United States District Court, S.D. New York
MELISSA I. RAMLAKHAN, Plaintiff,
CAROLYN W. COLVIN, Defendant.
OPINION AND ORDER
HONORABLE RONALD L. ELLIS, U.S.M.J.
Melissa Ramlakhan ("Ramlakhan") commenced this
action under the Social Security Act (the "Act"),
42 U.S.C. § 405(g), seeking judicial review of a final
decision of the Commissioner of Social Security
("Commissioner") denying her application for
Disability Insurance Benefits ("DIB") and
Supplemental Security Income ("SSI"). Ramlakhan
raises two issues: (1) the Administrative Law Judge
("ALJ") failed to weigh the opinion of her treating
physicians properly; and (2) the ALJ failed to consider the
side effects of Ramlakhan's medications. (Doc. No. 18
(Mem. of Law in Supp. Of Pl's Mot. for J. on the
Pleadings ("Pl Mem.")) at 14.) On March 17, 2016,
the Parties consented to the jurisdiction of the undersigned,
pursuant to 28 U.S.C. § 636(c). (Doc. No. 13.)
April 20, 2016, Ramlakhan filed a motion for judgment on the
pleadings pursuant to Rule 12(c) of the Federal Rules of
Civil Procedure, asking the Court to reverse the decision of
the Commissioner and remand for further proceedings. (Doc.
No. 17.) On May 17, 2016, the Commissioner cross-moved for
judgment on the pleadings pursuant to Rule 12(c), asking the
Court to affirm the Commissioner's decision and dismiss
the Complaint. (Doc. No. 20 (Mem. of Law in Supp. Of
Def.'s Mot. for J. on the Pleadings ("Def.
Mem.")) at 1.) For the reasons set forth below.
Ramlakhan's motion is GRANTED, the Commissioner's
cross-motion is DENTED. and the case is REMANDED for further
proceedings before the Social Security Administration.
22, 2012, Ramlakhan filed for DIB and SSI benefits, alleging
disability beginning on April 2, 2012. (Tr. of Admin.
Proceedings ("Tr.") at 388-401, 407.) The Social
Security Administration initially denied Ramlakhan's
application on August 13, 2012. (Tr. at 310-31.) On September
10, 2012, Ramlakhan filed a written request for a hearing
before an ALJ. (Id. at 332-33.) On September 25,
2013, Ramlakhan appeared before ALJ Mark Solomon, who
adjourned the proceedings to allow Ramlakhan to get an
attorney. (Id. at 264-70.) On January 28, 2014,
Ramlakhan appeared with counsel for a second hearing before
ALJ Soloman. (Id. at 271-309.) On March 26, 2014,
ALJ Soloman found that Ramlakhan was not disabled under
§§ 216(i) and 223(d) of the Social Security Act.
(Id. at 74-89.) On April 2, 2014, Ramlakhan
requested review of the ALJ's decision. (Id. at
72-73.) On September 25, 2015, the Appeals Council denied
Ramlakhan's request for review, therefore making the
ALJ's decision final. (Id. at 1-4.) Ramlakhan
initiated this action on October 15, 2015. (Doc. No. 1.)
The ALJ Hearing and Decision
1.Administrative Hearing Testimony and Other Sworn
September 25, 2013, ALJ Soloman asked a few questions before
adjourning to allow Ramlakhan to get counsel. (Tr. at
264-70.) For example, the ALJ asked Ramlakhan about an
operation that she had in May of 2013. Ramlakhan testified
that she had had arthroscopic surgery on her left knee, and
was receiving mental health treatment from her psychiatrist,
Dr. Ghumman. (Id. at 268-69)
Ramlakhan returned with counsel on January 28, 2014, she
testified that she was born on December 21, 1975, completed
her undergraduate degree in 2003, and was last employed at
Bobby Van's Steakhouse. (Tr. at 277.) In 2003, after the
birth of her second child, she had a "tummy tuck"
operation in order to sew back the muscles in her stomach to
support her back. (Id. at 284.) Ramlakhan had worked
full-time as a server at Bobby Van's Steakhouse from
November 10, 2010, to March 29, 2012. (Id. at
277-78.) She had previously worked as a server at Xaviars X20
on the Hudson, as a hostess at the Blair Perrone Steakhouse,
as a mail carrier for the United States Postal Service, and
as a member of a prostitution ring from 1991 to 2005. (Mat
was terminated from Bobby Van's Steakhouse because she
had a verbal confrontation with another employee that had
interrupted the lunch service, and that her former manager
had referred to as a "meltdown." (Id. at
278.) Ramlakhan testified that by the time she was
terminated, "[she] couldn't even lift [her] left arm
anymore in the way that a person would hold trays of
food." (Id. at 285.) Soon after, she applied
for unemployment benefits, which were initially denied, but
granted on appeal. Id. She collected unemployment
benefits for the full period of 99 weeks. (Id. at
also testified that she received substance abuse treatment
for alcohol, marijuana, and pain pills during and after the
time she began receiving unemployment benefits, and is
currently undergoing treatment at the Albert Einstein College
of Medicine ("Einstein"). (Id. at 279,
286.) Additionally, she testified that she uses a back brace
and occasionally uses a cane, and that she lives with her
mother, step-father, and two children-ages twelve and
eighteen. (Id. at 285-86.)
