Burleson v. Berryhill

MOTION for Summary Judgment - Social Security

W.D.N.C.April 5, 2017

1 IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF NORTH CAROLINA CHARLOTTE DIVISION FILE NO. 5:16-00195 RUTH ANNE BURLESON ) SSN# XXX-XX-7537 , ) Plaintiff, ) ) ) vs. ) ) ) CAROLYN COLVIN ) Acting Commissioner of the ) Social Security Administration, ) Defendant. ) __________________ ___________________ ) NOW COMES Plaintiff, Ruth Anne Burleson, by and through her undersigned counsel, and pursuant to 42 U.S.C. § 405(g), Rule 7(b) and 56 of the Federal Rules of Civil Procedure, Local Rule 7.1, the Western District of North Carolina’s Social Security Briefing Order and the Court’s January 3, 2017 Scheduling Order, and moves the Court to grant her relief from Defendant's final decision denying Plaintiff's claim for disability under Title II of the Social Security Act. In support of this Motion, Plaintiff files herewith a supporting brief and, in reliance thereon and on the facts of record, prays this Court to: 1. Reverse the final decision of the Defendant and order her to award Plaintiff the benefits to which Plaintiff is entitled; or 2. In the alternative, to reverse the final decision of the Defendant and remand Plaintiff's case for further proceedings consistent with applicable law, Circuit precedent and this Court's instructions. PLAINTIFF’S MOTION FOR JUDGMENT REVERSING OR MODIFYING THE DECISION OF THE COMMISSIONER OF THE SOCIAL SECURITY ADMINISTRATION OR REMANDING THE CAUSE FOR A REHEARING Case 5:16-cv-00195-RJC Document 11 Filed 04/05/17 Page 1 of 3 2 Respectfully submitted, this 5 th day of April, 2017. SASSER LAW FIRM, P.A. Attorney for Plaintiff s/Evan Metaxatos Evan Metaxatos 1011 East Morehead Street Suite 350 Charlotte, NC 28204 Phone: (704) 342-4200 Fax: (704) 342-0798 NC Bar #39918 emetaxatos@sasserlawoffice.com Case 5:16-cv-00195-RJC Document 11 Filed 04/05/17 Page 2 of 3 3 CERTIFICATE OF SERVICE Counsel for the Plaintiff certifies that the foregoing Plaintiff’s Motion for Judgment Reversing or Modifying the Decision of the Commissioner of the Social Security Administration or Remanding the Cause for a Rehearing was filed using the Court’s CM/ECF system which will send electronic notification and service of the document to: Social Security Administration (SSA) Bos.ecf.wdnc@ssa.gov This the 5 th day of April, 2017. Counsel for Plaintiff SASSER LAW FIRM, P.A. Attorney for Plaintiff s/Evan Metaxatos Evan Metaxatos 1011 East Morehead Street Suite 350 Charlotte, NC 28204 Phone: (704) 342-4200 Fax: (704) 342-0798 NC Bar #39918 emetaxatos@sasserlawoffice.com Case 5:16-cv-00195-RJC Document 11 Filed 04/05/17 Page 3 of 3 1 IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF NORTH CAROLINA CHARLOTTE DIVISION FILE NO. 5:16-00195 RUTH ANNE BURLESON ) SSN# XXX-XX- 7537, ) Plaintiff, ) ) ) vs. ) ) ) CAROLYN COLVIN ) Acting Commissioner of the ) Social Security Administration, ) Defendant. ) __________________ ___________________ ) By this action, the Plaintiff, Ruth Anne Burleson, seeks judicial review pursuant to 42 U.S.C. § 405(g) of the Defendant's final decision denying the Plaintiff's claim for disability benefits under Title II of the Social Security Act. Pursuant to Local Rule 7.1, the Western District of North Carolina’s Social Security Briefing Order and the Court’s January 3, 2017 Scheduling Order, Mrs. Burleson files this brief in support of and contemporaneously with Plaintiff’s Motion for Judgment Reversing Or Modifying The Decision Of The Commissioner Of The Social Security Administration Or Remanding The Cause For A Rehearing. PLAINTIFF’S MEMORANDUM IN SUPPORT OF HER MOTION FOR JUDGMENT REVERSING OR MODIFYING THE DECISION OF THE COMMISSIONER OF THE SOCIAL SECURITY ADMINISTRATION OR REMANDING THE CAUSE FOR A REHEARING Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 1 of 15 2 I. Summary of Case From 1995 until 2011, when her medical impairments forced her to leave, Mrs. Burleson worked as a nurse for a series of nursing homes and hospitals. R. 28, 215. Mrs. Burleson suffers from, inter alia, myasthenia gravis, cysts of the back and neck post-surgery, cervical and lumbar radiculopathy, disc osteophyte complex, degenerative disc disease of the lumbar spine, fibromyalgia, tendinitis of the right shoulder, bilateral carpal tunnel syndrome, osteoarthritis, gout, polyneuropathy, obstructive sleep apnea, anxiety and depression. R. 20. Mrs. Burleson is treated for her medical impairments by the following health care professionals:  Raj Kumar Joshi, MD – A board certified internist and Mrs. Burleson’s primary care physician. Dr. Joshi diagnosed Mrs. Burleson with, inter alia, depressive disorder and anxiety, two impairments never mentioned by the ALJ. R. 692, 700; See R. 18-30.  