United States District Court, N.D. Indiana, South Bend Division
ALYCE C. DALE, Plaintiff,
ANDREW M. SAUL, Commissioner of Social Security, Defendant.
OPINION AND ORDER
P. SIMON, UNITED STATES DISTRICT JUDGE.
Dale has appealed from an administrative law judge's
denial of her application for Social Security disability
benefits. In doing so, she claims that the ALJ committed two
errors which require a reversal of his decision. First, Dale
says that the ALJ improperly “played doctor” when
he reviewed and considered new medical evidence that came
into existence after Dale filed her application, without any
professional (i.e. medical) assistance. Second, she
says that the ALJ was required to but did not consider
medical expert opinion as to whether Dale's combined
impairments medically equaled two specific Social Security
disability listings. I agree that the ALJ's decision to
review and opine on Dale's new medical evidence and
recent conditions without the benefit of any review by an
additional medical professional was error. Consequently, the
ALJ's decision will be reversed and this matter remanded
so that such further medical opinion evidence may be obtained
and considered by an ALJ.
Dale applied for disability benefits on April 11, 2014,
claiming that as of November 1, 2012, she was disabled.
[A.R. 10.] Her initial claims were denied and on
February 10, 2017, she appeared before an ALJ through a video
hearing. [Id.] On March 29, 2017, the ALJ issued his
written decision which once again denied Dale benefits, and
after exhausting her administrative appeals, Dale has sought
review before me. [A.R. 7.]
written decision, the ALJ determined that Dale had the
following severe impairments: degenerative disc disease of
her lumbar spine, headaches, diabetes mellitus, and
osteoarthritis of the hips. [A.R. 12.] In addition, Dale
suffered from pituitary adenoma, i.e. a tumor on her
pituitary gland. [Id.] That condition and its
associated impairments were not discovered for more than a
year after Dale first applied for benefits. [A.R. 16.] In
June 2015, Dale had complaints of dizziness, ear pain, and
headaches and blurry vision. [Id.] In late
July/early August 2015, she underwent an MRI and a tumor on
her pituitary gland was discovered. The tumor was removed
that October and she subsequently underwent radiation
therapy. And while subsequent MRIs showed that the tumor had
not returned, Dale continued to report persistent headaches
(as of September 2016) as well as seizures, which were
partially treated with medication. [A.R. 17.]
evaluating these impairments, the ALJ determined that Dale
did not meet any of the applicable social security listings
for disability. Specifically, the ALJ examined listing 1.02
(dysfunctions of a joint), 1.04 (disorders of the spine),
11.02 (convulsive epilepsy), and 11.03 (non-convulsive
epilepsy). In doing so, the ALJ relied on the opinions of
state agency medical and psychological consultants. [A.R.
14.] Notably, those opinions were drafted in December 2014, a
full seven months prior to Dale's pituitary adenoma
diagnosis and the appearance of symptoms from it. The ALJ did
not order a re-review of Dale's medical records prior to
determining whether she met the epilepsy-related listings,
even though Dale's seizures did not begin to occur until
around the time her pituitary adenoma was discovered. [A.R.
15.] Nonetheless, the ALJ determined Dale did not meet or
equal any of those listings and proceeded to the next step of
the review process.
next step, the ALJ determined Dale's residual functional
capacity (RFC). He determined that Dale should be limited to
light work, subject to several additional limitations. Those
were: lifting up to 20 pounds occasionally, up to 10 pounds
frequently; carrying 20 pounds occasionally and 10 pounds
frequently; sitting, standing or walking for six hours,
pushing and pulling as much as she could lift or carry-
subject to the 20- and 10-pound restrictions previously
mentioned. [A.R. 15.] He also found that she could climb
stairs and ramps just fine, but never could climb ladders,
ropes or scaffolds. He also found she could stoop, kneel,
crouch and crawl, but never work on unprotected heights,
around moving mechanical parts, or operate a commercial
vehicle. [Id.]. The ALJ based this RFC upon his
review of Dale's testimony and submitted evidence, which
he labeled as a careful consideration of the entire record.
