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Woods v. Commissioner of Social Security

United States District Court, D. New Jersey

June 29, 2017

SHIRLA WOODS, Plaintiff,
v.
COMMISSIONER OF SOCIAL SECURITY, Defendant.

          OPINION

          KEVIN MCNULTY, UNITED STATES DISTRICT JUDGE.

         Shirla Woods brings this action pursuant to 42 U.S.C. §§ 405(g) and 1383(c) to review a final decision of the Commissioner of Social Security ("Commissioner") denying Woods's claims for Disability Insurance Benefits ("DIB") under Title II of the Social Security Act (the "SSA") and for Supplemental Security Income ("SSI") under Title XVI of the SSA. See 42 U.S.C. §§ 401-403 and 1381-1385. For the reasons set forth below, the careful and well-reasoned decision of the Administrative Law Judge ("ALJ") is largely affirmed, but is REVERSED and REMANDED for further proceedings as to certain discrete issues, listed in the Conclusion to this opinion.

         I. BACKGROUND

         Woods applied for DIB and SSI benefits on August 23, 2012, alleging a November 10, 2011 onset of disability (R 529-38).[1] Her claim was denied initially on January 17, 2013 (R 452-63), and again on reconsideration on May 22, 2013 (R 473-75). Woods subsequently requested and received a hearing before an ALJ (see R 30-61, 476), at which she testified on June 17, 2014 (see R 36-51).

         ALJ Kimberly L. Schiro issued a decision dated July 29, 2014, finding Woods "not disabled" (see R 15-25). On October 2, 2014, Woods filed a request for review of the ALJ's decision (see R 9-11), which the Appeals Council denied on January 27, 2016 (see R 1-5), thereby rendering the ALJ's July 29, 2014 decision the final decision of the Commissioner. Woods now appeals that decision.

         A prior application is relevant. Woods filed for Title II DIB on August 13, 2009, alleging that she had been disabled since February 26, 2009. (See R 15) Another ALJ, Miachel L. Lissek, denied Woods's 2009 application in a decision dated November 9, 2011. See Woods v. Colvin, No. 12-CV-06088 DMC JBC, 2013 WL 5730539. (See also R 235-378 (Exhibits 1F-18F)) On appeal to the United States District Court for the District of New Jersey, Judge Cavanaugh affirmed ALJ Lissek's decision on October 21, 2013. See Woods, 2013 WL 5730539, at *1. Referring to this history, ALJ Schiro concluded in her July 29, 2014 decision that Woods likely had an even greater residual functional capacity than she had possessed in 2011. (R 15)

         II. DISCUSSION

         To qualify for Title II DIB benefits, a claimant must meet the insured status requirements of 42 U.S.C. § 423. To be eligible for Title XVI SSI benefits, a claimant must meet the income and resource limitations of 42 U.S.C. § 1382. To qualify under either statute, a claimant must show that she is unable to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or that has lasted (or can be expected to last) for a continuous period of not less than twelve months. 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A); see, e.g., Diaz v. Comm'r of Soc. Sec, 577 F.3d 500, 503 (3d Cir. 2009).

         A. Five-Step Process and this Court's Standard of Review

         Under the authority of the Social Security Act, the Social Security Administration has established a five-step evaluation process for determining whether a claimant is entitled to benefits. 20 CFR §§ 404.1520, 416.920. This Court's review necessarily incorporates a determination of whether the ALJ properly followed the five-step process prescribed by regulation. The steps may be briefly summarized as follows:

Step 1: Determine whether the claimant has engaged in substantial gainful activity since the onset date of the alleged disability. 20 CFR §§ 404.1520(b), 416.920(b). If not, move to step two.
Step 2: Determine if the claimant's alleged impairment, or combination of impairments, is "severe." Id. §§ 404.1520(c), 416.920(c). If the claimant has a severe impairment, move to step three.
Step 3: Determine whether the impairment meets or equals the criteria of any impairment found in the Listing of Impairments. 20 CFR Pt. 404, Subpt. P, App. 1, Pt. A. If so, the claimant is automatically eligible to receive benefits (and the analysis ends); if not, move to step four. Id. §§ 404.1520(d), 416.920(d).
Step 4: Determine whether, despite any severe impairment, the claimant retains the Residual Functional Capacity ("RFC") to perform past relevant work. Id. §§ 404.1520(e)-(f), 416.920(e)-(f). If not, move to step five.
Step 5: At this point, the burden shifts to the Social Security Administration to demonstrate that the claimant, considering her age, education, work experience, and RFC, is capable of performing jobs that exist in significant numbers in the national economy. 20 CFR §§ 404.1520(g), 416.920(g); see Poulos v. Comm'r of Soc. Sec, 474 F.3d 88, 91-92 (3d Cir. 2007). If so, benefits will be denied; if not, they will be awarded.

