Scaife, Jr. v. Commissioner of Social Security

UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF NEW YORK

AUSTIN SERVESTER SCAIFE JR,

Plaintiff, DECISION AND ORDER

-vs- 18-CV-6562-MJP

COMMISSIONER OF SOCIAL SECUIRTY,

Defendant.

INTRODUCTION

Plaintiff Austin Servester Scaife, Jr. (“Plaintiff”) brings this action

pursuant to Section 205(g) of the Social Security Act, 42 U.S.C. § 405(g) and

§ 1383(c)(3) seeking judicial review of a final decision of the Commissioner of

Social Security (“Commissioner”) denying his application for Supplemental

Security Income (“SSI”). Pursuant to 28 U.S.C. § 636(c) the parties have

consented to the disposition of this case by a United States Magistrate Judge.

(ECF No. 14.)

Presently before the Court are cross-motions for judgment on the

pleadings pursuant to Rule 12(c) of the Federal Rules of Civil Procedure. (ECF

Nos. 10 & 12.) For the reasons set forth below, this matter must be remanded

for a rehearing.

PROCEDURAL BACKGROUND

On November 21, 2014, Plaintiff protectively filed an application for SSI

alleging disability, including “stress, learning disability and bipolar” beginning

on November 1, 1992. (R.1 60; 155.) The Social Security Administration denied

Plaintiff’s claim on July 2, 2015. (R. 60–67.) On December 14, 2016, a video

teleconference hearing was held before Administrative Law Judge (“ALJ”) who

was located in Falls Church, Virginia (R. 30; 32.) Plaintiff participated in the

hearing in Rochester, New York. (R. 30; 32.) The hearing was rescheduled to

permit Plaintiff time to obtain counsel. (R. 33.) The rescheduled hearing took

place on March 3, 2017, again via video teleconference. (R. 36; 38.) Plaintiff did

not appear for the hearing but was represented by an attorney. (R. 30.) A

vocational expert also testified at the hearing (R. 36; 38.)

The ALJ issued a decision on August 14, 2017, finding that Plaintiff had

the following severe impairments: “polysubstance abuse, depression, anxiety,

personality disorder and post-traumatic stress disorder (PTSD).” (R. 12.)

Nevertheless, the ALJ determined that Plaintiff was able to

perform a full range of work at all exertional levels but with the

following non-exertional limitations: he can perform simple,

routine tasks and make simple work-related decisions. He

requires a work environment where change is minimal. He can

tolerate occasional contact with supervisors and coworkers, but

must have no contact with the general public. He cannot engage

in tandem work. He will also have one unscheduled absence every

three months.

(R. 15.)

Plaintiff appealed to the Social Security Administration’s Appeals

Counsel and that body denied his request for review on June 7, 2018, making

1 “R __” refers to the page in the Administrative Record filed by the

Commissioner of Social Security.

the ALJ’s decision the Commissioner’s final decision. (R. 1.) Plaintiff filed this

lawsuit on August 2, 2018.

STANDARD OF REVIEW

Title 42 U.S.C. § 405(g) grants jurisdiction to district courts to hear

claims based on the denial of Social Security benefits. Section 405(g) provides

that the District Court “shall have the power to enter, upon the pleadings and

transcript of the record, a judgment affirming, modifying, or reversing the

decision of the Commissioner of Social Security, with or without remanding the

cause for a rehearing.” 42 U.S.C. § 405(g) (2007). It directs that when

considering a claim, the Court must accept the findings of fact made by the

Commissioner, provided that such findings are supported by substantial

evidence in the record. Substantial evidence is defined as “‘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

(1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938));

see also Metro. Stevedore Co. v. Rambo, 521 U.S. 121, 149 (1997).

To determine whether substantial evidence supports the

Commissioner’s findings, the Court must “examine the entire record, including

contradictory evidence and evidence from which conflicting inferences can be

drawn.” Brown v. Apfel, 174 F.3d 59, 62 (2d Cir. 1999) (quoting Mongeur v.

Heckler, 722 F.2d 1033, 1038 (2d Cir. 1983) (per curium)). Section 405(g) limits

the scope of the Court’s review to two inquiries: whether the Commissioner’s

findings were supported by substantial evidence in the record, and whether

the Commissioner’s conclusions are based upon an erroneous legal standard.