[Id.] I won't belabor the point or repeat the
ALJ's description of the evidence contained within his
written decision. [See A.R. 15-19.]
as is often the case in these types of cases, this RFC and
some additional hypothetical questions were posed to a
vocational expert (VE) who testified whether or not such a
hypothetical person with Dale's RFC could likely find
gainful employment. The ALJ determined that Dale could
perform her past relevant work as a Fast Food Worker and
Industrial Cleaner, as those jobs are defined in the
Dictionary of Occupational Titles. [A.R. 19-20.] He further
found she could perform the jobs of Housekeeping Cleaner,
Bakery Worker Conveyor Line and Poultry Eviscerator, all of
which existed in sufficient numbers in the national economy.
As a result, the ALJ found that Dale was not disabled within
the meaning of the Social Security Act and its regulations.
Social Security disability appeal, my role as district court
judge is limited. I don't start from scratch and
determine whether a claimant is disabled and entitled to
benefits. Instead, my review of the ALJ's findings is
deferential, to determine whether the ALJ applied the correct
legal standards and whether the decision's factual
determinations are supported by substantial evidence.
Shideler v. Astrue, 688 F.3d 306, 310 (7th Cir.
2012). If substantial evidence supports the ALJ's factual
findings, they are conclusive. Id.; 42 U.S.C.
§405(g). The Supreme Court has said that
“substantial evidence” means more than a
“scintilla” of evidence, but less than a
preponderance of the evidence. Richardson v.
Perales, 402 U.S. 389, 401 (1971). “Evidence is
substantial if a reasonable person would accept it as
adequate to support the conclusion.” Young v.
Barnhart, 362 F.3d 995, 1001 (7th Cir. 2004). My review
is guided by the principle that while “[t]he ALJ is not
required to address every piece of evidence or testimony
presented, but must provide a ‘logical bridge'
between the evidence and the conclusions so that [I] can
assess the validity of the agency's ultimate findings and
afford the claimant meaningful judicial review.”
Jones v. Astrue, 623 F.3d 1155, 1160 (7th Cir.
2010). Given this modest standard, the review is a light one,
but of course I cannot “simply rubber-stamp the
Commissioner's decision without a critical review of the
evidence.” Clifford v. Apfel, 227 F.3d 863,
869 (7th Cir. 2000). “[T]he decision cannot stand if it
lacks evidentiary support or an adequate discussion of the
issues.” Briscoe ex rel. Taylor v. Barnhart,
425 F.3d 345, 351 (7th Cir. 2005) (quoting Lopez ex rel.
Lopez v. Barnhart, 336 F.3d 535, 539 (7th Cir. 2003)).
main argument is that given that she began to experience
symptoms and was diagnosed with a tumor on her pituitary
gland during the review process, and, importantly, after her
file was reviewed by the state agency physicians, the
ALJ's opinion is inherently deficient. The point is not
just that her medical condition and impairments changed after
filing, but that they did so dramatically and that no state
agency physician conducted a re-review of her records after
her pituitary adenoma was diagnosed. This she says, led to an
improper consideration of her medical files by the ALJ in the
first instance in which the ALJ substituted his own lay
opinions for what should have been the opinions of
Commissioner's main retort to this is that additional
medical opinion was not necessary. Specifically, he says:
[T]he ALJ acknowledged the point that the State agency
medical consultant issued their opinions before
Plaintiff's pituitary tumor surfaced. In so doing, the
ALJ explained he included in the RFC additional postural and
environmental limitations to accommodate the evidence related
to the tumor and its effects, as well as hearing testimony.
[DE 18 at 7.] And therein lies the problem. The ALJ reviewed
the objective medical evidence and testimony relating to
Dale's pituitary tumor and its resulting impacts on her
abilities. The ALJ then formed his own opinions based on that
review and determined Dale was not disabled. That's
different than reviewing underlying medical records to see
whether they support the conclusions or opinion testimony
from a medical professional being offered by a claimant. One
is evaluating an opinion, the other is forming an opinion in
the first instance. The former is the ALJ's task in cases
like these, while the latter is impermissibly playing doctor.
“[A]n ALJ ...