines to decide on these issues because the medical and opinion evidence regarding
Ms. L.’s limited ability to perform manipulative activities dissipates all doubt that Ms. L. is
disabled. The record is sufficiently clear on this point alone to render remanding for further
proceedings unnecessary.
CONCLUSION
For the foregoing reasons, Plaintiff’s motion to reverse is granted, the Commissioner’s
motion to affirm is denied, and the case is remanded for a calculation of benefits.
DATED at Burlington, in the District of Vermont, this 29th day of October, 2019.
/s/ William K. Sessions III
William K. Sessions III
District Court Judge
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