Green-Younger v. Barnhart, 335 F.3d 99, 105-06 (2d Cir. 2003); see also

Mongeur, 722 F.2d at 1038 (finding a reviewing court does not try a benefits

case de novo).

A person is disabled for the purposes of SSI and disability benefits if he

or she is unable “to engage in any substantial gainful activity by reason of any

medically determinable physical or mental impairment which can be expected

to result in death or which has lasted or can be expected to last for a continuous

period of not less than 12 months.” 42 U.S.C. §§ 423(d)(1)(A) & 1382c(a)(3)(A).

In assessing whether a claimant is disabled, the ALJ must employ a five-step

sequential analysis. See Berry v. Schweiker, 675 F.2d 464, 467 (2d Cir. 1982)

(per curiam). The five steps are:

(1) whether the claimant is currently engaged in substantial

gainful activity;

(2) if not, whether the claimant has any “severe impairment”

that “significantly limits [the claimant’s] physical or mental

ability to do basic work activities”;

(3) if so, whether any of the claimant’s severe impairments

meets or equals one of the impairments listed in Appendix 1 of

Subpart P of Part 404 of the relevant regulations;

(4) if not, whether despite the claimant’s severe impairments,

the claimant retains the residual functional capacity [(“RFC”)] to

perform his past work; and

(5) if not, whether the claimant retains the [RFC] to perform

any other work that exists in significant numbers in the national

economy.

20 C.F.R. §§ 404.1520(a)(4)(i)-(v) & 416.920(a)(4)(i)-(v); Berry v. Schweiker, 675

F.2d at 467. “The claimant bears the burden of proving his or her case at steps

one through four[;] . . . [a]t step five the burden shifts to the Commissioner to

‘show there is other gainful work in the national economy [which] the claimant

could perform.’” Butts v. Barnhart, 388 F.3d 377, 383 (2d Cir. 2004) (quoting

Balsamo v. Chater, 142 F.3d 75, 80 (2d Cir. 1998)).

ANALYSIS

Plaintiff raises two issues for the Court’s review. First, Plaintiff asserts

that since the ALJ effectively rejected the opinion evidence in the record, he

relied on his own lay interpretation of the medical evidence to make his RFC

determination. (Pl.’s Mem. of Law at 1, Mar. 4, 2019, ECF No. 10-1.) In

addition, Plaintiff contends that the ALJ failed to fulfill his duty of developing

the record because he did not obtain a medical opinion that would have

addressed Plaintiff’s functional limitations. (Id.)

Having effectively rejected the opinion evidence in the record, the ALJ

substituted his own lay interpretation of the medical evidence when

determining Plaintiff’s RFC.

The Court agrees with Plaintiff that the ALJ erred in assessing

Plaintiff’s RFC. (Pl.’s Mem. of Law at 15–19.) “An ALJ is not a medical

professional, and is not qualified to assess a claimant’s RFC on the basis of

bare medical findings.” Benman v. Comm’r of Soc. Sec., 350 F. Supp. 3d 252,

257 (W.D.N.Y. 2018) (citations omitted). In other words, the ALJ may not

interpret raw medical data in functional terms. Smith v. Comm’r of Soc. Sec.,

337 F. Supp. 3d 216, 226 (W.D.N.Y. 2018) (citations omitted); Rodriguez v.

Colvin, No. 13-cv-07607, 2015 WL 1903146, at *24 (S.D.N.Y. Mar. 31, 2015)

(“An ALJ may not ... reject an examining source’s conclusions based on the

ALJ's own interpretation of the medical evidence, because … an ALJ may not

substitute his own opinion of the medical evidence for that of a medical

professional …. In determining that [the consultative doctor’s] findings did not

support her conclusions that Plaintiff suffered from significant limitations, the

ALJ did not rely on the opinion of any medical other professional, but instead

appears to have relied on his own interpretation of the evidence”). Indeed, it is

error for an ALJ to make an RFC determination without opinions from medical

professionals concerning the impact of the objective medical evidence on a

plaintiff’s RFC. Dennis v. Colvin, 195 F. Supp. 3d 469, 474 (W.D.N.Y. 2016).

Here, the record contained two medical opinions. On July 2, 2015, Dr.

