United States District Court, N.D. Indiana, Fort Wayne Division
OPINION AND ORDER
William C. Lee, Judge
This
matter is before the court for judicial review of a final
decision of the defendant Commissioner of Social Security
Administration denying Plaintiff's application for
Disability Insurance Benefits (DIB), as provided for in the
Social Security Act. Section 205(g) of the Act provides,
inter alia, "[a]s part of his answer, the [Commissioner]
shall file a certified copy of the transcript of the record
including the evidence upon which the findings and decision
complained of are based. The 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], with or without remanding the case for a
rehearing." It also provides, "[t]he findings of
the [Commissioner] as to any fact, if supported by
substantial evidence, shall be conclusive. . . ." 42
U.S.C. §405(g).
The law
provides that an applicant for DIB must establish an
"inability to engage in any substantial gainful activity
by reason of any medically determinable physical or mental
impairment which can be expected to last for a continuous
period of no less than 12 months. . . ." 42 U.S.C.
§416(i)(1); 42 U.S.C. §423(d)(1)(A). A physical or
mental impairment is "an impairment that results from
anatomical, physiological, or psychological abnormalities
which are demonstrable by medically acceptable clinical and
laboratory diagnostic techniques." 42 U.S.C.
§423(d)(3). It is not enough for a plaintiff to
establish that an impairment exists. It must be shown that
the impairment is severe enough to preclude the plaintiff
from engaging in substantial gainful activity. Gotshaw v.
Ribicoff, 307 F.2d 840 (7th Cir. 1962), cert. denied,
372 U.S. 945 (1963); Garcia v. Califano, 463 F.Supp.
1098 (N.D.Ill. 1979). It is well established that the burden
of proving entitlement to disability insurance benefits is on
the plaintiff. See Jeralds v. Richardson, 445 F.2d
36 (7th Cir. 1971); Kutchman v. Cohen, 425 F.2d 20
(7th Cir. 1970).
Given
the foregoing framework, "[t]he question before [this
court] is whether the record as a whole contains substantial
evidence to support the [Commissioner's] findings."
Garfield v. Schweiker, 732 F.2d 605, 607 (7th Cir.
1984) citing Whitney v. Schweiker, 695 F.2d 784, 786
(7th Cir. 1982); 42 U.S.C. §405(g). "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.'"
Rhoderick v. Heckler, 737 F.2d 714, 715 (7th Cir.
1984) quoting Richardson v. Perales, 402 U.S. 389,
401, 91 S.Ct. 1410, 1427 (1971); see Allen v.
Weinberger, 552 F.2d 781, 784 (7th Cir. 1977). "If
the record contains such support [it] must [be] affirmed, 42
U.S.C. §405(g), unless there has been an error of
law." Garfield, supra at 607; see
also Schnoll v. Harris, 636 F.2d 1146, 1150 (7th Cir.
1980).
In the
present matter, after consideration of the entire record, the
Administrative Law Judge (“ALJ”) made the
following findings:
1. The claimant meets the insured status requirements of the
Social Security Act through September 30, 2016.
2. The claimant has not engaged in substantial gainful
activity since March 31, 2011 (Ex. 7D, 8D, 9D, 10D), the
alleged onset date (20 CFR 404.1571 et seq., and
416.971 et seq.).
3. The claimant has the following severe impairments:
degenerative joint disease in both of her knees, discogenic
and degenerative changes in the lumbar spine, degenerative
changes in the cervical spine, supraventricular tachycardia,
peripheral artery disease, and obesity (20 CFR 404.1520(c)
and 416.920(c)).
4. The claimant does not have an impairment or combination of
impairments that meets or medically equals the severity of
one of the listed impairments in 20 CFR Part 404, Subpart P,
Appendix 1 (20 CFR 404.1520(d), 404.1525, 404.1526,
416.920(d), 416.925 and 416.926).
5. After careful consideration of the entire record, the
undersigned finds that the claimant has the residual
functional capacity to perform light work as defined in 20
CFR 404.1567(b) and 416.967(b) except that she is able to
stand/walk for a total of just 2 hours in an eight-hour
period and occasionally climb, balance, stoop, kneel, crouch,
and crawl.
6. The claimant is unable to perform any past relevant work
(20 CFR 404.1565 and 416.965).
7. The claimant was born on September 16, 1960 and was 50
years old, which is defined as an individual closely
approaching advanced age, on the alleged disability onset
date. The claimant subsequently changed age category to
advanced age when she attained age 55 in September 2015. Her
age category has not changed otherwise (20 CFR 404.1563 and
416.963).
8. The claimant has a limited education and is able to
communicate in English (20 CFR 404.1564 and 416.964).
9. The claimant has acquired work skills from past relevant
work (20 CFR 404.1568 and 416.968).
