United States District Court, D. Massachusetts
MEMORANDUM OF DECISION AND ORDER ON CROSS-MOTIONS REGARDING DENIAL OF SUPPLEMENTAL SECURITY INCOME BENEFITS
JUDITH GAIL DEIN, Magistrate Judge.
The plaintiff, John Allen Lightfoot ("Lightfoot"), has brought this action pursuant to sections 205(g) and 1631(c)(3) of the Social Security Act, 42 U.S.C. §§ 405(g) and 1383(c)(3), in order to challenge the final decision of the Commissioner of the Social Security Administration ("Commissioner") denying his claim for Supplemental Security Income ("SSI") benefits. The matter is presently before the court on the "Plaintiff's Motion for Order Reversing the Commissioner's Decision and Awarding Benefits" (Docket No. 21), by which the plaintiff is seeking an order reversing the Commissioner's decision and directing the payment of benefits, or in the alternative, remanding the matter to the Social Security Administration for further administrative proceedings before a newly selected Administrative Law Judge ("ALJ"). It is also before the court on the "Defendant's Motion to Affirm the Commissioner's Decision" (Docket No. 29), by which the Commissioner is seeking an order upholding her decision to deny Lightfoot's claim. At issue is whether the ALJ, in reaching her decision that Lightfoot was not disabled, erred by rejecting the plaintiff's claim that he meets the listing for mental retardation, and by failing to consider whether the plaintiff meets or medically equals the listing for organic mental disorders, under 20 C.F.R. Part 404, Subpart P, Appendix 1 ("Appendix 1") of the Social Security regulations. Also at issue is whether the ALJ committed reversible error by wrongfully rejecting and substituting her own views for the opinions of Lightfoot's primary care physician, Gustavo Velasquez, M.D., and by failing to conduct a proper assessment of the plaintiff's credibility. For all the reasons described below, this court concludes that the ALJ's justification for finding that Lightfoot did not satisfy the criteria of the listing for mental retardation, and her reasons for rejecting Dr. Velasquez's opinion regarding the limiting effects of Lightfoot's mental limitations, were not based on substantial evidence, and that the matter must be remanded for further consideration of these issues. Accordingly, the defendant's motion to affirm the Commissioner's decision is DENIED, and the plaintiff's motion to reverse is ALLOWED to the extent that it requests a remand to the Social Security Administration for further proceedings consistent with this decision. However, the plaintiff's request for a ruling that the matter be heard by a new ALJ upon remand is denied.
II. STATEMENT OF FACTS
Lightfoot was born on October 1, 1960, and was 51 years old at the time of his hearing before the ALJ. (Tr. 64, 166). He has an eleventh grade education, and has never completed any specialized job training, trade school or vocational school. (Tr. 201). In 1975, when he was 15 years old, Lightfoot was shot in the front of his head and underwent multiple procedures at Children's Hospital in Boston, including resection of the tip of his frontal lobe. (Tr. 204, 254, 583-84). Although he was able to recover from the shooting incident, Lightfoot claims that it caused him to suffer serious difficulties in school, and to leave school in the eleventh grade after failing all of his subjects. (Tr. 364-65, 583). He also claims that the incident adversely impacted his ability to engage in sports, and that he has never recovered the motivation, energy or strength that he had prior to the date of his injury. (Tr. 583).
The record shows that Lightfoot has not held any significant job since leaving high school. (Tr. 365, 583). Although the plaintiff did attempt to work in various capacities, including as a painter, construction worker and janitor, he claims that he was fired from every position that he ever held. (Id.). According to Lightfoot, he has managed to subsist on welfare benefits, food stamps, and assistance from his mother and common law wife, throughout his entire adult life. (See id.). He further contends that he has been completely disabled and incapable of working since March 2010, as a result of both his physical and mental impairments. (Tr. 62-63).
