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Pilarski v. Commissioner of Social Security

United States District Court, W.D. New York

September 30, 2014



FRANK P. GERACI, Jr., District Judge.

Darlene Marie Pilarski ("Claimant") brings this action pursuant to Title II of the Social Security Act ("the Act"), seeking review of the final decision of the Commissioner of Social Security ("the Commissioner") denying her application for Social Security Disability Insurance Benefits ("DIB"). Dkt. # 1. This Court has jurisdiction over this action pursuant to 42 U.S.C. § 405(g).

Currently before the Court are the parties' competing Motions for Judgment on the Pleadings pursuant to Rule 12(c) of the Federal Rules of Civil Procedure. Dkt. ## 7, 9. For the reasons set forth below, I find that the decision of the Commissioner is not in accordance with applicable legal standards, and accordingly, the Claimant's Motion for Judgment on the Pleadings is granted, and this matter is remanded to the Commissioner of Social Security for further administrative proceedings.


Claimant applied for DIB on December 1, 2009, alleging that she had been disabled within the meaning of the Act since December 31, 2007. After her application was denied at the initial administrative level on April 28, 2010, a hearing was held before Administrative Law Judge Edgardo Rogriquez-Quilichini ("the ALJ") on October 27, 2011, where the ALJ presided by videoconference. The Claimant was represented by the same counsel who represents her in this action. On November 25, 2011, the ALJ issued his decision, finding that the Claimant was not disabled within the meaning of the Act. That decision became the final decision of the Commissioner when the Appeals Council denied Claimant's request for review on May 28, 2013. The Claimant then timely commenced this action, seeking review of the Commissioner's final decision.


This Court's review of the Commissioner's decision is not de novo, and I may only set aside the Commissioner's decision if it is not supported by "substantial evidence" or is the product of legal error. See Cage v. Comm'r of Soc. Sec., 692 F.3d 118, 122 (2d Cir. 2012) (quoting Schaal v. Apfel, 134 F.3d 496, 501 (2d Cir. 1998)); Burgess v. Astrue, 537 F.3d 117, 127 (2d Cir. 2008) (quoting Shaw v. Chater, 221 F.3d 126, 131 (2d Cir. 2000)). Indeed, the Act holds that a decision by the Commissioner is "conclusive" if supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is defined as "more than a mere scintilla" and is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Burgess, 537 F.3d at 127 (quoting Halloran v. Barnhart, 362 F.3d 28, 31 (2d Cir. 2004)) (internal quotation marks omitted).

In this case, I need not discuss all of the underlying medical claims made by the Claimant, or the evidence adduced in the prior proceedings that could arguably provide substantial evidence to affirm the Commissioner's decision, as the Court is able to determine this matter based upon whether the ALJ properly applied the relevant legal standards in reaching his conclusion.

Claimant argues that the ALJ violated the so-called "treating-physician rule, " which is "a series of regulations set forth by the Commissioner... detailing the weight to be accorded a treating physician's opinion." de Roman v. Barnhart, No. 03 Civ. 0075(RCC)(AJP), 2003 WL 21511160, at *9 (S.D.N.Y. July 2, 2003).[1] In doing so, she argues that the Commissioner's decision is the product of legal error. With the standards described above in mind, and for the reasons that follow, I find that the Commissioner's decision contains legal error, and therefore remand is required.

Under the treating physician rule, the ALJ must give controlling weight to a treating physician's opinion when that opinion is "well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] record." 20 C.F.R. § 404.1527(c)(2); see also Green-Younger v. Barnhart, 335 F.3d 99 (2d Cir. 2003). While an ALJ may discount a treating physician's opinion if it does not meet this standard, the ALJ must "comprehensively set forth [his] reasons for the weight assigned to a treating physician's opinion." Halloran, 362 F.3d at 33.

Even when a treating physician's opinion is not given "controlling" weight, the ALJ must still consider several factors in determining how much weight it should receive. The ALJ must consider, inter alia, the "[l]ength of the treatment relationship and the frequency of examination"; the "[n]ature and extent of the treatment relationship"; the "relevant evidence..., particularly medical signs and laboratory findings, " supporting the opinion; the consistency of the opinion with the record as a whole; and whether the physician is a specialist in the area covering the particular medical issues. See Burgess, 537 F.3d at 129.

Here, the ALJ's statement of reasons to support his decision to not assign controlling weight to the opinions of Dr. Chen, the Claimant's treating physician, is not sufficient[2]. Dr. Chen is not mentioned in the ALJ's decision until page 7 of 9, and the following is the most substantial discussion regarding Dr. Chen in the ALJ's decision[3]:

"Conversely, I have afforded little weight to the opinion provided by Dr. Ya Li Chen through the Arthritis RFC Questionnaire (Exhibit 12F). Dr. Chen reported extreme limitations which are not substantiated by any evidence in file. Although claimant's diagnoses, inflammatory arthritis, fibromyalgia, and spondylitis, are consistent with the rest of the case record, other symptomatology and limitations are not explained nor supported by any treatment notes. In addition, other examining source [sic] that I have given great weight found and reported lesser limitations which are consistent with the record as a whole. Thus, it appears that Dr. Chen's opinion is based upon claimant's subjective complaints. Therefore, in the absence of any other evidence in [sic] file supporting Dr. Chen's assessments, I conclude that this opinion is less than persuasive."

This reasoning is quite generic[4], does not specify the ALJ's reasoning with any detail, and does not discuss the factors previously mentioned. This lack of reasoning not only hampers the Claimant's ability to understand the ALJ's decision, it hampers this Court's ability to review the merits and evidence regarding the ALJ's underlying decision. For example, the ALJ states that "other symptomatology and limitations are not explained nor supported by any treatment notes." Rather than providing the requisite good reasons' to deviate from the treating physician rule, this statement instead leaves the reader only with more questions. What symptomatology did the ALJ find problematic? Which limitations did the ALJ find to be unsupported? These are undoubtedly important ...

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