OPINION OF THE COURT
Evelyn Plummer asserts error in the denial of her application for social security disability insurance benefits under Title II of the Social Security Act, 42 U.S.C. §§ 401-433. The District Court granted summary judgment to the Commissioner of Social Security (“Commissioner”), affirming the Commissioner’s final decision denying the appellant’s claim. The District Court exercised jurisdiction under 42 U.S.C. § 405(g), and this Court has jurisdiction to hear Plummer’s appeal pursuant to 28 U.S.C. § 1291. For the reasons set forth below, we will remand to the Commissioner for further findings.
I.' Background
Plummer is a high school graduate with an Associate’s degree in business, with past work experience as a word processor and as a file clerk. She was twenty-six years old at the time of filing. On January 13, 1993, Plummer, unrepresented by counsel, filed an application for social security disability benefits, contending she suffered from bilateral carpal tunnel syndrome, deQuervain’s tenosynovitis, as well as other symptoms.
A. Medical History
It is not necessary to review all of the evidence in the record pertaining to Plum-mer’s medical impairments, as the Magistrate Judge’s report and the ALJ’s decision both summarize the pertinent medical history, which focuses on diagnoses of carpal tunnel syndrome and tendinitis.
1
See,
The first mention of potential psychiatric problems in the record is an evaluation on November 26, 1991 by a psychotherapist at the Counseling Program of the Pennsylvania Hospital. The report states, “[she] experiences heart palpitations, sweating, hand tremors, shakiness, has depressive bouts in which she feels lonely and removed.” Administrative Record (“Admin.R.”) at 128. The doctor diagnosed her with generalized anxiety disorder. Id. On December 18, 1991, she was diagnosed with depression, anxiety, and panic attacks by Philadelphia Health Services. Id. at 132. Plummer’s treatment records from Philadelphia Health Services on March 19, 1992, reveal a diagnosis of anxiety/panic disorder. Id. at 152. There is a medical note in her file from May 11, 1992, which states Plummer “has a psychiatric anxiety disorder.” Id. at 146. The file also notes the patient “refuses to see a therapist.” Id.
The next reference in the record to the claimant’s mental health is a July 13, 1994 Arthritis Center Progress Note. The note states Plummer is “depressed over employment situation.” Admin. R. at 206. She was prescribed Pamelor, an anti-depressant medication. Dr. Brent, her treating physician, also prescribed the anti-depressant Nortriptyline. Id. at 251. There is one final reference to the claimant’s mental state in the record. Upon filing for reconsideration of her denied claim for benefits, the claimant filed a mandated Reconsideration Disability Report, noting, “mentally, I am depressed and I don’t know what the future holds for me. I am taking an anti-depressant.” Id. at 71.
B. Procedural Background
Plummer’s initial application for disability benefits was denied on March 1, 1993. The hearing officer concluded Plummer was being treated for carpal tunnel syndrome, but that she had only mild limitation in motion which would not prevent her from working.
The unrepresented claimant requested reconsideration on April 9, 1993. 2 She filed the mandated Reconsideration Disability Report with her appeal. On this form, she stated her physical condition had deteriorated and she was suffering from depression. Admin. R. at 71. The Commissioner denied her reconsideration appeal on June 1, 1993, concluding that the claimant retained good strength and dexterity in her hands leaving her able to perform most normal activities. The Commissioner did not evaluate the claimant’s alleged mental impairments in determining that Plummer could return to employment. Id. at 50.
Plummer then filed a request for a hearing before an administrative law judge (“ALJ”) on June 10, 1993. A hearing took place on December 6, 1994, nearly eighteen months after the request was filed. According to the claimant’s counsel, immediately before the hearing, the ALJ informed him she would not evaluate the claimant’s psychiatric problems at the hearing. Further, the ALJ indicated to counsel that if he raised Plummer’s alleged depression and anxiety, she would remand the case for a new reconsideration determination because it had not been previously evaluated. Given the already lengthy delay, and the financial difficulties associ
[B]efore we went on the record we discussed there are some allegations and some references in a few of the doctors [sic] reports that there’s an anxiety problem here and I gave you the opportunity to have that evaluated and you declined, is that correct?
ATTY: Yes, I discussed it with my client, your honor, and she wanted to proceed. She said she couldn’t afford the delay.
Id. at 280. On April 29, 1995, the ALJ denied Plummer’s application for disability benefits. She concluded the claimant suffered from a “severe” impairment which precluded her from returning to her past relevant work, but that she retained the residual functional capacity to perform modified light work, and could perform jobs which existed in significant numbers in the local and national economy. The ALJ also made a specific finding that Plummer did not suffer from a “severe” mental impairment which affects her ability to perform work-related activities, even though (as noted above) she did not allow the claimant to present any evidence as to her mental state.