K. Lieber-Diaz, a psychologist, determined that there was “insufficient

evidence to evaluate clmt’s alleged psychiatric impairments due to failure to

cooperate.” (R. 60–66.) The ALJ gave “little weight” to Dr. Lieber-Diaz’s

opinion because it was based upon a review of the medical records available at

the time and further medical records had since become available. (R. 20.)

On July 8, 2016, Dr. Odysseus Adamides assessed Plaintiff at the

Catholic Family Center (R. 2094–2101.) After conducting an examination, Dr.

Adamides provided his opinion:

patient exhibits adequate IQ with bipolar depressed mood and

struggles with paranoia as defense, re: intrusive thoughts of past

family issues, prison and street-related trauma, thus needs

medication for stabilization. He exhibited capacity for rational

thought but emotional lability, requiring ongoing medication to

decrease irritable behavior or regression; if not treated he is @

risk for criminal recidivism or relapse. He still requires SSI to

complete treatment and safely survive in the community[.]

(R. 2097.)

The ALJ gave “[l]ittle weight” to Dr. Adamides’s opinion, stating that

the finding of a disability is reserved to the Commissioner. (R. 20.) The ALJ

further dismissed Dr. Adamides’s opinion because it was “vague, does not

provide a function-by-function analysis of the claimant’s work-related

restrictions and is inconsistent with the overall evidence of record.” (Id.) Of

note, the ALJ does not provide any explanation as to how Dr. Adamides’s

opinion is inconsistent with the record.

In effectively rejecting the opinions of Dr. Lieber-Diaz and Dr. Adamides

the ALJ did not rely on any opinion evidence from an acceptable medical source

when making his RFC determination. The ALJ, therefore, determined

Plaintiff’s RFC based on his own interpretation of the medical record, which is

not permissible. Accordingly, the RFC finding is not supported by substantial

evidence, and this error necessitates remand.

The ALJ failed to fulfill his obligation to develop the record and,

therefore, his RFC decision was not supported by substantial evidence.

An ALJ is statutorily required to develop a plaintiff’s “complete medical

history, including arranging for a consultative examination(s) if necessary, and

making every reasonable effort to help [the plaintiff] get medical reports from

[the plaintiff’s] own medical sources.” 20 C.F.R. § 416.945 (emphasis added);

Villa v. Colvin, No. 1:14-CV-00463, 2016 WL 1054757, at *4 (W.D.N.Y. Mar.

17, 2016) (“[a]lthough a claimant is generally responsible for providing

evidence upon which to base an RFC assessment, before the Administration

makes a disability determination, the ALJ is responsible for developing [the

claimant’s] complete medical history ….”) (internal quotations and citations

omitted). Title 20, section 416.912 of the Federal Code of Regulations provides

that “[e]very reasonable effort means that we will make an initial request for

evidence from your medical source or entity that maintains your medical

source's evidence, and, at any time between 10 and 20 calendar days after the

initial request, if the evidence has not been received, we will make one follow-

up request to obtain the medical evidence necessary to make a determination.”

20 C.F.R. § 416.912. Moreover,

[w]here the record is devoid of any opinions from treating or

examining medical sources regarding [the] Plaintiff’s functional

or work capacity limitations, such as Plaintiff’s lifting, carrying,

sitting or standing limits ...[,] the ALJ [is] obligated to develop the

record and obtain RFC assessments from [the] Plaintiff’s treating

and/or examining physicians …. An ALJ’s failure to do so

necessitates remand.

Salone v. Berryhill, No. 6:16-CV-06491-MAT, 2018 WL 6333421, at *2

(W.D.N.Y. Dec. 5, 2018) (internal quotations and citations omitted). Having

rejected the only available medical opinion evidence, the record is devoid of any

indication that the ALJ made any attempt to arrange for a consultative

examination, or to otherwise obtain an opinion that would address Plaintiff’s

functional limitations. Without having done this, the ALJ failed to meet his

duty of developing the record and remand is required.

CONCLUSION

For the foregoing reasons, the Court grants Plaintiff's motion for

judgment on the pleadings (ECF No. 9) and denies Commissioner’s motion for

judgment on the pleadings (ECF No. 11). The case is remanded pursuant to

the fourth sentence of 42 U.S.C. § 405(g) for an expedited hearing. The Clerk

of the Court will enter judgment in favor of the Plaintiff and close this case.

IT IS SO ORDERED.

DATED: March 2, 2020

Rochester, New York | | /

MARK W. PEDERSEN

United States Magistrate Judge