         For the purpose of this appeal, the Court conducts a plenary review of the legal issues. See Schaudeck v. Comm'r of Soc. Sec, 181 F.3d 429, 431 (3d Cir. 1999). The factual findings of the ALJ are reviewed "only to determine whether the administrative record contains substantial evidence supporting the findings." Sykes v. Apfel, 228 F.3d 259, 262 (3d Cir. 2000). Substantial evidence is "less than a preponderance of the evidence but more than a mere scintilla." Jones v. Barnhart, 364 F.3d 501, 503 (3d Cir. 2004) (citation omitted). "It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Id. When substantial evidence exists to support the ALJ's factual findings, this Court must abide by the ALJ's determinations. See Id. (citing 42 U.S.C. § 405(g)).

         This Court may, under 42 U.S.C. § 405(g), affirm, modify, or reverse the Commissioner's decision, or it may remand the matter to the Commissioner for a rehearing. Podedwomy v. Harris, 745 F.2d 210, 221 (3d Cir. 1984); Bordes v. Comm'r of Soc. Sec, 235 F.App'x 853, 865-66 (3d Cir. 2007) (non-precedential). Outright reversal with an award of benefits is appropriate only when a fully developed administrative record contains substantial evidence that the claimant is disabled and entitled to benefits. Podedwomy, 745 F.2d at 221-222; Morales v. Apfel, 225 F.3d 310, 320 (3d Cir. 2000).

         Remand is proper if the record is incomplete, or if there is a lack of substantial evidence to support a definitive finding on one or more steps of the five step inquiry. See Podedwomy, 745 F.2d at 221-22. Remand is also proper if the ALJ's decision lacks adequate reasoning or support for its conclusions, or if it contains illogical or contradictory findings. See Burnett v. Comm'r of Soc. Sec, 220 F.3d 112, 119-20 (3d Cir. 2000); Leech v. Barnhart, 111 F.App'x 652, 658 (3d Cir. 2004) ("We will not accept the ALJ's conclusion that [the claimant] was not disabled during the relevant period, where his decision contains significant contradictions and is therefore unreliable.") (not precedential). It is also proper to remand where the ALJ's findings are not the product of a complete review which "explicitly weigh[s] all relevant, probative and available evidence" in the record. Adomo v. Shalala, 40 F.3d 43, 48 (3d Cir. 1994) (internal quotation marks omitted).

         B. The ALJ's Decision

         ALJ Schiro properly followed the five-step process. I summarize her conclusions here:

Step 1
At step one, ALJ Schiro found that Woods met the insured requirements of the SSA through December 31, 2014, and had not engaged in substantial gainful activity from the alleged onset date of November 10, 2011 (R 17).
Step 2
At step two, the ALJ found that Woods had the following severe impairments: insulin dependent diabetes mellitus, degenerative joint disease of the spine, and depression with anxiety (R 18).
At this step, the ALJ rejected Woods's claim that she suffers a severe impairment attributable to fibromyalgia. Substantial evidence in the record, which the ALJ thoroughly evaluated, supported this conclusion. Specifically, ALJ Schiro recognized that Woods reported to consultative examiner Rahel Eyassu, MD that she had been diagnosed with fibromyalgia. But the ALJ also observed that medical records from Woods's treating physicians did not show any such diagnosis or evidence of the tender points typically associated with fibromyalgia. (R 18; see, e.g., R 555, 604-606, 617-23)[2] Woods was not receiving medication or any other treatment for fibromyalgia. (Id.) Consistently, the consultative examiner found no joint swelling, crepitus, or instability, and could not identify any particular trigger/tender points because, during a trigger point examination, Woods complained of pain everywhere. (Id.)[3]
The ALJ also acknowledged Woods's alleged fibroids and anemia, but again concluded that the treatment records did not establish that either caused a medically determinable severe impairment. (R 18, 555; see, e.g., 604, 616-33) Substantial evidence supported this conclusion as well.
Step 3
At step three, ALJ Schiro stated that Woods's impairment or combination of impairments neither met nor medically equaled the severity of one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1 (R 18). With respect to physical impairments, she found that Woods failed to meet the criteria for medical listing 1.02, Major dysfunction of joint(s);[4] for medical listing 1.04, Disorders of the Spine;[5] and for medical listing 9.08, Diabetes mellitus.[6] ALJ Schiro specifically found that there was no evidence of neuropathy, acidosis, retinopathy, or any end organ damage to support Listing 9.08. I find that substantial evidence supports these conclusions.

