Bellinger v. Commissioner of Social Security

          RULING ON THE PLAINTIFF'S MOTION TO REVERSE AND THE DEFENDANT'S MOTION TO AFFIRM THE DECISION OF THE COMMISSIONER

          MICHAEL P. SHEA, U.S.D.J.

         In this appeal from the Social Security Commission's denial of benefits, plaintiff Rebecca L. Bellinger argues that the Administrative Law Judge (ALJ) erred because he (1) did not consider the weekly infusions required to treat Bellinger's anemia in assessing the severity of that condition or in evaluating her residual functional capacity (RFC); (2) did not consider the severity of Bellinger's neck pain; (3) failed to state his reasons for declining to give controlling weight to the medical source opinion of Bellinger's treating neurologist; (4) failed to apply the treating physician rule to the joint opinion of Bellinger's treating psychiatrist and therapist; and (5) failed to explain how he considered the records from a consultative examination with a psychologist. I agree with Ms. Bellinger's first, third, and fourth arguments and grant her motion to remand the case to the Commissioner. I express no opinion on her remaining arguments.

         I assume familiarity with the procedural history of the case, the ALJ's opinion, the record, and the five sequential steps used in the analysis of disability claims. I incorporate the relevant portions of Bellinger's medical history as necessary to my analysis of her argument in this appeal.^[1]

         STANDARD OF REVIEW

         “A district court reviewing a final . . . decision pursuant to ...42 U.S.C. § 405(g), is performing an appellate function.” Zambrana v. Califano, 651 F.2d 842, 844 (2d Cir. 1981). “The findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive.” 42 U.S.C. § 405(g). Accordingly, a district court may not make a de novo determination of whether a plaintiff is disabled in reviewing a denial of disability benefits. Wagner v. Sec'y of Health & Human Servs., 906 F.2d 856, 860 (2d Cir. 1990). Rather, the court's function is to ascertain whether the correct legal principles were applied in reaching the decision, and whether the decision is supported by substantial evidence. Johnson v. Bowen, 817 F.2d 983, 985 (2d Cir. 1987). If the Commissioner's decision is supported by substantial evidence, that decision will be sustained, even where there may also be substantial evidence to support the plaintiff's contrary position. Schauer v. Schweiker, 675 F.2d 55, 57 (2d Cir. 1982). The Second Circuit has defined substantial evidence as “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Williams v. Bowen, 859 F.2d 255, 258 (2d Cir. 1988) (citation and quotation marks omitted). Substantial evidence must be “more than a mere scintilla or a touch of proof here and there in the record.” Id.

         DISCUSSION

         I. The ALJ Failed to Consider Mr. Bellinger's Frequent Anemia Treatments in Formulating the RFC

         Ms. Bellinger argues that the ALJ erred by failing to consider the length and frequency of her treatments for anemia in in formulating the RFC. I agree.

         Ms. Bellinger developed anemia following gastric bypass surgery in 2008. (ECF No. 16-3 at 25; ECF No. 16-11 at 262.) In June 2014, she began weekly intravenous infusions lasting 2-3 hours for 10 weeks followed by a one-month break. (ECF No. 16-3 at 25; ECF No. 16-11 at 153-262.) The treatments took place at the New London Cancer Center. (ECF No. 16-11 at 196.) Ms. Bellinger reported feeling fatigued at several of her infusion appointments. (See ECF No. 22-1 at 5; ECF No. 16-11 at 153, 156, 159, 260.)

         At step two, the ALJ acknowledged Ms. Bellinger's anemia and treatments. (ECF No. 16-3 at 25.) He concluded that the anemia was “non-severe” because she “responded well to treatment with no side effects or evidence of end-stage organ disease . . . .” (Id.) The ALJ also noted that, although Ms. Bellinger was treated at a cancer center, there was “no evidence of cancer in the record.” (Id.)^[2] In formulating the RFC, the ALJ again noted Ms. Bellinger's testimony regarding her treatments but did not explain whether or how he incorporated that information into his conclusion. (ECF No. 16-3 at 28.)

         While the ALJ need not explicitly analyze every piece of evidence in the record, see Lowry v. Astrue, 474 Fed.Appx. 801, 805 (2d Cir. 2012), he “must include a narrative discussion describing how the evidence supports each conclusion.” Titles II & XVI: Assessing Residual Functional Capacity in Initial Claims, SSR 96-8P, 1996 WL 374184 at *7 (S.S.A. July 2, 1996). A discussion is sufficient when it allows a reviewing court to “glean the rationale” of the ALJ's decision. Lowry 474 Fed.Appx. at 805; Quinto v. Berryhill, No. 3:17-CV-00024 (JCH), 2017 WL 6017931, at *5 (D. Conn. Dec. 1, 2017).

         “The RFC assessment must be based on all of the evidence in the case record . . . including limitations or restrictions imposed by the mechanics of treatment (e.g., frequency of treatment, duration, disruption to routine, side effects of medication).” SSR 96-8P, 1996 WL 374184 at *5. “Absenteeism due to the frequency of treatment is a relevant factor so long as the treatment is medically necessary and concerns the conditions on which the disability claim is founded.” Griffin v. Comm'r of Soc. Sec., No. 2:15-CV-13715, 2017 WL 991006, at *2 (E.D. Mich. Mar. 15, 2017). “Where the ALJ has made no findings about the limitations caused by the claimant's need for treatment, courts have remanded because it is not the role of the court to speculate as to the ALJ's rationale.” Quinto, 2017 WL 6017931, at *5. In Quinto, for example, the court concluded that remand was necessary where the ALJ failed to consider testimony that the claimant required nebulizer treatments every four to five hours. Id. at *9. The court explained that the error was not harmless because the vocational expert had opined that using the nebulizer once or twice per day would preclude all employment. Id.

         In this case, Ms. Bellinger's testimony and her medical records establish that she received weekly IV infusions for anemia that lasted 2-3 hours. (ECF No. 16-3 at 64; ECF No. 16-11 at 153-262.) The ALJ acknowledged that Ms. Bellinger was concerned that she might lose her job due to absences from her condition (id. at 36, 37), and that absences due to appointments with specialists could affect her employment prospects (id. at 39) (“Despite her medical conditions and frequent appointments with specialists, the complainant is able to perform . . . .”) (emphasis added). Although the ALJ also acknowledged Ms. Bellinger's anemia and treatments (ECF No. 16-3 at 25), he concluded that Ms. Bellinger had

the residual functional capacity to perform sedentary work as defined in 20 CFR 404.1567(a) and 416.967(a) except she could perform simple, routine and repetitive tasks. In addition, she could occasionally bend, balance, twist, climb, crawl, kneel, and squat. Furthermore, she could have occasional ...