The Appeals Council of the Social Security Administration declined further review on May 7, 1996, making the ALJ’s determination an appealable final decision. On December 4, 1996, Plummer filed an action pursuant to 42 U.S.C. § 405(g) in the United States District Court for the Eastern District of Pennsylvania seeking judicial review of her denial of disability benefits under Title II of the Social Security Act. The District Court referred the case to a Magistrate Judge to determine if the Commissioner’s decision was supported by substantial evidence. Upon consideration of the parties’ cross-motions for summary judgment, the Magistrate Judge recommended the Commissioner’s motion for summary judgment be granted. The District Court adopted the Magistrate Judge’s report, and granted summary judgment for the Commissioner on July 22, 1998. Plummer now appeals the District Court’s decision.
II. Discussion
On appeal, Plummer contends the ALJ erred in discounting the treating rheuma-tologist’s diagnosis of her condition, and in relying on an incomplete hypothetical in her examination of the vocational .expert. Plummer also argues the ALJ treated the evidence of her mental impairments improperly.
Congress provides for judicial review of the Commissioner’s decisions to deny a claimant’s application for disability benefits. 42 U.S.C. § 405(g). The role of this Court is identical to that of the District Court, namely to determine whether there is substantial evidence to support the Commissioner’s decision.
Adorno v. Shalala,
The Social Security Administration has promulgated regulations incorporating a sequential evaluation process for determining whether a claimant is under a disability. 20 C.F.R. § 404.1520;
Williams v. Sullivan,
In step three, the Commissioner compares the medical evidence of the claimant’s impairment to a list of impairments presumed severe enough to preclude any gainful work. 20 C.F.R. § 404.1520(d). If a claimant does not suffer from a listed impairment or its equivalent, the analysis proceeds to steps four and five. Step four requires the ALJ to consider whether the claimant retains the residual functional capacity to perform her past relevant work. 20 C.F.R. § 404.1520(d). The claimant bears the burden of demonstrating an inability to return to her past relevant work.
Adorno v. Shalala,
If the claimant is unable to resume her former occupation, the evaluation moves to the final step. At this stage, the burden of production shifts to the Commissioner, who must demonstrate the claimant is capable of performing other available work in order to deny a claim of disability. 20 C.F.R. § 404.1520(f). The ALJ must show there are other jobs existing in significant numbers in the national economy which the claimant can perform, consistent with her medical impairments, age, education, past work experience, and residual functional capacity. The ALJ must analyze the cumulative effect of all the claimant’s impairments in determining whether she is capable of performing work and is not disabled. See 20 C.F.R. § 404.1523. The ALJ will often seek the assistance of a vocational expert at this fifth step.
See, Podedworny v. Harris,
The Commissioner has supplemented this sequential process for evaluating a claimant’s eligibility for benefits with additional regulations dealing specifically with mental impairments. 20 C.F.R. § 404.1520a. These procedures require the hearing officer (and ALJ) to record the pertinent signs, symptoms, findings, functional limitations and effects of treatment contained in the case record, in order to determine if a mental impairment exists. 20 C.F.R. § 404.1520a(b)(l). If an impairment is found, the examiner must analyze whether certain medical findings relevant to a claimant’s ability to work are present or absent. § 404.1520a(b)(2). The examiner must then rate the degree of functional loss resulting from the impairment in certain areas deemed essential for work.
3
If the mental impairment is considered “severe”, the examiner must then determine if it meets a listed mental disorder. § 404.1520a(c)(2). If the impairment is severe, but does not reach the level of a listed disorder, then the examiner must
In this case, the ALJ concluded Plum-mer is not entitled to disability benefits, finding that: (1) Plummer has not performed any substantial gainful activity since the alleged onset date of disability; (2) Plummer’s wrist impairments impose significant restrictions on work-related activities, and are considered “severe” impairments; (3) Plummer does not suffer from any impairments which would meet the severity criteria listed in the relevant regulation; (4) Plummer cannot perform her past work as a clerk/typist because it involves extensive bilateral finger and hand manipulation; and (5) Plummer nonetheless has the capacity to perform a number of jobs which exist in significant numbers in the national economy. The ALJ sought the assistance of a vocational expert in making this determination. In addition, the ALJ specifically found that the claimant’s mental health problem was not “severe” and imposed no significant restrictions on her ability to perform work-related activities. She attached a PRT form explaining her finding.
