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Vega v. Colvin

United States District Court, D. Massachusetts

March 2, 2016

RUBY VEGA, Plaintiff,
CAROLYN W. COLVIN, Acting Commissioner, Social Security Administration, Defendant.




This is an action under section 205(g) of the Social Security Act, 42 U.S.C. § 405(g). Compl. ¶ 1, ECF No. 1. The Plaintiff Ruby Vega seeks review of the denial of her applications for social security disability insurance benefits (“SSD”) and supplemental security income payments (“SSI”) (together, “benefits”) by the Acting Commissioner of the Social Security Administration (“Commissioner”). Id. ¶¶ 1, 12. Vega argues that the decision of the Administrative Law Judge (the “hearing officer”)[1] denying her benefits is not supported by substantial evidence and is contrary to law. Id. ¶ 13. She requests that this Court reverse the Commissioner’s decision and grant her the benefits for which she applied. Id. ¶¶ 13-14. The Commissioner argues that the hearing officer’s factual findings are supported by substantial evidence and are conclusive, Def.’s Answer 3, ECF No. 7, and accordingly requests that this Court enter judgment affirming the Commissioner’s decision, Def.’s Mot. Order Affirming Decision Comm’r, ECF No. 13.

Although this Court owes appropriate deference to the hearing officer’s decision, in this case it suffers from a fundamental flaw that calls for vacatur. Instead of supporting his determinations regarding the weight accorded to Vega’s treating physicians’ testimony, Vega’s credibility, and her residual functional capacity with reference to expert opinion, the hearing officer here improperly took it upon himself to interpret the underlying medical evidence itself. This flaw underlies each of the three errors that Vega identifies. Because the hearing officer was not empowered to draw conclusions about Vega’s functional capabilities on the basis of his independent analysis of her examination results and clinical findings contained in her medical records, the Court holds that his decision is not supported by substantial evidence.

A. Procedural Background

Vega applied for both SSD and SSI benefits on January 10, 2012. SSA Admin. R. Soc. Sec. Procs. (“Admin. R.”) 213, 215, ECF No. 8.[2] On February 28, 2012, the Social Security Administration (“Administration”) denied her application. Id. at 131. Vega filed a request for reconsideration on April 12, 2012, id. at 144, and the Administration again determined that Vega was not entitled to benefits, id. at 147.

Vega requested a hearing and appeared before a hearing officer on August 7, 2013. Id. at 33. On September 20, 2013, the hearing officer issued a decision finding that Vega was not disabled for the purpose of sections 216(i), 223(d), and 1614(a)(3)(A) of the Social Security Act and accordingly denied her application for benefits. Id. at 12-26. Vega filed a request for review of the hearing officer’s decision, id. at 10, which the Commissioner denied on August 29, 2014, id. at 1.

On October 20, 2014, Vega filed a complaint in this Court seeking review of the Commissioner’s decision pursuant to Section 205(g) of the Social Security Act, 42 U.S.C. § 405(g). Compl. ¶ 1. The Commissioner filed an answer, Def.’s Answer, along with a certified copy of the transcript of the administrative record, Admin. R., on December 22, 2014. Thereafter, on February 2, 2015, Vega filed a motion for judgment on the pleadings, Pl.’s Mot. J. Pleadings, ECF No. 9, and a supporting memorandum, Mem. Supp. Mot. J. Pleadings, ECF No. 10 (“Pl.’s Mem.”). On April 16, 2015, the Commissioner moved for an order affirming its decision, Def.’s Mot. Order Affirming Decision Comm’r, ECF No. 13, and filed a supporting memorandum, Mem. Supp. Mot. Order Affirming Decision Comm’r (“Def.’s Mem.”), ECF No. 14.

B. Factual Background

Vega was born on September 19, 1969. Admin. R. 213. At various times in the past she was employed as a billing clerk, admission clerk, insurance clerk, and customer service representative. Id. at 68-69, 242, 252. Vega has not worked since April 2009, when she was laid off. Id. at 241.