travels by herself, but sometimes needs assistance putting on
her clothes, putting together her toiletries for bathing,
turning on the shower, and putting on her shoes. (Tr. at
287.) She does not do any household chores without
assistance. (Id. at 288.) This includes cooking,
cleaning, mopping, or dusting. Id. Ramlakhan cannot
perform tasks that require the use of her hands for more than
ten minutes, including washing dishes or typing. Id.
She alternates between sitting and standing every two to five
minutes because of pain. (Id. at 292-293.) Her back
pain makes it difficult for her to concentrate on reading,
writing, or accomplishing tasks. (Id. at 295.) To
soothe her back pain, Ramlakhan will lie down once or twice
per day with hot pads on her back. (Id. at 296.)
days are spent reminding her children of daily tasks, such as
brushing teeth, taking vitamins, and reminding her younger
daughter not to forget her book bag. (Id. at 289.)
She also checks up on her ninety-nine-year-old grandmother
"maybe twice a week." (Id. at 290.)
Additionally, Ramlakhan goes to therapy at Next Steps three
days a week. Id. Ramlakhan testified that once or
twice per week she does not leave her home, and stays in her
room. (Id. at 299.)
has a panic attack at least once per day. (Id. at
297.) The panic attacks can be "anywhere from 10 minutes
to hours, " and can be triggered when remembering
something in her past. Id. Memories that trigger
panic attacks range from her pimp and girls she used to work
with, to falling out of the window of her apartment complex
at fifteen years old. Id. The latter incident
occurred in 1991, when Ramlakhan attempted to flee after her
stepfather argued with and strangled her. (Id. at
294, 449-50.) Ramlakhan plunged "at least seven stories
while trying to scale down the side of her building on two
bed sheets draped out her window." (Id. at
449.) "[S]he apparently slipped or lost grip of the
sheets and fell, reportedly cracking ribs and breaking her
leg and possibly suffering internal injuries." (Tr. at
Ramlakhan's testimony, vocational expert Dr. Gerald
Belchick testified about Ramlakhan's capability to work,
and what type of work she is able to do. (Id. at
300.) The ALJ asked Dr. Belchick about a hypothetical
claimant with Ramlakhan's age, education, and work
experience whose work would be limited to:
(1) sedentary work with the ability to sit for six hours,
stand or walk for up to two hours; (2) lifting and carrying
up to 10 pounds occasionally and five pounds frequently; (3)
no climbing of rope, ladders and scaffolds; (4) occasionally
climbing of ramps and stairs; (5) occasionally balancing,
stooping, kneeling, crouching, and crawling; (6) avoiding
work at unprotected heights and with hazardous machinery; (7)
remembering, understanding, and carrying out simply
instructions; (8) maintaining attention and concentration for
"rout work;" (9) maintaining a regular schedule;
(10) performing a low stress job, defined as one with only
simply decision making, and no close interpersonal contact
with the general public.
(Id. 303-04.) Using the Dictionary of
Occupational Titles ("DOT")  from the U.S.
Department of Labor, Dr. Belchick testified that Ramlakhan
could be a bench hand assembler, with 218, 000 jobs in the
national economy; surveillance system monitor, with 81, 000
jobs in the national economy; or an addresser, with 196, 000
jobs in the national economy. (Id. at 304-06.) Dr.
Belchick testified that if Ramlakhan is found to be credible
in her ability to stand or sit for no more than five minutes,
or if claimant were to miss more than five percent of work,
all of the proposed jobs would be void. (Id. at
Consulting Psychiatrist Arlene Broska, Ph.D.
30, 2012, Dr. Arlene Broska, a psychologist, evaluated
Ramlakhan at the ALJ's request. (Tr. at 496-500.) Dr.