A. ALJ’s Treatment of the Medical Evidence
Plummer contends the ALJ’s decision is not supported by substantial evidence and must be overturned, because the ALJ improperly substituted her own judgment in place of the medical evidence, particularly of her treating physician, Dr. Brent. Further, she argues the ALJ then erred in relying on the opinion of a vocational expert that there are jobs available which Plummer can perform, when the hypothetical used did not incorporate the entirety of the claimant’s impairments.
Because the claimant established she is unable to return to her past employment, the ALJ had the burden to show there is other employment the claimant is capable of performing.
Ferguson v. Schweiker,
Treating physicians’ reports should be accorded great weight, especially “when their opinions reflect expert judgment based on a continuing observation of the patient’s condition over a prolonged period of time.”
Rocco v. Heckler,
Plummer argues the ALJ improperly rejected the medical opinion of her treating physician Dr. Brent, as expressed in his answers to interrogatories. Dr. Brent agreed with a statement made by Plum-mer that she could go days at a time when she has great difficulty performing even
The ALJ, in reviewing all of the medical evidence in the record, as well as the testimony at the hearing, concluded Plum-mer was capable of performing certain positions classified as “light work.” She discounted Dr. Brent’s interrogatory answers because they were inconsistent with the medical evidence. The ALJ states in her opinion:
The medical evidence shows that the claimant has only had conservative treatment for her carpal tunnel syndrome/tendinitis. Her physicians have advised her to wear wrist splints and have prescribed pain medications. The claimant’s treating physicians have precluded her from performing the type of clerical work she had been performing in the past, which ostensibly caused her impairment, but no physician has ever imposed any functional limitations which would preclude her from performing all types of work. I specifically note that I accorded Dr. Brent’s interrogatory responses limited probative weight because these responses were based primarily on the claimant’s subjective complaints and included no narrative support for the predominately one-word answers presented. In his narrative reports, the only limitations Dr. Brent specified were associated with work such as typing and filing. Dr. Brent and all of the other physicians the claimant consulted only reported that the claimant cannot perform job duties requiring repetitive fine finger manipulation and/or handling.
Admin. R. at 28-29.
In fact, only one month before the answers to the initial interrogatories, Dr. Brent noted Plummer’s hands and wrists had somewhat improved.
Id.
at 205. Dr. Brent did not mention the existence of complete “flare-ups” where the claimant is unable to use her hands at all. The ALJ was entitled to place greater reliance on the doctor’s full medical opinion than his cursory answers to the interrogatories.
See, Williams v. Sullivan,
In addition, the ALJ reviewed several other treating physician’s reports in reaching her decision. None of the doctors who evaluated the claimant found her unable to perform any work which required occasional use of her hands — rather, they reported the claimant cannot perform jobs which require repetitive fine finger manipulation and handling. For instance, Dr. Schneider, who examined Plummer for her
The ALJ then employed a vocational expert in considering whether jobs existed which the claimant could perform given her “severe” impairments. Plummer argues the ALJ’s reliance on the vocational expert was misplaced because the hypothetical asked did not include the medical evidence that the claimant cannot perform any jobs in which she must be able to use her hands on demand. Because the ALJ did not err in rejecting this argument as inconsistent with the objective medical evidence in the record as a whole, we conclude the hypothetical used was appropriate.
The ALJ solicited testimony from the vocational expert as to whether a person of Plummer’s age, education, past work experience, who was capable of performing light work that did not require bilateral dexterity or extensive handling of objects, could perform work available in significant numbers in the national economy. In eliciting the testimony, the ALJ requested the vocational expert to assume a hypothetical individual who was capable of light work which involved standing, walking and/or the use of foot controls but could not perform work which required fine manual dexterity or extensive handling of objects with prolonged or repetitive use of the hands.
This hypothetical encompasses all the limitations which the ALJ found were suffered by the claimant. The vocational expert’s testimony was in response to a hypothetical that fairly set forth every credible limitation established by the physical evidence. As such, it can be relied upon as substantial evidence supporting the ALJ’s conclusion that Plummer is not totally disabled.
See Chrupcala v. Heckler,
The claimant argues she cannot perform the jobs which the vocational expert identified because there are periods during which she has “flare-ups” and cannot use her hands at all. The jobs listed all require intermittent or occasional use of the upper extremities on demand. As discussed
supra,
the ALJ’s conclusion that the claimant can perform certain light level work is supported by substantial evidence in the record.