Edward Gray Hill, MD – A board certified neurologist at Salem Neurological, who, inter alia, treated Mrs. Burleson for her radiculopathy and carpal tunnel syndrome. On October 10, 2011, Dr. Hill wrote “[o]bviously there is no way she can return to gainful employment at this time. Her temporary disability needs to be continued.” R. 284.  Douglas Dussel Pritchard, MD – A physician board certified in anesthesiology and pain management. Dr. Pritchard’s objective physical examination of Mrs. Burleson noted, inter alia, decreased bilateral grip strength, numbness in both hands, loss of sensation below both knees and muscle weakness. R. 368.  Michael Dennis Getter, MD – A board certified orthopedic surgeon, Dr. Getter noted 16 our Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 2 of 15 3 of 16 fibromyalgia trigger points on multiple exams. R. 425, 450. On March 13, 2012, Dr. Getter also performed Mrs. Burleson’s C7-T1 cervical anterior corpectomy and laminectomy. R. 386.  Trishwant Singh Garcha, MD – A physician board certified in neurology, neurophysiology and clinical neurophysiology, Dr. Garcha diagnosed Mrs. Burleson with Myasthenia Gravis and wrote three opinion letters in support of Mrs. Burleson’s disability. R. 478, 552-552, 568, & 741-743. The ALJ never mentions Mrs. Burleson’s Myasthenia Gravis in her decision. See R. 18-30. In his final opinion letter, Dr. Garcha noted, In summary, while Mrs. Burleson suffers from a variety of medical and musculoskeletal problems, she has two definite processes which resultant [sic] definite muscle weakness which cause her definite disability. The first process is that of a low cervical-upper thoracic spinal cord involvement by an epidural cyst mass like structure which caused spinal cord involvement (Myelopathy) and resultant permanent leg weakness, bladder involvement, spasticity, and limb ataxia. While surgically corrected with decompressive surgery, the epidural cyst has returned in a smaller but persistent manner and still causes some residual symptoms. The second process is that of her Myasthenic syndrome, which appears to be progressively worsening with increasing waxing and waning weakness and intermittent diplopia. R. 742. Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 3 of 15 4 On February 10, 2012, Mrs. Burleson filed an application for Title II Social Security disability benefits, alleging a disability beginning on May 27, 2011. R. 174-176. Mrs. Burleson’s date last insured is December 31, 2015. R. 59. Mrs. Burleson has at least a high school education and was born on August 30, 1966, making her a younger individual as of her alleged onset of disability, but a person closely approaching advanced age as of August 30, 2016. R. 198, 204 CFR § 404.1563. In the March 10, 2015 Administrative Law Judge (“ALJ”) decision giving rise to this action, the ALJ found that Mrs. Burleson had not engaged in substantial gainful activity since her alleged onset date. R. 20. The ALJ found that Mrs. Burleson had severe impairments of tendinitis of the right shoulder, fibromyalgia, bilateral carpal tunnel syndrome, osteoarthritis, gout, polyneuropathy, degenerative disc disease of the lumbar spine, obstructive sleep apnea, cysts of the back and neck post-surgery, cervical and lumbar radiculopathy, and disc osteophyte complex. Id. The ALJ further found that Mrs. Burleson did not have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, App’x 1. R. 21. Instead, the ALJ found that Mrs. Burleson retained the residual functional capacity (“RFC”) to perform a reduced range of sedentary work. R. 25. While the ALJ acknowledged that Mrs. Burleson's RFC precluded her past relevant work, the ALJ denied Mrs. Burleson at the fifth step of the sequential evaluation process by concluding that, given “the claimant’s age, education, work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that the claimant can perform.” R. 28-29. Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 4 of 15 5 For all of the reasons stated herein, Plaintiff prays the Court to reverse the final decision of the Defendant Commissioner and award her benefits. In the alternative, Plaintiff prays the Court to remand the cause for further proceedings. II. Procedural History On February 10, 2012, Mrs. Burleson filed a claim for Title II Social Security disability benefits, alleging a disability beginning May 27, 2011. R. 174-176. Mrs. Burleson's claim was denied and appealed through the administrative stages of the Social Security system. R. 59-69, 71-85. On February 12, 2015, Mrs. Burleson appeared at a video hearing before an ALJ. R. 18. In a decision dated March 10, 2015, the ALJ denied Mrs. Burleson's claims for disability benefits. R. 15-35. On August 22, 2016, the Appeals Council denied Mrs. Burleson's request for review, leaving the ALJ’s March 10, 2015 decision as the Commissioner’s final administrative decision. R. 1-6. On October 26, 2016, Mrs. Burleson, through the undersigned counsel, filed her complaint seeking judicial review of the Commissioner’s final decision. III. Standard of Review and Relevant Law The Commissioner uses a five step process to evaluate a disability claim. The Commissioner asks, in sequence, whether the claimant: (1) worked at the substantial gainful activity level during the alleged period of disability; (2) had a severe impairment; (3) had an impairment that met or equaled the severity of a listed impairment; (4) could return to his past relevant work; and (5) if not, Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 5 of 15 6 could perform any other work in the national economy. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4) (2010). Under the Social Security Act, the court reviews the issues of whether the Commissioner applied the correct legal standards and whether the Commissioner's decision is supported by substantial evidence. See Richardson v. Perales, 402 U.S. 389, 390, 91 S. Ct. 1420, 1422, 28 L. Ed. 2d 842 (1971); Walls v. Barnhart, 296 F.3d 287, 290 (4th Cir. 2002); Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir. 1990). A necessary predicate to engaging in substantial evidence review is a record of the basis for the ALJ's ruling. See Gordon v. Schweiker, 725 F.2d 231, 235 (4th Cir. 1984). The record should include a discussion of which evidence the ALJ found credible and why, and specific application of the pertinent legal requirements to the record evidence. Hines v. Bowen, 872 F.2d 56, 59 (4th Cir. 1989). If the reviewing court has no way of evaluating the basis for the ALJ's decision, then "the proper course, except in rare circumstances, is to remand to the agency for additional investigation or explanation." Florida Power & Light Co. v. Lorion, 470 U.S. 729, 744, 105 S. Ct. 1598, 84 L. Ed. 2d 643 (1985). See also Radford v. Colvin, 734 F.3d 288, 295 (4th Cir. N.C. 2013). The Commissioner has the burden of proof at step 5 to show that Mrs. Burleson retains the capacity to perform alternative work activities and that specific jobs exist in the national economy that she can perform. Bowen v. Yuckert, 482 U.S. 137, 146 (1987); Grant v. Schweiker, 699 F.2d 189, 191 (4th Cir. 1983). Finally, the Commissioner can only defend her decision based on the reasons articulated by Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 6 of 15 7 the Administrative Law Judge and she cannot offer alternative grounds upon judicial review. SEC v. Chenery Corp., 318 U.S. 80, 87 (1943); Patterson v. Bowen, 839 F.2d 221, 225 (4th Cir. 1988). IV. Issues Presented 1. Whether ALJ erred in failing to address and evaluate all of Mrs. Burleson’s medical impairments. 