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concluding that social security regulations "direct that medical opinions unsupported by relevant evidence or explanations not be given substantial weight."
Summary of this case from LaPlante v. ColvinOpinion
Civil Action No. 03-10006-DPW.
June 16, 2004
MEMORANDUM AND ORDER
Victoria DiBenedetto brings this action under 42 U.S.C. § 405(g) to challenge the decision of the Commissioner of the Social Security Administration ("SSA") denying her supplemental security income ("SSI") benefits. She maintains she is entitled to benefits because she is unable to work as a result of shoulder and back pain, as well as depression and anxiety disorders.
I. BACKGROUND
A. Medical History
Mrs. DiBenedetto was born on August 6, 1969. She has a tenth grade education; her past work experience includes employment as an assembler. (Tr. 83). She alleges that she became disabled on August 29, 1998 due to back and shoulder pain and depression. (Tr. 82).
Mrs. DiBenedetto sought medical attention for neck and back pain and headaches beginning on October 15, 1998. She received a course of chiropractic treatments at the Medford Chiropractic Center ending on January 18, 1999. (Tr. 99-104).
Dr. Harry Senger, a consultive psychologist, interviewed her on May 25, 2000. Mrs. DiBenedetto described her daily life as centered around the home, caring for her four young children and disabled husband She told Dr. Senger she rarely leaves her house, engaging in no outside social activities and maintaining no real friendships. (Tr. 106). When asked about her work history, Mrs. DiBenedetto reported that she last worked in 1987 as a bench assembler, a position she held for about one year. She quit that job because of stress caused by an abusive relationship with an ex-boyfriend. When asked if she could return to work, Mrs. DiBenedetto responded she was unable to, complaining of "too much pain" in her back and feeling "too stressed out." (Tr. 105).
Mrs. DiBenedetto described being depressed for "some years" with a gradual increase in severity. (Tr. 105). She complained of sleeplessness, feelings of guilt and worthlessness, poor energy, lack of interest in life, and weight gain. She denied feeling suicidal or experiencing delusions or hallucinations. She further denied any past substance abuse or psychiatric hospitalizations. (Tr. 105-06). Mrs. DiBenedetto did report seeing a psychiatrist in 1999, but stopped because she didn't like him. As part of this treatment, she was taking 10 mg of Prozac daily with no side effects and felt it had helped some. (Tr. 106).
Dr. Senger noted that although Mrs. DiBenedetto appeared moderately depressed, she was able to comprehend and answer his questions cooperatively and rationally, with good eye contact. (Tr. 107). She effectively interpreted proverbs, was properly oriented, gave no bizarre answers, and her memory was intact. There was no observable indication of delusions, hallucinations, or thought disorder. Dr. Senger diagnosed her condition as major depressive disorder (untreated), residual Post-Traumatic Stress Syndrome (resulting from the prior abusive relationship), and mild agoraphobia. (Tr. 107). Overall, he found Mrs. DiBenedetto able to comprehend, remember, and carry out instructions, and capable of completing a range of daily tasks, including self and child care. (Tr. 108).
On June 6, 2000, Dr. Jane Marks reviewed Mrs. DiBenedetto's medical record and prepared a mental residual functional capacity assessment, rating her work and living impairments. (Tr. 109-21). Dr. Marks found that she had a slight restriction of daily living activities, slight to moderate difficulties in maintaining social interaction, and seldom deficiencies in concentration (Tr. 120). Considering these slight limitations, Dr. Marks concluded that Mrs. DiBenedetto "should be able to understand [and] carry out tasks in a low stress setting [with] tactful supervision." (Tr. 111).
Dr. Ashok Bhargava, a consultative physician, examined Mrs. DiBenedetto on July 8, 2000. She complained of back, shoulder, and neck pain resulting from several car accidents. She described chronic pain in her lower back radiating into her upper back, along with constant pain in her shoulders and neck. For pain control, she had been taking Tylenol and receiving no other local treatments. (Tr. 124). Mrs. DiBenedetto further related having frequent migraine headaches, but denied having any aura, visual problems, or neurological deficits. (Tr. 125). On physical examination, Dr. Bhargava noted that Mrs. DiBenedetto was normal except for painful range of motion in her neck and shoulders. However, despite the pain, she exhibited full range of motion in her neck, shoulders, and back, with no observed inflammation or swelling. An x-ray of the shoulder returned normal. Similarly, her gait, grip strength, and leg raising were normal. (Tr. 125). Dr. Bhargava concluded Mrs. DiBenedetto has degenerative joint disease of her cervical spine, lumbosacral spine and both shoulders, worsened by her nonendocrine obesity. (Tr. 125).