Vega claims her conditions became disabling in July 2011. Id. She points to a number of purportedly debilitating conditions. First, Vega suffers from a cervical disc disease that causes her severe pain originating in her neck and back and extending throughout her body. Id. at 249-51, 270-72, 492. Second, she has been diagnosed with fibromyalgia, which causes her to experience chronic neck and back pain as well as stiffness and weakness in her joints. Id. at 771-74. Third, Vega suffers from anxiety and has panic attacks as a result of her severe pain. Id. at 430-31.

Vega saw several specialists, underwent a battery of clinical tests, and pursued various courses of treatment in an effort to resolve her medical conditions or at least manage her symptoms. Her primary treating physicians were neurosurgeon Dr. James Tiesi, who addressed Vega’s cervical spondylosis, and rheumatologist Dr. Ginge DeSilva, who treated her fibromyalgia. Vega also saw a nurse practitioner, who diagnosed her with anxiety. Id. at 430. Per her doctors’ recommendations, Vega underwent physical therapy and was administered tender point injections for her pain. Id. at 330, 344-66, 370-73. Vega also saw a chiropractor, id. at 643-56, and took a number of medications to help manage both her pain and her resultant anxiety, see id. at 499, 505-06, 511, 515-16, 520-21.

The record contains myriad examination results and clinical observations. Certain reports indicate “mild” or “normal” findings and improvements in Vega’s condition, see, e.g., id. at 615-16, 710-12, 852-53, while others list significant abnormalities and chronicle the worsening of her symptoms, see, e.g., id. at 331-32, 336-37, 463, 873.[3] The record also contains medical opinions from Vega’s treating sources as to the functional implications of her impairments, which the Court discusses in detail given their significance in this case.

1. Dr. Tiesi

Neurosurgeon Dr. Tiesi completed a “Spinal Impairment Questionnaire” on July 24, 2012. Admin. R. 492-98. In it, Dr. Tiesi diagnosed Vega with both cervical spondylosis and probable rheumatologic disease. Id. at 492. He noted her prognosis was “fair/good” and claimed that his “clinical findings” supported his diagnoses, specifically noting Vega’s cervical tenderness and limited range of motion. Id. He went on to state that Vega reported daily muscular and soft tissue pain in her neck, shoulders, and extremities, id. at 494, that medications had not worked to completely eliminate her pain, id. at 495, and that Vega’s impairments are “ongoing” such that they are likely to persist for at least one year, id. at 496. Dr. Tiesi indicated that Vega’s symptoms and limitations were not “reasonably consistent” with the impairments detailed in the questionnaire, noting that she had “more symptoms than expected from MRI findings[.]” Id. at 494.

As for specific functional limitations, Dr. Tiesi found that Vega could sit for 8 hours in a day, though not continuously. Id. at 495. He indicated that she could stand or walk for 4 hours per day. Id. Dr. Tiesi reported that Vega could lift or carry 0-5 pounds frequently, and 5-50 pounds occasionally. Id. at 495-96. He stated that Vega’s condition would interfere with her ability to maintain her neck in a single position, but that she could perform a job that required this so long as she had “appropriate breaks[.]” Id. at 497. Finally, he opined that Vega’s conditions would likely cause her to have “‘good days’ and ‘bad days[, ]’” and to miss work more than three times per month. Id.

Per his letter accompanying this questionnaire, Dr. Tiesi’s evaluation was based exclusively on Vega’s cervical spondylosis diagnosis, even though it appeared she suffered from additional impairments. See id. at 491. He noted that while physical therapy and pain management injections at first seemed to improve her condition, she subsequently reported worsening conditions, at which point “[h]er symptoms . . . were out of line with her diagnosis of cervical spondylosis and more consistent with a rheumatologic disease.” Id. Dr. Tiesi concluded:

From a neurosurgical standpoint [Vega] has cervical spondylosis which may limit her activities at times due to symptoms of neck pain and decreased range of motion. Her other symptoms however I will have to defer to rheumatology as far as prognosis and limitations. From a neurosurgical viewpoint I see no reason the patient cannot ...

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