United States District Court, M.D. Alabama, Northern Division
WINDY G. SANDERS, Plaintiff,
CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.
SUSAN RUSS WALKER, Chief Magistrate Judge.
Plaintiff Windy G. Sanders brings this action pursuant to 42 U.S.C. § 405(g) and § 1383(c)(3) seeking judicial review of a decision by the Commissioner of Social Security ("Commissioner") denying her applications for disability insurance benefits and supplemental security income under Titles II and XVI of the Social Security Act. The parties have consented to entry of final judgment by the Magistrate Judge, pursuant to 28 U.S.C. § 636(c). (Doc. ## 9, 10). Upon review of the record, the court concludes that the Commissioner's decision is due to be reversed.
Plaintiff filed the present applications on September 13, 2010. (R. 151-58). At the initial administrative level, Maxine Laffitte - a Single Decisionmaker ("SDM") - completed a "Physical Residual Functional Capacity Assessment" form expressing her opinion regarding plaintiff's functional limitations. (R. 78-85). Lafitte concluded that, although plaintiff's condition precluded work at that time, it should improve sufficiently to permit plaintiff to work within twelve months of her alleged onset date and, therefore, that the duration of plaintiff's disability was not sufficient to qualify for benefits. (R. 99-100). She denied plaintiff's claims on November 16, 2010 (R. 86, 87, 89-100).
Plaintiff requested a hearing before an Administrative Law Judge. (R. 8). On March 20, 2012, ALJ Maria Kusznir issued decision denying plaintiff's claims. (R. 12-38). She determined that plaintiff has "severe" impairments of "complete right knee replacement" and obesity. (R. 17). ALJ Kusznir found that plaintiff "does not have an impairment or combination of impairments that meets or medically equals the severity of" any impairment within the Commissioner's "listings" including, specifically, Listing 1.02A (R. 18), and that plaintiff's residual functional capacity does not preclude the performance of her past relevant work "as a security guard with a sit stand option" as "actually and generally performed" (R. 32-33) or other work that exists in significant numbers in the national economy (R. 33-34). Plaintiff sought review of the ALJ's decision by the Appeals Council which, on August 2, 2013, denied plaintiff's request for review. (R. 1-5). Plaintiff commenced the present action thereafter. (Doc. # 1).
Standard of Review
The court's review of the Commissioner's decision is narrowly circumscribed. The court does not reweigh the evidence or substitute its judgment for that of the Commissioner. Rather, the court examines the administrative decision and scrutinizes the record as a whole to determine whether substantial evidence supports the ALJ's factual findings. Davis v. Shalala , 985 F.2d 528, 531 (11th Cir. 1993); Cornelius v. Sullivan , 936 F.2d 1143, 1145 (11th Cir. 1991). Substantial evidence consists of such "relevant evidence as a reasonable person would accept as adequate to support a conclusion." Cornelius , 936 F.2d at 1145. Factual findings that are supported by substantial evidence must be upheld by the court. The ALJ's legal conclusions, however, are reviewed de novo because no presumption of validity attaches to the ALJ's determination of the proper legal standards to be applied. Davis , 985 F.2d at 531. If the court finds an error in the ALJ's application of the law, or if the ALJ fails to provide the court with sufficient reasoning for determining that the proper legal analysis has been conducted, the ALJ's decision must be reversed. Cornelius , 936 F.2d at 1145-46.
In this appeal, plaintiff contends that the Commissioner's determination that her impairments do not meet or medically equal the severity of Listing 1.02(A) was not "issued in accordance with applicable law" and is not supported by substantial evidence. (Plaintiff's brief, Doc. # 12). As to the ALJ's alleged failure to comply with applicable law, plaintiff argues - as she did before the Appeals Council (see R. 235) - that the ALJ erred by reaching her step-three finding without obtaining and considering the opinion of a medical expert on the issue of medical equivalence to Listing 1.02A. (Doc. # 12, pp. 4-6). Plaintiff acknowledges that "the ultimate responsibility for determining medical equivalence rests with the Administrative Law Judge." ( Id., p. 5). However, she notes that the Commissioner's regulations require this determination to be reached "with due consideration given to the opinion of one or more physicians or psychologists designated by the Commissioner of Social Security." (Id.)(citing 20 C.F.R. §404.1526(c)). Plaintiff argues that the administrative record includes no opinion from a physician "concerning the issue of whether the plaintiff's combination of severe impairments are medically the equivalent to any of the Listings' found in the Listing of Impairments[.]'" ( Id., p. 6; see also id., p. 8).
The court agrees that an ALJ's finding regarding medical equivalence must be supported by an opinion as to medical equivalence from a physician (or psychologist) designated by the Commissioner. 20 C.F.R. §§ 404.1526(c), 416.926(c)); SSR 96-6p; Barnett v. Barnhart , 381 F.3d 664, 670 (7th Cir. 2004)("Whether a claimant's impairment equals a listing is a medical judgment, and an ALJ must consider an expert's opinion on the issue."); cf. Wilkinson o/b/o Wilkinson v. Bowen , 847 F.2d 660 (11th Cir. 1987)(finding no error in an ALJ's reliance on the opinion of a non-examining physician; observing that "[w]hen deciding medical equivalence, the Secretary must consider the medical opinion of one or more designated physicians on an advisory basis."). Section 404.1526 of the Commissioner's regulations, cited by the plaintiff (id., p. 5), defines medical equivalence and specifies how the Commissioner reaches her finding on that issue. 20 C.F.R. § 404.1526; see also id., § 416.926 (the corresponding provision as to Title XVI claims). The regulation defines medical equivalence to mean that the claimant's "impairment(s)... is at least equal in severity and duration to the criteria of any listed impairment." 20 C.F.R. §§ 1526(a), 416.926(a). A finding as to medical equivalence requires a determination of whether the claimant has findings related to the claimant's impairment or combination of impairments that are "at least of equal medical significance" to those required to meet a listing. 20 C.F.R. §§ 1526(b), 416.926(b) (emphasis added). The particular subsection cited by the plaintiff states:
(c) What evidence do we consider when we determine if your impairment(s) medically equals a listing? When we determine if your impairment medically equals a listing, we consider all evidence in your case record about your impairment(s) and its effects on you that is relevant to this finding. We do not consider your vocational factors of age, education, and work experience (see, for example, § 404.1560(c)(1)). We also consider the opinion given by one or more medical or psychological consultants designated by the Commissioner. (See § 404.1616).
20 C.F.R. § 404.1526(c)(italics in original; emphasis in bold type added).
Social Security Ruling 96-6p sets forth the Commissioner's policy that "appl[ies] at the administrative law judge and Appeals Council levels to opinions about equivalence to a listing in the Listing of Impairments and RFC assessments, issues that are reserved to the Commissioner[.]" SSR 96-6p, 1996 ...