Lightfoot filed an application for SSI benefits on March 4, 2010, claiming that he had been unable to work since July 16, 2009. (Tr. 166-73). He subsequently amended the alleged onset date of his disability to his application date of March 4, 2010. (Tr. 183). The plaintiff's application was denied initially in July 2010. (Tr. 102, 104-06). It was denied again upon reconsideration in October 2010. (Tr. 103, 110-12).
Thereafter, Lightfoot requested and was granted a hearing before an ALJ, which was scheduled to take place on October 19, 2011 in Boston, Massachusetts. (Tr. 113-15, 131-36). Prior to the hearing, Lightfoot's student attorney from the WilmerHale Legal Services Center of Harvard Law School submitted a Hearing Memorandum on the plaintiff's behalf, arguing therein, as at the hearing and before this court, that Lightfoot was presumptively disabled under the Social Security regulations because he satisfied the criteria of Listing 12.02 of Appendix 1 for organic mental disorders, as well as the criteria of Listing 12.05 for mental retardation. (Tr. 157-62). Alternatively, counsel has consistently asserted that the combination of Lightfoot's residual functional capacity ("RFC"), age, limited education and lack of prior work experience, rendered him disabled and entitled to benefits because he was incapable of performing any type of substantial gainful activity. (See Tr. 162-64).
The hearing took place before the ALJ, Constance D. Carter, on the morning of October 19, 2011, as scheduled. (Tr. 58-92). During the hearing, Lightfoot testified regarding such matters as the nature of his impairments, his activities of daily living, and the severity and limiting effects of his symptoms. (Tr. 64-83). The ALJ also elicited testimony from a vocational expert ("VE"), who responded to hypothetical questions designed to determine whether jobs exist in the regional or national economies for an individual with the same age, educational background, past work experience, and RFC as the plaintiff. (Tr. 85-89).
On October 27, 2011, the ALJ issued a decision denying Lightfoot's application for benefits. (Tr. 39-52). The plaintiff then filed a request for review by the Social Security Appeals Council, and on April 25, 2013, the Appeals Council denied the request, thereby making the ALJ's decision the final decision of the Commissioner for purposes of review. (Tr. 1-3, 37). Accordingly, Lightfoot has exhausted his administrative remedies, and the case is ripe for review pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3).
The ALJ's Decision
The ALJ concluded that from March 4, 2010 through the date of her decision on October 27, 2011, Lightfoot had not been "under a disability, as defined in the Social Security Act, " which defines "disability" as "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment or combination of impairments 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 12 months." (Dec. 1 and Finding #10; Tr. 42, 52). See also 42 U.S.C. § 1382c(a)(3)(A). There is no dispute that the ALJ, in reaching her decision, applied the five-step sequential evaluation required by 20 C.F.R. § 416.920. The procedure resulted in the following analysis, which is detailed in the ALJ's "Findings of Fact and Conclusions of Law." (See Dec. 3-11; Tr. 44-52).
The first inquiry in the five-step process is whether the claimant is "engaged in substantial gainful work activity[.]" Seavey v. Barnhart , 276 F.3d 1, 5 (1st Cir. 2001). If so, the claimant is automatically considered not disabled and the application for benefits is denied. See id. In the instant case, the ALJ determined that Lightfoot had not engaged in substantial gainful work activity since March 4, 2010, the alleged onset date of his disability. (Dec. Finding #1; Tr. 44). Therefore, the ALJ proceeded to the next step in the sequential analysis.
The second inquiry is whether the claimant has a "severe impairment, " meaning an "impairment or combination of impairments which significantly limits [the claimant's] physical or mental ability to do basic work activities[.]" 20 C.F.R. § 416.920(c). If not, the claimant is considered not disabled and the application for benefits is denied. See Seavey , 276 F.3d at 5. Here, the ALJ concluded that Lightfoot suffered from several severe impairments, including osteoarthritis, asthma, mild mental retardation, and obesity. (Dec. Finding #2; Tr. 44). Accordingly, her analysis continued.