5
There is no indication in the medical record, except for the terse interrogatory responses by Dr. Brent, that Plummer experiences extended periods of time where she cannot use her hands or
B. ALJ’s Treatment of the Claimant’s Mental Impairments
The most troublesome aspect of this case is the ALJ’s treatment of the evidence relating to Plummer’s mental impairments. As noted supra, there is substantial evidence in the record that the claimant suffers from both depression and anxiety. In addition, Plummer directly raised a psychiatric issue below in her comments on the Reconsideration Disability Report, which was not considered by the hearing officer on reconsideration. Admin. R. at 50.
Prior to the hearing, the ALJ offered Plummer’s counsel an onerous choice: remand the case for a “new” reconsideration decision incorporating the psychiatric issues or proceed with no testimony concerning the claimant’s mental health. This choice was particularly troublesome because it took eighteen months from the time of her appeal for Plummer to receive a hearing before an ALJ. 7 Faced with the daunting prospect of another lengthy delay, Plummer chose to proceed without raising any psychiatric claims. As a consequence, there was no testimony during the hearing concerning Plummer’s mental impairments, nor did the ALJ order a psychological examination. Nonetheless, in her written decision, the ALJ made explicit conclusions, and worse, a finding, regarding Plummer’s mental health. The ALJ wrote:
With regard to her mental health status, there is no evidence of record that the claimant has any thought disorder or significant deficit of memory or concentration or that she has any difficulties in routine interactions with other people. There is no evidence that she has ever been treated ... on a regular basis by a psychologist or psychiatrist. Therefore, I specifically find that the claimant’s mental health problem is ‘not severe’ and imposes no significant restrictions on her ability to perform work-related activities.
In addition, the ALJ attached a PRT form in which she concluded the claimant suffered from mild affective and anxiety related disorders, which only caused slight restrictions on her daily activities, and thus had no effect on her residual functional capacity.
The ALJ’s decision, the claimant argues, unfairly prejudiced her claim because the judge made explicit findings without giving the claimant an opportunity to fully testify, develop, and explore her mental impairments. We agree. We conclude the ALJ did not give proper consideration to the claimant’s alleged mental impairments as is required by law. The ALJ cannot ignore evidence of a mental impairment in the record, nor can she effectively force a claimant to waive her rights to have the evidence considered in her disability determination.
When there is evidence of a mental impairment that allegedly prevents a claimant from working, the Commissioner must follow the procedure for evaluating mental impairments set forth in 20 C.F.R. § 404.1520a.
Andrade v. Secretary of Health & Human Services,
The statute concerning the evaluation of mental impairments provides, “an initial determination under subsection (a), (c), (g) or (i) of this section that an individual is not under a disability, in any case where there is evidence which indicates the existence of a mental impairment, shall be made only if the Commissioner of Social Security has made every reasonable effort to ensure that a qualified psychiatrist or psychologist has completed the medical portion of the case review and any applicable residual functional capacity assessment.” 42 U.S.C. § 421(h). Thus, “when the record contains evidence of a mental impairment, the Secretary [now Commissioner] cannot determine that the claimant is not under a disability without first making every reasonable effort to ensure that a qualified psychiatrist ... has completed the medical portion of the case review and any applicable residual functional capacity assessment.”
Andrade v. Secretary of Health & Human Services,
Because 42 U.S.C. § 421(d), which covers hearings before an ALJ, is excluded from § 421(h)’s purview, an ALJ is not required to employ the assistance of a qualified psychiatrist or psychologist in making an initial determination of mental impairment. Instead, the Commissioner’s regulations provide an ALJ with greater flexibility than other hearing officers. At the initial and reconsideration levels, 'a PRT form — outlining the steps of the § 404.1520a procedure — must be completed and signed by a medical consultant. 20 C.F.R. § 404.1520a(d)(l). However, the ALJ has several options available: she can complete and sign the document without the assistance of a medical adviser; she can call a medical adviser for assistance in completing the document; or, if new evidence is received or the issue of mental impairments arises for the first time, she can remand the case for completion of the document and a new determination. 20 C.F.R. § 404.1520a(d)(l)(i-iii). In summary, the regulations allow the ALJ to remand for further review, to proceed with a determination without the assistance of a medical adviser, or to call a medical adviser for assistance with the case. In all cases, however, the ALJ has a duty to consider all evidence of impairments in the record.
Clearly, the ALJ did not fulfill her duty to explore the claimant’s alleged mental impairment.
