Rial v. Commissioner of Social Security
1:17-cv-01128
W.D.N.Y.Jul 23, 2019Background
- Claimant William R. Rial filed for disability insurance benefits and SSI alleging onset December 1, 2009; applications were denied and an ALJ (LeCours) issued an unfavorable decision on May 5, 2016; Appeals Council denied review, making the ALJ decision final. The claimant died in 2018 and the administrator substituted as plaintiff.
- ALJ found severe impairments: lumbar degenerative disc disease, COPD, and obesity, and assessed an RFC for medium work with occasional stooping/kneeling/crouching/crawling and avoidance of concentrated pulmonary irritants.
- No treating or examining physician rendered a specific opinion quantifying COPD-related work limitations in the record before the ALJ. Consultative examiner Dr. Liu did not address respiratory limitations.
- Treating pulmonologist Dr. Norman Fiorica submitted a September 6, 2016 report (after the ALJ decision) describing severe airflow obstruction and opining the claimant could not lift more than 10 pounds; the Appeals Council refused to consider it as not relating to the period at issue.
- The district court found the ALJ’s respiratory limitation (avoidance of "concentrated" irritants) was not grounded in a medical opinion and was effectively a lay RFC determination; it also held the Appeals Council erred in refusing to consider Dr. Fiorica’s report and remanded for further proceedings including obtaining treating opinions and considering Dr. Fiorica’s report.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ALJ erred by relying on his own lay interpretation to limit respiratory exposure rather than a medical opinion | ALJ substituted lay judgment for medical opinion; RFC restriction to "avoid concentrated" irritants lacks medical support | ALJ’s limitation suffices to account for COPD; substantial evidence supports RFC | Court: ALJ improperly made speculative RFC regarding respiratory limits without physician opinion; remand to develop record |
| Whether Appeals Council erred in rejecting Dr. Fiorica’s September 6, 2016 report as not relating to the period at issue | Fiorica’s report is based on prior tests (2010, 2016), bears on claimant’s condition during the relevant period, and contradicts ALJ’s RFC (10-lb vs medium work) | Appeals Council: report does not relate to the period at issue | Court: Appeals Council erred; report is new, material, relates to the relevant period and must be considered; remand required |
Key Cases Cited
- Bowen v. City of New York, 476 U.S. 467 (ALJ five-step sequential evaluation framework)
- Kohler v. Astrue, 546 F.3d 260 (special technique for mental impairments applies in addition to five-step analysis)
- Machadio v. Apfel, 276 F.3d 103 (Commissioner’s disability determination must be supported by substantial evidence and correct legal standards)
- Lisa v. Secretary of Dept. of Health and Human Servs., 940 F.2d 40 (evidence post-dating ALJ decision may be relevant to show severity/continuity of impairments and relate to earlier period)