Broska found that Ramlakhan's "demeanor and
responsiveness to questions w[ere] cooperative. Her manner of
relating, social skills, and overall presentation were
adequate." (Tr. at 498.) Ramlakhan's affect was
dysphoric and her mood was dysthymic. Id.
Ramlakhan's "thinking was coherent and goal directed
with no evidence of hallucinations, delusions, or paranoia in
the evaluation setting." Id. Ramlakhan's
insight and judgment were poor. (Id. at 499.)
Ramlakhan appeared to be able to "follow and understand
simple directions and instructions[, ...] perform simple
tasks independently[, ...] maintain attention and
concentration ... [but] [s]he may not make appropriate
decisions, relate adequately with others, or appropriately
deal with stress." Id. Dr. Broska diagnosed
Ramlakhan with depressive disorder, and polysubstance abuse
and dependence that is in early remission. (Id. at
500.) Additionally, Dr. Broska diagnosed Ramlakhan with
personality disorder, and noted her back, shoulder, and ankle
Consulting Examiner Marilee Mescon, M.D.
30, 2012, Dr. Marilee Mescon met Ramlakhan for a consultative
internal medicine examination at the Commissioner's
request. (Id. at 490-95.) Ramlakhan's chief
complaints were "[l]eft knee pain; multiple trauma; left
shoulder pain; [and a] history of marijuana and alcohol
abuse." (Id. at 490.) Dr. Mescon reported that
the "pain scale for the left knee goes from a 10/10 to
7/10 with analgesic medications. She describes the pain in
her left knee as sharp and aching, sometimes the left knee
gives out and has falling [sic] only once." Id.
Ramlakhan described the "pain in her back as burning and
sticking and pinching, on a scale of 10/10 going to 8/10 with
analgesic medications." (Tr. at 490.) Additionally.
Ramlakhan described the "pain in [her] left shoulder as
sharp, aching, and sticking on a scale of 10/10 going to 7/10
with analgesic medications." (Id. at 491.)
informed Dr. Mescon that she was able to shower, bathe, and
dress. (Id. at 492.) On examination, Ramlakhan's
gait and stance were normal, she could squat halfway, and she
could walk on her heels and toes. (Id. at 492.)
Ramlakhan needed no help changing for her examination or
getting on and off the examination table. She was able to
rise from a chair without difficulty. Id. In Dr.
Mescon's musculoskeletal assessment, Ramlakhan's
cervical spine showed full flexion. (Id. at 493.) Dr.
Mescon found full range of motion ("ROM") in
Ramlakhan's elbows, forearms, wrists bilaterally, hips,
and knees. (Id. at 493-94.)
Mescon reviewed an x-ray of Ramlakhan's lumbosacral
spine, which showed that Ramlakhan was "[s]tatus post
surgery following a compression fracture." (Id.
at 494-95.) Dr. Mescon's diagnosis was that Ramlakhan had
left knee injury; a left shoulder injury; multiple trauma
after suicidal gesture; and an old compression fracture on
her back. (Id. at 494.) Dr. Mescon's stated that
her "[l]ong-term prognosis is fair to poor."
Id. On the basis of her examination findings. Dr.
Mescon stated that "there [were] no limitations in
[Ramlakhan's] ability to sit, but her capacity to stand
for long periods of time, climb, push, pull, or carry heavy
objects would be moderately to severely limited because of
all of [Ramlakhan's] medical problems." (Tr. at
Treating Psychiatrist Daniel Cohen, M.D.
12, 2012, Dr. Daniel Cohen, the Medical Director at the
Metropolitan Center for Mental Health, completed a mental
evaluation of Ramlakhan. (Id. at 485-89.) Dr. Cohen
noted that he had first seen Ramlakhan on April 19, 2012.
(Id. at 485.) Dr. Cohen's treating diagnoses are
post-traumatic stress disorder, generalized anxiety disorder
with agoraphobia, and recurrent major depressive disorder.
Id. Dr. Cohen noted that Ramlakhan "continues
to suffer from panic attacks, restless sleep, tension,
unreasonable worry, flash backs, sweating, substance abuse,
impulse behavior, with a history of questionable decision
"presented as neat and cooperative, [and her] speech was
relaxed, [and] logical, [yet] overwhelmed."