Mrs. DiBenedetto was involved in a fourth automobile accident on August 19, 2000. She returned to the Medford Chiropractic Center on August 25, 2000 for treatment of neck and back pain. She received a course of treatment ending November 27, 2000. (Tr. 140-45).
Jane Barbiasz, RNCS, assessed Mrs. DiBenedetto's mental condition following visits in October and November of 2000. Nurse Barbiasz described Mrs. DiBenedetto as "stressed by her chronic pain and neediness of her family," and suffering from life-long depression, compounded by the demands of her four children and disabled husband (Tr. 137). However, Nurse Barbiasz observed no sign of suicidal ideation, psychosis, or paranoia. (Tr. 137). She stated that Mrs. DiBenedetto did not have any noted concentration deficits that might interfere with task completion, (Tr. 137), nor did she believe that Mrs. DiBenedetto's anxiety required excessive supervision. (Tr. 138). Nurse Barbiasz diagnosed Mrs. DiBenedetto with migraine headaches, dysthymia, and a mood disorder due to chronic pain. (Tr. 137). On December 14, 2000, reviewing Nurse Barbiasz's report, Dr. Sumner Stone, consultative psychiatrist, rated Mrs. DiBenedetto's limitations on daily living, social functioning, and concentration as "mild." (Tr. 155).
Dr. Lalit Savla, a consultative physician, examined Mrs. DiBenedetto on March 28, 2001. Dr. Savla found that Mrs. DiBenedetto's fourth car accident in 2000 had caused increased pain in her neck and back, but that the pain was still manageable by the use of Tylenol. (Tr. 160-61). On physical examination, Dr. Savla found no neurological deficits with respect to motor strength, reflexes, or sensation. Flexion, extension, and lateral movements of the cervical spine were normal. (Tr. 161). Mrs. DiBenedetto could rotate her shoulders 160 degrees without pain and up to 180 degrees with some pain. There was no tenderness in the lumbar spine, leg raising was normal, and her gait was steady. (Tr. 161-62). Dr. Savla found that the conclusions of Dr. Bhargava's prior examination diagnosing Mrs. DiBenedetto with chronic cervical and lumbar sprain, chronic headaches, and depression remained essentially intact. (Tr. 162). Using Dr. Savla's report, Dr. Mary Connolly conducted a vocational analysis on April 17, 2001, concluding that Mrs. DiBenedetto retained the capacity to perform light, unskilled jobs. (Tr. 172).
In December 2001, Nurse Barbiasz, having treated Mrs. DiBenedetto's depression regularly for fourteen months, submitted an updated appraisal of her mental condition. She described Mrs. DiBenedetto as suffering from chronic depression, with major depressions triggered by stress. She opined that it would not be advisable for Mrs. DiBenedetto to take a job which would take her out of the home. (Tr. 177).
On January 7, 2002, at the behest of the Massachusetts Disability Evaluation Services, Dr. Debra Rosenblum, a psychiatrist, assessed the claimant. Dr. Rosenblum confirmed that Mrs. DiBenedetto was seeing Nurse Barbiasz monthly and taking Celexa, an antidepressant. Mrs. DiBenedetto reported that this medication "helps somewhat" but that she remained symptomatic. (Tr. 179). Dr. Rosenblum described Mrs. DiBenedetto as "somewhat difficult to interview," because she did not want to answer certain questions. (Tr. 180). Her affect was restricted and her mood depressed. Mrs. DiBenedetto described having occasional auditory hallucinations and becoming paranoid when she leaves the house. On the Mental Status Exam, Mrs. DiBenedetto could not interpret a proverb, could not spell "world" backwards, and could not perform simple calculations, suggesting to Dr. Rosenblum deficits in concentration which may be due to depression or a preexisting learning disability. (Tr. 180). Dr. Rosenblum diagnosed her condition as major depression with psychotic features, Post-Traumatic Stress Syndrome, and a learning disorder. (Tr. 180). Based on Dr. Rosenblum's report, on January 22, 2002, the Commonwealth of Massachusetts declared Mrs. DiBenedetto disabled through July 18, 2003. (Tr. 173).