8
The ALJ, as contemplated by the regulations, completed the mental impairment review, including the residual functional capacity assessment, by.herself without the assistance of a medical consultant. § 404.1520a(d)(l)(i). The regulations explicitly require, however, that “the evidence must be carefully reviewed and conclusions supported by it.” § 404.1520a(b). There is no indication the ALJ did so, and her determination of the claimant’s mental impairments is not supported by substantial evidence in the record. In addition, the ALJ did not solicit Plummer’s testimony at the hearing as to how her anxiety
The record contains numerous references to the claimant’s depression and anxiety. To review, the evidence in this instance includes several diagnoses of depression and generalized anxiety disorder. On November 26, 1991, she was diagnosed with generalized anxiety disorder. It was reported that she “experiences heart palpitations, sweating, hand tremors, shakiness, has depressive bouts in which she feels lonely and removed.” On December 18, 1991, she was diagnosed with depression, anxiety and panic attacks. On March 19, 1992, she was diagnosed with anxiety/panic disorder. On May 11, 1992, it was noted in her medical file that she “has a psychiatric anxiety disorder.” Finally, on July 13, 1994, she was prescribed Pamelor and Nortriptyline, both anti-depressants.
Given the evidence in the record, we cannot conclude substantial evidence supports the ALJ's decision regarding the extent of the claimant’s mental impairment. While the mere presence of a mental disturbance does not automatically indicate a severe disability, it cannot be ignored by the ALJ.
Bernal v. Bowen,
The ALJ was obligated to investigate the claimant’s mental impairments. This could have been accomplished either by remanding the case for further development, by seeking medical assistance, or perhaps by soliciting testimony directly from the claimant. This obligation is heightened when the Commissioner fails, as he did here, to satisfy his obligation under 42 U.S.C. § 421(h) and 20 C.F.R. § 404.1520a to have a qualified psychiatrist or psychologist evaluate Plummer’s claim during the initial or reconsideration stage. Thus, it was particularly unjust for the ALJ to prohibit Plummer from developing her mental impairment claim and then to issue a factual finding that could preclude Plummer from raising the issue in a subsequent application.
9
Under these circumstances, additional development of
This Court has noted in the past our frustration with the delays in disability determinations by the Social Security Administration.
See, e.g., Woody v. Secretary of Health and Human Services,
III. Conclusion
For the foregoing reasons, this Court will reverse the District Court’s grant of summary judgment and remand to the Commissioner of Social Security for further action consistent with this opinion.
Notes
. The claimant was diagnosed with deQuer-vain's tendinitis of the left wrist in September, 1991.
Admin. R.
at 230. In December 1992, she was diagnosed with bilateral carpal tunnel syndrome.
Id.
at 216. This diagnosis was contradicted by another orthopedic surgeon in December 1992 who saw no evidence of carpal tunnel syndrome.
Id.
at 185. Treating rheumatologist, Dr. Brent, diagnosed
. Plummer retained counsel on April 23, 1993.
. § 404.1520a(b)(3) provides for the examination of the degree of functional loss in four areas of function considered essential to work. These areas of activities are: daily living; social functioning; concentration, persistence, or pace; and deterioration or de-compensation in work or work-like settings. The degree of functional loss is rated on a scale that ranges from no limitation to so severe the claimant cannot perform these work-related functions. This information is then detailed on a PRT form.
. “Q: Ms. Plummer states that as a result of her above condition(s), that she may go days at a time when she has great difficulty performing even minor hand activities with either hand, including buttons, turning doorknobs, etc. Is this credible? A: Yes.” Interrogatories to Dr. Brent, 11-22-94, Admin. R. at 203.
. Light level work is defined at 20 C.F.R. 404.1567(b): "Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds.” The ALJ concluded Plummer could perform light work, although limited to those positions which do not require bilateral dexterity or extensive handling of objects.
. In this regard, the ALJ took notice that the claimant drives her child to day-care everyday, which requires the use of her hands and wrists “on demand” as well.
. The initial request for a hearing was filed on June 10, 1993. The actual hearing was scheduled for December 6, 1994.
. We note, however, that there is sufficient evidence in the record, including the claimant’s statement on the Reconsideration Disability Report that she is “depressed” and on medication, that her mental impairments should have been evaluated before reaching the ALJ hearing level. 20 C.F.R. § 404.1520a (requiring the Commissioner to record all pertinent signs, symptoms, findings and functional limitations in order to determine if a mental ‘ impairment exists); 20 C.F.R. § 404.900(b) (noting the Commissioner considers at each step of the review process all information presented by the claimant as well as all other information in the record).
. We have no jurisdiction to review the Commissioner's application of res judicata unless the decision is accompanied by a hearing.
See Califano v. Sanders,