(Id. at 487.) Ramlakhan's mood was moderately
depressed and expansive. Id. Ramlakhan was oriented,
her memory was intact, and her ability to perform
calculations was appropriate. Id. Dr. Cohen noted
"average insight, [and a] history of questionable
decision making." Id.
informed Dr. Cohen that she was "able to travel
independently, do household chores, groom herself, prepare
meals, and do laundry." (Id. at 488.) Ramlakhan
told Dr. Cohen that she worked "as a waitress, and
discussed having issues with her supervisors and work
colleagues." Id. Dr. Cohen noted that suicidal
features were present, and that Ramlakhan had four prior
attempts, in 1992, 1999, 2002, and 2004. Id. Based
upon the medical findings provided in his report, Dr. Cohen
found Ramlakhan was "very limited" in her ability
to do work related mental activities. Id.
Treating Physician Sireen Gopal, M.D.
9, 2013, Dr. Sireen Gopal treated Ramlakhan for back pain.
(Tr. at 814-16.) Ramlakhan's gait was normal and her
cardiovascular system had a regular rate and rhythm, but a
palpation revealed tenderness in her bilateral lumbar facet
joints and sacroiliac ("SI") joints. (Id.
at 814.) Dr. Gopal conducted a negative bilateral SLR test,
and found Ramlakhan's spine was normal. Id.
Ramlakhan's upper and lower extremities were bilateral,
and her deep tendon reflexes were bilaterally symmetrical.
August 9, 2013, Dr. Gopal met with Ramlakhan because
Ramlakhan was having "pain while washing dishes."
(Id. at 805.) Palpation revealed "paraspinal
tenderness, moderate aggravat[ion] at end of the day."
Id. Ramlakhan showed a decreased ROM that causes
pain, lumbar instability, and a reduced motor strength of
4-/5. Id. On August 21, 2013, Dr. Gopal
met with Ramlakhan for "shooting pain down the
legs." (Id. at 803.) Palpation revealed that
there was moderate tenderness present, and Ramlakhan's
back stability was fair. Id. On September 26, 2013,
Dr. Gopal's palpation findings included tenderness of the
lumbar facet joints and SI joints, but Ramlakhan's gait
was normal, and the SLR test was negative bilaterally.
(Id. at 801.) In addition, Dr. Gopal ordered a
magnetic resonance imaging ("MRI") scan for
Ramlakhan. (Id. at 802.)
October 22, 2013, the "MRI of the lumbar spine was
performed with a Philips Panorama midfield open
scanner." (Id. at 819.) The MRI reoort stated
that Ramlakhan's himhar spine was "significantly
limited due to [a] susceptibility artifact related to
[Ramlakhan's] metallic surgical hardware. There is mild
levoscoliosis of the lumbar spine. There is [a] mild chronic
compression fracture involving the L2 vertebreal body. No
acute compression fractures [were] seen." (Tr. at 819.)
January 20, 2014, Dr. Gopal submitted a medical source
statement. (Id. at 822-28.) Dr. Gopal noted that
Ramlakhan was diagnosed with "lumbar radiculopathy,
lumbosacral arthritis, postlaminect synd/lumbar, sacroilitis,
and unspecified myalgia and myositis." (Id. at
822.) Dr. Gopal noted Ramlakhan's pain is located in her
"mid to low back, radiating into bilateral buttocks and
hips, and into the front of the bilateral thighs."
Id. Ramlakhan's symptoms were described as a
constant "cramping, sharp, [and] aching" pain.
Id. Dr. Gopal marked down that depression and
anxiety affect Ramlakhan's pain, and that she had a
"marked limitation" in her ability to deal with
work stress. Id. Dr. Gopal also noted that Ramlakhan
is constantly experiencing "pain severe enough to
interfere with attention and concentration."
Gopal opined that Ramlakhan could sit for a maximum of
fifteen continuous minutes at a time, and for a total of one
hour during an eight hour day. (Id. at 823-24.) Dr.
Gopal wrote that Ramlakhan could stand or walk for a maximum
of fifteen continuous minutes at a time, but did not specify
the total amount of time allowable during an eight hour
workday. (Id. at 824-25.) Dr. Gopal also noted that
Ramlakhan would need to lie down or recline for a total of
one hour during the workday. (Id. at 825.) Dr. Gopal
opined that Ramlakhan could occasionally lift up to ten
pounds, but never more than that. (Id. at 826.)
Ramlakhan could occasionally balance, rotate her neck,
repetitively use her hands, but she could never
stoop. (Id. at 826-27.) Dr. Gopal
estimated that on average Ramlakhan would be absent from work
"more than 1 times a month" (Id. at 828.)