B. Procedural History
Mrs. DiBenedetto filed an application for SSI benefits on January 18, 2000, alleging an inability to work since August 29, 1998, due to back and shoulder pain and depression. (Tr. 82). The SSA denied her claim initially on August 1, 2000 (Tr. 45), relying on reports from Dr. Senger and Dr. Bhargava. On April 9, 2001 Mrs. DiBenedetto's claim was denied on reconsideration as well. (Tr. 50). Reports from the Medford Chiropractic Center, Nurse Barbiasz, and Dr. Savla were used to reconsider the claim. (Tr. 50).
Following the denial of her application on reconsideration, Mrs. DiBenedetto requested a hearing before an Administrative Law Judge ("ALJ"). Mrs. DiBenedetto and her attorney appeared at a hearing convened before ALJ Thomas Fallon on February 14, 2002. (Tr. 22). The ALJ issued a decision on August 9, 2002, finding that Mrs. DiBenedetto was not disabled as defined by the Social Security Act and was thus not entitled to SSI benefits.
On September 11, 2002, Mrs. DiBenedetto filed a request for review of the hearing decision. The Appeals Council denied Mrs. DiBenedetto's request on November, 1, 2002, making the ALJ's decision the final decision of the Commissioner. She brought this action on January 2, 2003.
C. The Disability Standard and the Decision of the ALJ
1. The Disability Standard
An individual is considered disabled under the Social Security Act if she is unable to participate in "any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months." 42 U.S.C. § 1382 c (a) (3)(A).
In determining whether a claimant meets this definition of disability, the Commissioner applies a sequential evaluation prescribed by SSA regulations. 20 C.F.R. § 416.920; see Goodermote v. Sec'y of Health Human Servs., 690 F.2d 5, 6-7 (1st Cir. 1982). The Commissioner asks five questions in the following order:
First, is the claimant currently employed and is that employment a substantial gainful activity? If so, the claimant is automatically considered not disabled. 20 C.F.R. § 416.920 (b).
Second, does the claimant have a severe impairment? A "severe impairment" means an impairment "which significantly limits [the claimant's] physical or mental capacity to perform basic work activities." If not, the claimant is automatically considered not disabled. 20 C.F.R. § 416.920 (c).
Third, does the claimant's impairment meet the duration requirement and equal an impairment on the list of impairments in Appendix 1 to the social security regulations? If so, the claimant is automatically found disabled. If not, the Commissioner goes on to ask the fourth question. 20 C.F.R. § 416.920 (d).
These first three questions are threshold tests. If the claimant is working or has the physical or mental capacity to perform basic work functions, she is automatically considered not disabled. Similarly, if she has an impairment listed in Appendix 1, she is automatically considered disabled. The inquiry ends. If, however, her ability to perform basic work functions is impaired significantly (question two) but there is no Appendix 1 impairment (question three), the Commissioner then proceeds to ask the fourth question.
Fourth, does the claimant's impairment prevent her from performing the kind of work she has done in the past? If not, the claimant is found not disabled and the inquiry proceeds no further. If so, the Commissioner asks the fifth question. 20 C.F.R. § 416.920 (e).
Fifth, can the claimant do other work considering her "residual functional capacity," age, education, and past work experience? If not, the claimant is considered disabled. 20 C.F.R. § 416.920 (f).
To determine whether a claimant can perform prior jobs, the regulations require the ALJ to evaluate the claimant's RFC. This designates the claimant's ability to work despite physical or mental limitations. The RFC is not a decision about whether a claimant is disabled, but is used as the basis for determining the particular types of work a claimant may be able to do despite her impairment(s). See 20 C.F.R. § 416.945.
