582 F.Supp.3d 151
S.D.N.Y.2022Background
- Plaintiff Willetha Russ applied for DIB and SSI alleging chronic pain from a 2016 car accident (onset Jan 31, 2018); applications were denied and ALJ Best found her not disabled on Sept. 30, 2019.
- Medical record includes conservative treatments, shoulder surgery (Feb 2018), ongoing high pain ratings (often 8–10/10) and pain-management visits through Aug. 2019 documenting exacerbation with walking, sitting, standing.
- The ALJ relied principally on two non-treating medical opinions: Dr. Rosenberg (examining, Aug. 9, 2018) and Dr. Mohanty (record review, Aug. 21, 2018), and found Russ capable of a range of light and sedentary work with limitations.
- No treating physician provided a functional assessment covering Aug. 2018–Aug. 2019; the ALJ noted absence of a treating opinion and faulted plaintiff’s representative for not producing one.
- The ALJ treated the post-August‑2018 pain-management records as not changing the state‑agency reviewer’s findings, effectively adopting a medical conclusion without a medical source for that period.
- Magistrate Judge Lehrburger granted Russ’s motion, denied the Commissioner’s, and remanded because the ALJ failed to adequately develop the record by not obtaining a treating-source functional assessment for the post‑Aug‑2018 records.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| ALJ duty to develop the record / failure to obtain treating opinion | ALJ should have sought functional assessment from pain-management treating providers (Aug 2018–Aug 2019) because those records could affect RFC. | ALJ had sufficient longitudinal record and need not have obtained treating-source statement; plaintiff’s counsel could have provided one. | Court: Remand. ALJ failed to develop the record; no medical opinion addressed post‑Aug‑2018 records and ALJ impermissibly substituted his own medical judgment. |
| ALJ substituting his own medical judgment | ALJ impermissibly interpreted medical evidence for the period lacking medical opinion. | ALJ reasonably concluded the new records did not change state‑agency opinion. | Court: Held ALJ substituted lay judgment for expert opinion; that was legal error warranting remand. |
| RFC supported by substantial evidence | RFC not supported because it ignored treating‑source input and later pain records. | RFC is supported by examining and reviewing consultants and claimant’s activities. | Court: Did not decide on substance; remanded so ALJ can obtain treating opinion and then reassess RFC. |
| VE reliance on DOT vs O*NET | DOT listings relied on by VE are outdated; O*NET is more current and reliable. | Regulations permit reliance on DOT and other official sources; O*NET not required. | Court: Declined to mandate O*NET; noted DOT may be stale but upheld use of DOT under current regulations and did not remand on that ground. |
Key Cases Cited
- Sims v. Apfel, 530 U.S. 103 (ALJ has duty to develop the record; proceedings are inquisitorial)
- Pratts v. Chater, 94 F.3d 34 (ALJ must investigate facts and develop record even if claimant is represented)
- Balsamo v. Chater, 142 F.3d 75 (ALJ may not substitute his own medical judgment for competent medical opinion)
- Tankisi v. Commissioner of Social Security, [citation="521 F. App'x 29"] (absence of treating-source statement is not always fatal; depends on record sufficiency)
- Brault v. Social Security Admin., Commissioner, 683 F.3d 443 (standard of review—substantial evidence)
- Estrella v. Berryhill, 925 F.3d 90 (treating-physician rule and the need to provide good reasons for weight assignments)
- Kohler v. Astrue, 546 F.3d 260 (failure to apply correct legal standard is reversible error)
- Greek v. Colvin, 802 F.3d 370 (ALJ cannot use own expertise to fill gaps in medical evidence)