245 F. Supp. 3d 290
D. Mass.2017Background
- James Swales filed for SSI in July 2012; application denied administratively and after hearing the ALJ found him not disabled in a July 25, 2014 decision; Appeals Council denied review and Swales appealed under 42 U.S.C. § 405(g).
- ALJ found severe impairments: back disorder, right knee disorder (post-ACL reconstruction), affective disorder, and anxiety disorder; no listing-level impairment.
- ALJ assessed an RFC for light work with restrictions: occasional lower-extremity push/pull, no ladder climbing, limited to occasional interaction with others, simple routine tasks, and environmental limitations.
- ALJ rejected treating physician Dr. Louis Maggio’s 2012 medical-source RFC (which limited lifting to <10 lbs and standing/walking <2 hours) as unsupported and inconsistent with the record, citing other objective evidence including orthopedist Dr. Ayers’s reports (one noting marathon training).
- Court concluded the ALJ erred by formulating a light-work RFC based on its own lay interpretation of technical medical findings (without an expert functional assessment) and remanded for further proceedings; because of the remand the court did not decide the separate mental-RFC challenge.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ALJ properly assessed physical RFC | Swales: ALJ ignored/took little weight from treating RFC (Dr. Maggio) and substituted lay judgment for a medical RFC | Commissioner: ALJ permissibly discounted Dr. Maggio as unsupported/inconsistent and relied on objective records | Court: ALJ erred—record’s technical medical findings required an expert RFC; remand for further development |
| Whether ALJ properly weighed treating physician opinion | Swales: Dr. Maggio’s RFC should have controlling or greater weight | Commissioner: Dr. Maggio’s opinion was not well-supported, contained qualifications, and conflicted with other evidence | Held: ALJ permissibly applied regulatory factors in discounting Maggio but still needed an expert RFC because the medical record was not lay-plain |
| Whether VE testimony at step five was reliable | Swales: VE’s testimony relied on an RFC unsupported by medical expert | Commissioner: VE relied on ALJ’s RFC which was supported by record | Held: VE testimony infirm because it was premised on an RFC the ALJ formulated via lay interpretation; remand required |
| Whether failure to attend consultative exams justified adverse inference | Swales: N/A (not primary argument due to remand) | Commissioner: Noncooperation with consultative exams can justify denying benefits | Held: Court noted nonattendance could support an adverse finding on remand but declined to decide now; ALJ may address on remand |
Key Cases Cited
- Seavey v. Barnhart, 276 F.3d 1 (1st Cir. 2001) (Step 5 burden on Commissioner to identify jobs claimant can perform)
- Richardson v. Perales, 402 U.S. 389 (Sup. Ct. 1971) (definition of substantial evidence)
- Consolidated Edison Co. v. NLRB, 305 U.S. 197 (Sup. Ct. 1938) (standard for substantial evidence)
- Manso-Pizarro v. Sec’y of Health & Human Servs., 76 F.3d 15 (1st Cir. 1996) (ALJ may not render medical judgments from raw clinical findings)
- Gordils v. Sec’y of Health & Human Servs., 921 F.2d 327 (1st Cir. 1990) (limits on ALJ’s common-sense RFC conclusions; caution re: light-work findings)
- Berrios-Lopez v. Sec’y of Health & Human Servs., 951 F.2d 427 (1st Cir. 1991) (ALJ not qualified to translate technical findings into RFC without medical opinion)
- Santiago v. Sec’y of Health & Human Servs., 944 F.2d 1 (1st Cir. 1991) (expert RFC generally required unless limitations are obvious to layperson)