2. The ALJ's Decision
Applying this five-step analysis, the ALJ first found that Mrs. DiBenedetto had not engaged in substantial gainful activity since August 29, 1998. (Finding 1, tr. 19). He next determined that she suffers from a combination of physical and mental impairments considered severe, but that her condition did not meet or equal an impairment listed in Appendix 1 of the social security regulations. (Findings 2-3, tr. 19).
At question four, the ALJ determined that Mrs. DiBenedetto retained the residual functional capacity (RFC) to perform light work with moderate limitations on her ability to socially interact and to maintain concentration. (Finding 5, tr. 19). He found that while Mrs. DiBenedetto was a "sincere witness," her testimony regarding the severity of her physical pain and mental condition, when weighed against medical evidence, was insufficient to establish a limitation that would preclude her ability to perform past work. (Tr. 19). The ALJ identified Mrs. DiBenedetto's past relevant work as an assembler, a position which did not require the type of basic functions precluded by her identified impairments. (Finding 7, tr. 19). Accordingly, in answering question four affirmatively, the ALJ found Mrs. DiBenedetto not disabled as defined by the SSA, and consequently denied her application for SSI.
Light work involves lifting no more than twenty pounds at a time with frequent lifting or carrying of objects weighing up to ten pounds. A job is in this category if it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. 20 C.F.R. § 416.967 (b).
II. DISCUSSION
Mrs. DiBenedetto challenges the decision of the Commissioner on grounds that the ALJ's denial of SSI benefits is not supported by substantial evidence. Specifically, she argues the ALJ made two errors in declaring her non-disabled: (1) he failed to consider her nonexertional impairments and (2) he inappropriately applied the Medical-Vocational Guidelines (the "Grid").
A. Standard of Review
A district court has the power to enter a judgment "affirming, modifying, or reversing" a decision of the Commissioner of the SSA "with or without remanding the cause for a hearing." 42 U.S.C. § 405 (g). A denial of social security disability benefits must be upheld unless the Commissioner has committed legal or factual error in evaluating an applicant's claim. Manso-Pizarro v. Sec'y of Health Human Servs., 76 F.3d 15, 16 (1st Cir. 1996).
The Commissioner's factual findings are conclusive if supported by substantial evidence. 42 U.S.C. § 405 (g); Manso-Pizarro, 76 F.3d at 16. Substantial evidence is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971);see Montalvo v. Barnhart, 239 F. Supp.2d 130 (D. Mass. 2003). In reviewing the record, the district court must avoid reinterpreting the evidence or otherwise substituting its own judgment for that of the Commissioner. Colon v. Sec'y of Health Human Servs., 877 F.2d 148, 153 (1st Cir. 1989).
B. Review of the Commissioner's Decision
Upon review of the ALJ's application of the five-step analysis, I find his evaluation and denial of Mrs. DiBenedetto's disability claim to be supported by substantial evidence.
The Code of Federal Regulations classifies neither the back and shoulder pain nor the depression and anxiety from which Mrs. DiBenedetto suffers as within the criteria of any impairment listed in Appendix 1. See 20 C.F.R. Part 404, Appendix 1 at 1.00, 12.04. Compared to the Listings, her symptoms are not considered severe enough to prevent her from performing any gainful activity; hence, Mrs. DiBenedetto may not be found automatically disabled at question three. See 20 C.F.R. § 404.1525.
Proceeding to question four, the issue is whether substantial evidence supports the ALJ's finding that Mrs. DiBenedetto retains the functional capacity to perform her past work as a bench assembler. It is well settled that a claimant seeking disability benefits has the initial burden of proving that her impairments prevent her from performing her former type of work. Gray v. Sec'y of Heath Human Servs., 760 F.2d 369, 371 (1st Cir. 1985); Pelletier v. Sec'y of Health, Ed., Welfare, 525 F.2d 158, 160 (1st Cir. 1975); Santiago v. Sec'y of Health Human Servs., 944 F.2d 1, 5 (1st Cir. 1991). To do so, the claimant must initially produce relevant evidence of the physical and mental demands of her prior work. Pitchard v. Schweiker, 692 F.2d 198, 202 (1st Cir. 1982). She must then describe those impairments which she says she has and how her current functional capacity precludes the performance of those demands. See 20 C.F.R. § 416.912. If the claimant fails to meet this burden, the ALJ will determine that she retains the capacity to return to her prior work, and she is found not disabled.