The third inquiry is whether the claimant has an impairment equivalent to any of the specifically listed impairments in Appendix 1 of the Social Security regulations, in which case the claimant would automatically be found disabled. See Seavey , 276 F.3d at 5; 20 C.F.R. § 416.920(d). At this step, the ALJ rejected Lightfoot's contention that he satisfied Listing 12.05 and/or Listing 12.02, ruling that there was "nothing in the medical evidence of record establishing that any of the claimant's impairments is of listing level severity." (Dec. 4; Tr. 45). Therefore, she concluded that Lightfoot's impairments, either alone or in combination, did not meet or medically equal any of the listed impairments. (Dec. Finding #3; Tr. 45). As detailed below, while this court concludes that the ALJ's findings with respect to Listing 12.02 are supported by the record, her rejection of an IQ test result for Lightfoot and her failure to assess whether Lightfoot showed deficits in adaptive functioning require that this matter be remanded for further consideration of whether he meets Listing 12.05.
Because the ALJ determined that Lightfoot's impairments did not meet or medically equal any of the listed impairments, her analysis continued. The fourth inquiry asks whether "the applicant's residual functional capacity' is such that he or she can still perform past relevant work[.]" Seavey , 276 F.3d at 5. In the instant case, the ALJ determined as follows with respect to Lightfoot's RFC:
After careful consideration of the entire record, I find that the claimant has the residual functional capacity to perform light work as defined in 20 CFR 416.967(b) except the claimant can push and/or pull occasionally with his upper or lower extremities, he can never climb ladders, ropes or scaffolds, he can occasionally climb ramps or stairs, balance, stoop, kneel, crouch or crawl, he needs to avoid concentrated exposure to extreme heat or cold, noise, irritants, such as fumes, odors, dust, gases or poorly ventilated areas, unprotected heights and hazardous machinery, he can occasionally grasp with his left hand and he can perform simple, routine tasks with occasional decision-making and occasional changes in the work setting.
(Dec. Finding #4; Tr. 46).
As detailed below, Lightfoot objects to the ALJ's decision to reject the opinion of his treating physician, Gustavo Velasquez, M.D., that Lightfoot's physical and mental impairments were more limiting, and her decision not to credit all of Lightfoot's testimony as to the extent of his symptoms. For the reasons explained below, this court concludes that the ALJ's assessment of Lightfoot's physical impairments are supported by the record. However, her assessment of his mental impairments must be reconsidered on remand.
After reviewing Lightfoot's testimony, the medical evidence of record, and the available opinion evidence, the ALJ concluded that her assessment of Lightfoot's RFC was "supported by the medical evidence of record as a whole." (See Dec. 10; Tr. 51). She then determined that Lightfoot had no past relevant work, so there was no need to consider, at step four, whether he retained the RFC to perform such work. (See Dec. Finding #5; Tr. 51). Consequently, the ALJ reached the fifth and last step in the sequential analysis.
The fifth inquiry is whether, given the claimant's RFC, education, work experience and age, the claimant is capable of performing other work. See Seavey , 276 F.3d at 5; 20 C.F.R. § 416.920(g). If so, the claimant is not disabled. 20 C.F.R. § 416.920(g). At step five, the Commissioner has the burden "of coming forward with evidence of specific jobs in the national economy that the applicant can still perform." Seavey , 276 F.3d at 5. In the instant case, the ALJ relied on the testimony of the VE to conclude that Lightfoot was capable of performing work that exists in significant numbers in the national economy. (Dec. 11; Tr. 52). Therefore, the ALJ found that Lightfoot was not disabled. (Id.).
Additional factual details relevant to this court's analysis are described below where appropriate.
A. Standard of Review
Lightfoot is seeking judicial review of the Commissioner's "final decision" pursuant to the Social Security Act § 205(g), 42 U.S.C. § 405(g) (the ...