10. Considering the claimant's age, education, work
experience, and residual functional capacity, the claimant
has acquired work skills from past relevant work that are
transferable to other occupations with jobs existing in
significant numbers in the national economy (20 CFR 404.1569,
404.1569(a), 404.1568(d), 416.969, 416.969(a), and
416.968(d)).
11. The claimant has not been under a disability, as defined
in the Social Security Act, from March 31, 2011, through the
date of this decision (20 CFR 404.1520(g) and 416.920(g).
(Tr. 13- 22).
Based
upon these findings, the ALJ determined that Plaintiff was
not entitled to disability insurance benefits. The ALJ's
decision became the final agency decision when the Appeals
Council denied review. This appeal followed.
Plaintiff
filed her opening brief on October 25, 2018. On January 23,
2019, the defendant filed a memorandum in support of the
Commissioner's decision, to which Plaintiff replied on
January 31, 2019. Upon full review of the record in this
cause, this court is of the view that the ALJ's decision
should be remanded.
A five
step test has been established to determine whether a
claimant is disabled. See Singleton v. Bowen, 841
F.2d 710, 711 (7th Cir. 1988); Bowen v. Yuckert, 107
S.Ct. 2287, 2290-91 (1987). The United States Court of
Appeals for the Seventh Circuit has summarized that test as
follows:
The following steps are addressed in order: (1) Is the
claimant presently unemployed? (2) Is the claimant's
impairment "severe"? (3) Does the impairment meet
or exceed one of a list of specific impairments? (4) Is the
claimant unable to perform his or her former occupation? (5)
Is the claimant unable to perform any other work within the
economy? An affirmative answer leads either to the next step
or, on steps 3 and 5, to a finding that the claimant is
disabled. A negative answer at any point, other than step 3,
stops the inquiry and leads to a determination that the
claimant is not disabled.
Nelson v. Bowen, 855 F.2d 503, 504 n.2 (7th Cir.
1988); Zalewski v. Heckler, 760 F.2d 160, 162 n.2
(7th Cir. 1985); accord Halvorsen v. Heckler, 743
F.2d 1221 (7th Cir. 1984). From the nature of the ALJ's
decision to deny benefits, it is clear that Step 5 was the
determinative inquiry.
Plaintiff
was born on September 16, 1960 and was 56 years-old on the
date that the ALJ issued her decision. In March 2011,
Plaintiff presented for treatment of knee pain and lower
extremity swelling. (AR 724.) Examination revealed lower
extremity edema. Id. Doctors prescribed the main
medication methadone and the muscle relaxant Flexeril.
Id. In April 2011, doctors observed that Plaintiff
was shaking, gritting her teeth, was tearful, and presented
with a racing heart. (AR 722.) Doctors prescribed the
antidepressant Lexapro and the anti-anxiety medication Xanax.
Id. She developed increasingly severe back pain in
May 2011. (AR 720.) Her depression persisted in mid-2011 and
doctors prescribed the antidepressant Elavil. (AR 711.) In
November 2011, she presented with chest pain, dyspnea on
exertion, and tachycardia. (AR 645.) An echocardiogram (ECG)
reflected concentric left ventricular hypertrophy with
impaired diastolic function. (AR 647.) Examination in
December 2011 confirmed lower extremity edema. (AR 715.) A
December 2011 pulmonary function test demonstrated decreased
mid-expiratory flows and decreased diffusion capacity which
could have been a component of anatomic emphysema. (AR 628.)
In
January 2012, doctors diagnosed supraventricular tachycardia
after Plaintiff presented with a rapid heart rate. (AR 631.)
An ECG suggested possible left ventricular enlargement. (AR
639.) Examination in March 2012 revealed tenderness to
palpation over the lumbar spine. (AR 712.) Doctors prescribed
the narcotic pain medication Vicoprofen, for Plaintiff had
recently tapered off of methadone. (AR 712.) A July 2012 MRI
of the lumbar spine confirmed disc bulge with facet
arthropathy and bilateral foraminal narrowing at ¶ 3-L4,
disc bulge with foraminal narrowing at ¶ 4-L5, and facet
arthropathy at ¶ 5-S1. (AR 652.) A July 2012 x-ray of
the knees reflected marked medial compartmental joint space
narrowing and tricompartmental osteophytes. (AR 666.)
Plaintiff presented at a neurological clinic in October 2012
for treatment of severe headaches. (AR 787.) She suffered
incapacitating headaches that lasted for two-to-three days,
up to three occasions each month. Id. She attempted
to lie down when the headaches occurred but the pain often
interrupted her sleep. Id. Additionally, the
headaches produced impaired concentration and decreased
appetite. Id. Doctors diagnosed migraine headache
with aura and prescribed ...