In evaluating whether Mrs. DiBenedetto met her burden of proof, the ALJ referred to a disability report in which Mrs. DiBenedetto listed her previous employment as an assembler. (Tr. 83). In this report, she identified some of the position's requirements, including the ability to grasp and handle small and large objects and lift and carry no more than ten pounds. (Tr. 83). In her application for SSI benefits and during her hearing, Mrs. DiBenedetto cited symptoms of depression, anxiety, and agoraphobia, as well as neck, back, and shoulder pain, preventing her from returning to her past work. Weighing her testimony with the medical evidence submitted, the ALJ concluded that "[t]he claimant's medically determinable depression and anxiety as well as back pain, shoulder pain and headaches do not prevent the claimant from performing her past relevant work" as a bench assembler, a position which did not require the type of work functions precluded by her impairments. (Finding 7, tr. 19). To determine whether the ALJ's conclusions regarding the limitations imposed by Mrs. DiBenedetto's physical and mental conditions are supported by substantial evidence, I will consider each in turn.
1. Exertional Impairments
The ALJ's determination that Mrs. DiBenedetto's exertional impairments do not prevent her from returning to her past job is adequately supported by the record. In drawing this conclusion, the ALJ assessed her descriptions of physical limitations in light of the medical reports by Dr. Bhargava and Dr. Savla. He found Mrs. DiBenedetto's statements at testimony "not totally credible" because, despite her complaints of pain, she was not receiving any active therapy for her condition. (Tr. 18-19). Moreover, he found she was able to treat this pain with over-thecounter medications and continued to perform a range of household activities. (Tr. 18). The ALJ also reasonably found that repeated medical examinations did not corroborate her reports of pain. Radiographic images of Mrs. DiBenedetto's shoulders were negative, there was no evidence of any neurological deficits with respect to motor strength, and the range of motion in her neck, back, and shoulders was intact. (Tr. 17). Flexion, extension, and lateral movements of the spine were normal. (Tr. 161). Overall, physical exam by the two physicians proved "essentially normal." (Tr. 18). Given these physical assessments, the ALJ appropriately found Mrs. DiBenedetto as fit for light work — defined as frequent lifting or carrying of objects weighing less than ten pounds, see supra note 2, at 9.
Mrs. DiBenedetto's past work seems to fit in this category. As a bench work assembler, she was sedentary, required to lift less than ten pounds and to handle and grasp small and large objects. (Tr. 83). The record does not reflect any limitations on Mrs. DiBenedetto's ability to perform either task. Indeed, Dr. Salva's report expressly states that she "can lift in the range of 10-15 pounds" and the physical residual functional capacity assessment prepared by Dr. Connolly concludes that Mrs. DiBenedetto can frequently carry ten pounds, with an unlimited ability to push and pull that same weight. (Tr. 164). Dr. Bhargava noted in his report that Mrs. DiBenedetto's "grip is normal," (Tr. 125), and Dr. Connolly found no limitations on her handling and fingering capacities (Tr. 165). These medical reports provide substantial evidence to support the ALJ's determination that Mrs. DiBenedetto is not prevented from performing her past work because of exertional impairments.
2. Nonexertional Impairments
Mrs. DiBenedetto alleges in her complaint that the ALJ failed to properly consider her nonexertional impairments. The contention is without merit. The ALJ specifically evaluated the evidence of Mrs. DiBenedetto's mental condition in his decision. (Tr. 17-19). He was careful to reference her mental limitations specifically in defining Mrs. DiBenedetto's RFC: "light work with moderate limitations on her ability to socially interact and to maintain concentration." (Finding 5, Tr. 19). Weighing medical reports and Mrs. DiBenedetto's own testimony, the ALJ ultimately found that while her mental impairments cause moderate limitations, they would not preclude her from jobs that did not require frequent public contact and involved routine repetitive tasks. (Finding 6, Tr. 19, Tr. 18).
A nonexertional limitation is an impairment-caused limitation affecting such capacities as mental abilities, vision, hearing, speech, climbing, balancing, stooping, kneeling, crouching, crawling, reaching, handling, fingering, and feeling. Environmental restrictions are also considered to be nonexertional. 20 C.F.R. § 416.969a.