         The ALJ also found that Woods's mental impairments, alone and in combination, did not meet or medically equal listings 12.04, Depressive, bipolar and related disorders, or 12.06, Anxiety and obsessive-compulsive disorders.[7]

         ALJ Schiro acknowledged that Woods reported to the psychiatric consultative examiner, Dr. Tolchin, that she has received outpatient care for mental disorders since 2012. But the ALJ found no evidence regarding mental health care in the record. She noted that Woods also testified at her hearing that she is not receiving mental health treatment or being prescribed psychotropic medication. (R 18) ALJ Schiro also considered record evidence and Woods's own testimony indicating that Woods handles her own personal care, drives and shops independently, pays bills and handles money, and gets along with others including authority figures. (R 19; see R 586-92) The only indication of Woods's mental health impairments in the record from the relevant time frame, ALJ Schiro reasoned, were Dr. Tolchin's report that Woods has mildly impaired attention and concentration, and trouble with handling stress. (R 19) Dr. Tolchin also diagnosed Woods with major depression secondary to chronic pain. (Id.)

         Whether using the former or newer 12.04 and 12.06 listing criteria, I find that substantial evidence supports ALJ Schiro's conclusion that the record evidence satisfies neither the "paragraph B" nor the "paragraph C criteria. (See R 18-19)

         Step 4 - RFC and Ability to Perform Past Work

         Next, ALJ Schiro defined Woods's RFC as follows:

[T]he claimant has the [RFC] to perform sedentary work as defined in 20 CFR 404.1567(a) and 416.967(a) except that she can perform simple, routine tasks at the sedentary exertional level. She cannot climb ladders/ropes/scaffolds or work around hazards (moving mechanical parts or at unprotected heights). She cannot crawl and can occasionally climb ramps and stairs, stoop, kneel and crouch. She is limited to low stress work, which I define as follows: there are only occasional changes in work routines: the work only involves simple decision-making: there is occasional contact with coworkers and supervisors: there is no public contact: the work cannot require working on teams or in collaboration with others. Finally, she requires a five-minute break for every hour of sitting.

(R 19-20).[8]

         To arrive at this RFC, ALJ Schiro comprehensively evaluated the record evidence, following a two-step process in which she determined (1) whether the evidence supports the existence of medically determinable physical or mental impairments and whether the impairment could reasonably be expected to produce the pain and other symptoms Woods reports; and (2) the extent to which the "intensity, persistence, and limiting effects" of Woods's symptoms limit Woods's functioning, assigning credibility-based weight to statements concerning intensity, persistence, and limiting effect in the record. (R 20)[9]

         Turning to the record, ALJ Schiro considered that Woods reports chronic pain throughout her body but particularly in her back, hips, and shoulders. (R 21) The ALJ recited Woods's allegations that she wakes with pain in the morning, has difficulty sitting, concentrating, and falling asleep due to pain, uses a cane to walk, and depends in part on her mother-with whom Woods and her young daughter live-to cook and clean. (R 20-21) Woods also occasionally requires her mother's help in the shower, ALJ Schiro noted. The ALJ found it significant that Woods is, however, capable of driving to pick up her daughter from school, of handling her own personal care (albeit with some difficulty), of preparing simple foods and performing very light cleaning, and of going shopping with assistance. (R 20, 22) ALJ Schiro also noted that Woods avoids taking medication for fear of side effects and dependency. (Id.) She further observed that Woods's "only modality of relief is a heating [pad], " which Woods uses to fall asleep. (R 20, 22)

         ALJ Schiro then listed several types of medical evidence that would support Woods's subjective reports but which are lacking in the record: evidence of significant musculoskeletal impairment; reports of positive straight leg or range of motion testing; evidence of neurological deficits; a fibromyalgia diagnosis, evidence of tender points, or other clinical indicia of fibromyalgia; evidence that Woods sought treatment from an orthopedist; evidence that Woods cannot ambulate without a cane or that a physician prescribed such an assistive device; and evidence of acidosis, neuropathy, retinitis, lower extremity edema, neurological deficits, or abdominal abnormalities (i.e., evidence of complications due to diabetes mellitus). (R 21)

         ALJ Schiro weighed the absence of this evidence against the presence of the following evidence: a diagnosis of degenerative joint disease of the cervical and lumbosacral aspects of the spine (although the record shows no associated positive clinical findings, the ALJ cautioned); annual treatment records from Woods's nephrologist, Dr. Gandhi, who manages Woods's diabetes mellitus and ...


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