United States District Court, E.D. North Carolina, Eastern Division
TERRENCE W. BOYLE, District Judge.
This matter is before the Court on the parties' cross-motions for judgment on the pleadings. [DE 17 & 22]. A hearing on this matter was held in Raleigh, North Carolina on January 30, 2014 at 2:00 p.m. For the reasons discussed below, this matter is REMANDED for further consideration by the Commissioner.
On March 30, 2010, plaintiff filed applications for disability insurance benefits under Title II of the Social Security Act ("Act") and supplemental security income under Title XVI of the Act. Plaintiff[ alleged an onset date of October 5, 2005, due to a partially paralyzed left hand, high blood pressure, right hand problems from history of injury, diabetes, hip problems and tremors. Plaintiffs applications were denied initially and upon reconsideration. An Admisitrative Law Judge ("ALJ") held a hearing and issued a decision denying plaintiffs claim. On October 23, 2012, the Appeals Council denied review rendering the ALJ's decision the final decision of the Commissioner. Plaintiff now seeks judicial review of the Commissioner's final decision pursuant to 42 U.S.C. § 405(g).
The ALJ found that plaintiff suffers from the severe impairments of diabetes, history of multinodular goiter, chronic right hand weakness, and chronic right hip pain. [Tr. 14]. Plaintiff has received treatment at Sparrow hospital [Tr. 327-335], Onslow Memorial Hospital [Tr. 260-78, 307-17]., Community Care Clinic [Tr. 249-59, 279-97, 323-26], Office Park Eye Center [Tr. 318-22], and State Agency Professionals [Tr. 70-111, 300-06]. Plaintiff received relatively limited, routine, conservative treatment for her impairments. [Tr. 16, 249-97, 307-26].
In 2001, plaintiff was admitted for severe diabetic ketoacidosis, mild pancreatitis, hypertension, hyperlipidemia, and mild obesity. [Tr. 327-35]. In March 2009, plaintiffs diabetes appeared to be in good control, her hypertension was improving, and she continued to lose weight, diet, and exercise. [Tr. 286]. On May 5, 2010, Dr. Murfin conducted a consultative hand examination based upon plaintiffs complaints of partial paralysis of the left hand, right hand problems due to a cut, hip problems, high blood pressure, diabetes and body tremors. [Tr. 301-06]. Plaintiff reported that her diabetes and hypertension were controlled with medication. [Tr. 302]. Dr. Murfin noted that plaintiff could not make a right fist due to weakness of the fourth and fifth finders and her grip strength was 4/5 bilaterally. [Tr. 304]. The small joints of the hand and wrist were all normal, she could raise both arms overhead, and she could rise from a chair without assistance. [Id]. Based upon the exam, Dr. Murfin opined that her ability to stand and move about was significantly impaired and that she was able to hear, speak, and travel. [Tr. 299, 305].
In October, 2010, Dr. Cox completed RFC assessments based upon a review of the evidence and opined that plaintiff could perform a full range of light work (occasionally lift 20 pounds, frequently lift 10 pounds, sit, stand, or walk for 6/8 hours in an 8 hour workday, with unlimited push/pull, with additional limitations to handling and fingering and avoiding concentrated exposure to hazards). [Tr. 106-08].
When a social security claimant appeals a final decision of the Commissioner, the district court's review is limited to the determination of whether, based on the entire administrative record, there is substantial evidence to support the Commissioner's findings. 42 U.S.C. § 405(g); Richardson v. Perales, 402 U.S. 389, 401 (1971). Substantial evidence is defined as "evidence which a reasoning mind would accept as sufficient to support a particular conclusion." Shively v. Heckler, 739 F.2d 987, 989 (4th Cir. 1984)(quoting Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir. 1966)). If the Commissioner's decision is supported by such evidence, it must be affirmed. Smith v. Chafer, 99 F.3d 635, 638 (4th Cir. 1996).
In making a disability determination, the ALJ engages in a five-step evaluation process. 20 C.F.R. § 404.1520; see Johnson v. Barnhart, 434 F.3d 650 (4th Cir. 2005). The analysis requires the ALJ to consider the following enumerated factors sequentially. At step one, if the claimant is currently engaged in substantial gainful activity, the claim is denied. At step two, the claim is denied if the claimant does not have a severe impairment or combination of impairments significantly limiting him or her from performing basic work activities. At step three, the claimant's impairment is compared to those in the Listing of Impairments. See 20 C.F.R. Part 404, Subpart P, App. 1. If the impairment is listed in the Listing of Impairments or if it is equivalent to a listed impairment, disability is conclusively presumed. However, if the claimant's impairment does not meet or equal a listed impairment then, at step four, the claimant's residual functional capacity ("RFC") is assessed to determine whether plaintiff can perform his past work despite his impairments. If the claimant cannot perform past relevant work, the analysis moves on to step five: establishing whether the claimant, based on his age, work experience, and RFC can perform other substantial gainful work. The burden of proof is on the claimant for the first four steps of this inquiry, but shifts to the Commissioner at the fifth step. Pass v. Chater, 65 F.3d 1200, 1203 (4th Cir. 1995).
Here, the ALJ erred at step four of the sequential evaluation. The ALJ's finding that plaintiff could return to her past relevant work is not supported by substantial evidence in the record. Indeed, the substantial evidence in the record establishes that plaintiff cannot return to her past relevant work.
The ALJ found plaintiff had an RFC of light and further limited her to a limited range of light work which included frequent bilateral fingering, handling, and grasping. [Tr. 15]. Under the ALJ's RFC, Ms. Faulk would be expected to use her hands for fine manipulation for about two-thirds, or just under 6 hours, of an eight hour workday. The ALJ based his decision in part on a faulty credibility determination. Although required to specify the reasons for the finding on credibility based on the evidence in the case record, the ALJ failed to list any valid reason for discounting the testimony of plaintiff. The ALJ simply stated that plaintiff's testimony was not credible because of her routine and conservative treatment and because her testimony revealed that her conditions were not disabling. [Tr. 16]. Plaintiff's treatment was limited because she did not have sufficient financial resources to pursue more extensive treatment options. This is a justifiable reason for lack of treatment. SSR 96-7p. Plaintiff's testimony was consistent with limiting her use of hands to occasional. Therefore the ALJ's credibility determination was flawed. Giving plaintiff's testimony the proper weight, it is clear to this Court that the ALJ's finding at step four that plaintiff could use her hands frequently and therefore could perform her past relevant work is not supported by substantial evidence.
Ms. Faulk has been diagnosed with Carpal Tunnel Syndrome, [Tr. 323. 325], and testified that she was unable to type and perform her job as she once had and was fired as a result. [Tr. 31]. Dr. Murfin noted plaintiffs decreased grip strength [Tr. 304]. He also noted her tremors and determined that her thyrotoxicosis, [Tr. 316-17], was probably causing her weakness and possibly causing her tremors, and was likely present and symptomatic for about four or five years prior to his 2010 evaluation. [Tr. 305]. As a result of the tremors and Carpal Tunnel Syndrome the evidence in the record shows that it would have been ...