This conclusion is well supported by the record. It is consistent with the findings of Dr. Senger, who described Mrs. DiBenedetto as "able to comprehend, remember, and carry out instructions and to relate adequately." (Tr. 108). Similarly, Dr. Marks defined Mrs. DiBenedetto's limitations in maintaining social functioning as "slight to moderate" and her deficiencies in concentration as "seldom," (Tr. 120), concluding that Mrs. DiBenedetto "should be able to carry out tasks in a low stress situation." (Tr. 111). More recently, the evaluations by Nurse Barbiasz and Dr. Rosenblum confirmed that Mrs. DiBenedetto suffers from no psychosis, paranoia, or ideas of reference. (Tr. 137, 174). While both diagnosed her with depression, neither pinpointed medical evidence that Mrs. DiBenedetto would be unable to perform basic work tasks. Nurse Barbiasz did not note any deficits in concentration that would interfere with timely task completion. (Tr. 138). And despite "certain deficits in [Mrs. DiBenedetto's] concentration" during her interview with Dr. Rosenblum, she was able to communicate, remember, follow instructions, and relate. (Tr. 175). None of the examining physicians corroborated with medical evidence Mrs. DiBenedetto's testimony of anxiety attacks or agoraphobia severe enough to preclude her from working. (Tr. 12). Reviewing the medical record as a whole, a reasonable mind could accept it as more than adequate to support the ALJ's conclusion that Mrs. DiBenedetto's mental impairments do not prevent her return to work.
In her brief, Mrs. DiBenedetto points to Dr. Senger's and Dr. Rosenbaum's assignments of Global Assessment of Functioning (GAF) scores of 50 and 52, respectively, as evidence contravening the ALJ's findings. However, these scores indicate she was functioning fairly well, with moderate symptoms that would cause only moderate difficulty in social and occupational functioning. See Global Assessment of Functioning Scale,available at http://www.avapl.org/gaf/GAFSheet.html#Global. Indeed, the ALJ's finding parallels the GAF ranking; he too characterized Mrs. DiBenedetto's mental condition as only moderately limiting her ability to interact socially and to maintain concentration. (Finding 5, Tr. 19). Rather than contradicting the ALJ's finding, the GAF scores provide further substantiation.
"A GAF score represents `the clinician's judgment of the individual's overall level of functioning.' The score is taken from the GAF scale, which `is to be rated with respect only to psychological, social, and occupational functioning.' The GAF scale ranges from 100 (superior functioning) to 1 (persistent danger of severely hurting self or others, persistent inability to maintain minimal personal hygiene, or serious suicidal act with clear expectation of death.)" Munson v. Barnhart, 217 F. Supp.2d 162, 164 n. 2 (D. Me. 2002) (quoting American Psychiatric Ass'n Diagnostic and Statistical Manual of Mental Disorders 32, 34 (4th ed., text rev. 2000)).
Although Mrs. DiBenedetto does not raise the issue explicitly in her brief, her contentions might be read to argue that the ALJ did not give proper weight to the opinion of Nurse Barbiasz, Mrs. DiBenedetto's treating psychiatric professional. In her December 12, 2001 letter, Nurse Barbiasz opined "it would not be advisable for Mrs. DiBenedetto to take a job which would take her out of the home." (Tr. 177). While SSA regulations tend to give greater weight to the opinions of treating sources, statements, such as those of Nurse Barbiasz, are not dispositive. 20 C.F.R. § 416.927 (d)(2). The determination of an individual's capacity to function in a work environment and the finding of disability is explicitly reserved to the Commissioner, not a treating professional. See 20 C.F.R. § 416.927 (e)(1) ("We are responsible for making the determination or decision about whether you meet the statutory definition of disability. . . . A statement by a medical source that you are `disabled' or `unable to work' does not mean that we will determine that you are disabled.") Granted, "[t]he ALJ may not `substitute his own layman's opinion for the findings and opinion of a physician.'"Chelte v. Apfel, 76 F. Supp.2d 104, 109 (D. Mass. 1999) (quoting Gonzalez Perez v. Sec'y of Health Human Servs., 812 F.2d 747, 749 (1st Cir. 1987)). Here however, the ALJ relied not on his own opinion but on the reports of Dr. Senger and Dr. Rosenblum, both of whom examined Mrs. DiBenedetto and found that she had only moderate limitations on her ability to function. Moreover, in contrast to the more specific reports of these physicians, Nurse Barbiasz's letter simply makes the conclusory statement that "it would be not be advisable" for the claimant to work, providing no explanation or specific supporting evidence. SSA regulations direct that medical opinions unsupported by relevant evidence or explanations not be given substantial weight. 20 C.F.R. § 404.27 (d)(3). The ALJ here was reasonable in his consideration of Nurse Barbiasz's opinion.
Nurse Barbiasz, of course, could have been a significantly more useful source of information regarding Mrs. DiBenedetto's mental health. The record indicates that she treated Mrs. DiBenedetto's depression monthly for approximately 14 months at the time of the ALJ hearing (October 2001-December 2002) (Tr. 39, 177, 179). Conspicuously missing from the record, however, are the medical records from Lawrence Memorial Hospital documenting these visits. I recognize that while the claimant bears the burden of proof on the issue of disability, Small v. Califano, 565 F.2d 797, 800 (1st Cir. 1977), the Commissioner also has a certain obligation to develop an adequate record from which a reasonable conclusion can be drawn. See Miranda v. Sec'y of Health, Ed., and Welfare, 514 F.2d 996, 998 (1st Cir. 1975). I find the ALJ here adequately discharged this duty to develop. Among other things, he questioned Mrs. DiBenedetto about her depression and the course of treatment she was receiving. He also specifically alerted Mrs. DiBenedetto's attorney that the records from Lawrence Memorial Hospital would be helpful (Tr. 39-40). Since these records are missing from the record, it appears the suggestion was not followed to completion.
Evaluating the record as a whole, I find substantial evidence supports the ALJ's conclusion that neither Mrs. DiBenedetto's physical nor her mental impairments prevent her return to work as an assembler.
C. Application of the "Grid"
Mrs. DiBenedetto also contends that the ALJ erred in using the "Grid" in his analysis because she suffers from nonexertional limitations. She asserts that given the presence of these impairments, the ALJ was obligated to use a vocational expert to determine whether she could be gainfully employed.
But the Grid is a tool utilized at question five. At that stage of the sequential analysis, the burden is on the Commissioner to demonstrate that there are jobs in the national economy that a claimant can perform. Pelletier, 525 F.2d at 160. Where a claimant's impairments are only exertional, the Grid provides a streamlined method by which the Commissioner can carry this burden. 20 C.F.R. Part 404, Subpart P, Appendix 2; see, e.g., Sherwin v. Sec'y of Health Human Servs., 685 F.2d 1, 1 (1st Cir. 1982). And, where a claimant has nonexertional impairments in addition to exertional limits, the Grid may not accurately reflect the availability of jobs such a claimant could perform.Heggarty v. Sullivan, 947 F.2d 990, 996 (1st Cir. 1991). If the occupational base is significantly limited by a nonexertional impairment, the Commissioner may not rely on the Grid to carry the burden of proving that there are other jobs a claimant can do. Id. Usually, testimony of a vocational expert is required.Id., see also Ramos v. Sec'y of Health Human Servs., 514 F. Supp. 57, 64 (D.P.R. 1981).
However, the inquiry proceeds to question five only if the ALJ finds that the claimant is unable to perform her past relevant work (question four). At question four, if the claimant fails to meet her burden of proving that her impairments prevent her from working her former jobs, the ALJ will find her not disabled, and the inquiry ends there. That is what happened here. The ALJ determined that Mrs. DiBenedetto had not met her initial burden at question four. His inquiry never proceeded to question five, never necessitating an application of the Grid or testimony by a vocational expert. In context, it appears that the ALJ referenced the Grid in his decision as an additional finding with respect to asserted exertional limitations. It was neither necessary to nor dispositive of the question of Mrs. DiBenedetto's disability. Thus, while her legal analysis regarding the application of the Grid in cases of nonexertional impairments is essentially sound, it is not particularly relevant. The ALJ did not err in his application of the appropriate analysis, and, as discussed in Section II.B.,supra, his findings terminating at question four are supported by substantial evidence.