2. Whether the ALJ erred in her evaluation of Mrs. Burleson’s opinion evidence. V. Argument 1. The ALJ erred in failing to address and evaluate all of Mrs. Burleson’s medical impairments. The Social Security Administration (“SSA”) employs a five-step sequential evaluation process to determine whether a claimant is disabled. 20 C.F.R. § 404.1520; Hancock v. Astrue, 667 F.3d 470, 472-73 (4th Cir. 2012). At the second step of this evaluation, the SSA is tasked with considering whether any of a claimant’s medical impairments are “severe.” 20 C.F.R. § 404.1520(a)(4)((ii). Even if a claimant’s medically determinable impairments are not severe, however, the SSA must consider the limiting effects of all of a claimant’s impairments in formulating a claimant’s residual functional capacity (“RFC”). 20 C.F.R. § 404.1545(e). In considering the claimant’s severe and non-severe impairments, the SSA must evaluate all relevant record evidence. Patterson v. Comm'r of SSA, 846 F.3d 656, 659 (4th Cir. 2017). This RFC assessment is a holistic and fact-specific evaluation; the ALJ cannot conduct it properly without reaching detailed conclusions at step 2 concerning the type and severity of the claimant's impairments. Id. Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 7 of 15 8 In the present case, the ALJ failed to mention, let alone analyze, some of Mrs. Burleson’s most substantial medical impairments; an error that requires remand. Id. a. Myasthenia Gravis During Mrs. Burleson’s hearing the following exchanges occurred between her and the ALJ: Q: Why can’t you do these things that you used to do? A: Well, because of the – my spine is ceased up and I have myasthenia gravis with chronic fatigue. It’s just - - Q: Now what is that which you just said? A: The myasthenia gravis - - Q: Yes ma’am. A: -- is a neuromuscular disease. Q: And what are the symptoms with that? A: Oh, I get real tired real easily. I -- it comes on -- the spell can come on suddenly. I get blurred vision. Q: And who diagnosed you with that? A: Dr. Gurcha [PHONETIC] in Statesville Neurologists. . . . Q: Has your condition gotten any worse or better or stayed the same since you stopped working back in May of 2011? A: It’s – as you can look at the diagnosis, it’s gotten worse for all of them and the worst was, like I said, I thought I had multiple sclerosis, but it’s the myasthenia gravis and it’s – it’s a terrible disease. Q: All Right. Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 8 of 15 9 A: I have to – if I eat, I keep water with me at all times because I’m scared if my muscles go limp, food won’t go down. I’ve had to spit food out before. I have to be very careful. R. 48, 51-52. For his part, Dr. Garcha also took Mrs. Burleson’s Myasthenia Gravis seriously. Dr. Garcha noted in his second opinion letter supporting Mrs. Burleson’s disability that her repetitive nerve stimulation findings were “supportive of a myastheme syndrome/process” and that “she does appear to have a component of myasthema.” R. 552. Dr. Garcha formally diagnosed Mrs. Burleson’s Myasthenia Gravis in April 2013. R. 568. In his third opinion letter, Dr. Garcha concludes that Mrs. Burleson’s Myasthenia Gravis is one of two “definite processes” causing muscle weakness, diplopia, swallowing difficulty and her resultant disability. R. 742. Despite the severity of Mrs. Burleson’s Myasthenia Gravis, the ALJ never mentions it as a severe impairment. R. 20. The ALJ never mentions Mrs. Burleson’s Myasthenia Gravis as a non-severe impairment. R. 20-21. The ALJ never mentions whether Mrs. Burleson met listing 11.12 for Myasthenia Gravis. R. 21-22; See 20 CFR Part 404, Subpart P, App’x 1. 1 The ALJ never mentions Myasthenia Gravis at all. Though the ALJ notes that her list of non-severe impairments considered is not exclusive, the ALJ nevertheless “leaves us to wonder” whether Mrs. Burleson’s Myasthenia Gravis was ever considered, a mystery which precludes “meaningful review.” Fox v. Colvin, 632 Fed. Appx. 750, 755 (4th Cir. 2015), citing Mascio v. Colvin, 780 F.3d 632, 638 (4th Cir. 2015). As a result, Mrs. Burleson’s claim should be remanded for further proceedings so that her Myasthenia Gravis can be properly assessed and so that the SSA can determine whether her Myasthenia Gravis meets a listing, and if not, how her 1 Given Mrs. Burleson’s complaints of difficulty swallowing, she also arguably meets Listing 11.12 for Myasthenia Gravis as the listing was structured at the time of the decision. See DI 34131.013 Neurological Listings from 12/15/04 to 09/28/16, available at https://secure.ssa.gov/poms.nsf/lnx/0434131013. Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 9 of 15 10 Myasthenia Gravis nevertheless affects her RFC. b. Depression and Anxiety Mrs. Burleson was also diagnosed with both depression and anxiety by her primary care doctor, Dr. Joshi, over multiple office visits. See R. 692, 700, 704, 707. Mrs. Burleson also alleged cognitive impairments, noting on a Disability Report submitted to the SSA that “I don’t think to [sic] clearly, its like I am in a fog.” R. 231. Despite this, the ALJ failed to evaluate the severity of Mrs. Burleson’s mental health impairments pursuant to SSA’s special technique. See 20 C.F.R. § 404.1520a; Patterson v. Comm'r of SSA, 846 F.3d at 659. Since the ALJ never mentioned Mrs. Burleson’s mental health impairments in her decision, the SSA is precluded from doing so now and the SSA’s final decision should be reversed or remanded for further proceedings to ascertain the limiting effects of her mental health impairments. Chenery Corp., 318 U.S. at 87. 2. The ALJ erred in her evaluation of Mrs. Burleson’s opinion evidence. The ALJ also erred in failing to properly consider the medical source opinions of a number of Mrs. Burleson’s treating physicians. As a result, Mrs. Burleson’s claim should be reversed or remanded for further proceedings in order to properly evaluate all of her opinion evidence. a. Dr. Leo Young’s Opinion Evidence On July 13, 2011, Leo Young, MD, the claimant’s treating physician, completed a Standard Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 10 of 15 11 Insurance Company Questionnaire in which he assessed Mrs. Burleson as having the following limitations:  Can sit, stand and walk, only 2 hours out of a total work day of only 4 hours. R. 330.  Can occasionally lift 11-20 lbs; Can occasionally carry, push and pull 1-10 lbs. R. 330.  Cannot use hands for repetitive action such as pushing/pulling. R. 330.  Can occasionally bend, stoop, climb stairs, reach at shoulder level, reach below shoulder level, reach above shoulder level. R. 331. The ALJ gave Dr. Young’s opinion partial weight. R. 27. The ALJ further explained that Mrs. Burleson was capable of working a full eight hour day, though she was limited to sedentary work. R. 27. The ALJ stated that otherwise, “[h]owever, the remaining limitations given by Dr. Young are supported by the medical evidence as the claimant has had a negative carpal tunnel test, has a normal gait and testified that she can drive a car over an hour and shop” Id. (emphasis added). This is a confusing sentence. If the remaining limitations given by Dr. Young are supported by the medical evidence, then the ALJ erred by failing to incorporate these same limitations into Mrs. Burleson’s RFC. The SSA’s final decision should be reversed or remanded. b. Dr. Garcha’s Opinion Evidence Adjudicators at the hearing level or at the Appeals Council level must consider the findings from medical sources even though they are not bound by them. SSR 16-3p, 81 Fed. Reg. 51, 14166 (March 16, 2016). Mrs. Burleson’s treating neurologist, Trishwant S. Garcha, MD, submitted two, independent opinion letters prior to Mrs. Burleson’s ALJ hearing, and another before the Appeals Council. The SSA adjudicators, however, only considered one. Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 11 of 15 12 Dr. Garcha’s second letter is undated, but includes a fax stamp of June 12, 2013. R. 552-553. In his letter, Dr. Garcha writes that Mrs. Burleson, inter alia:  “can only sit, stand or walk for brief periods ranging from 5 to 10 up to 15 to 20 minutes. She can only sit for 15 to 20 minutes and then has to stand or move.”  Bending and stooping are very difficult.  She cannot kneel or crawl.  Climbing is difficult but she’s able to go up approximately 8-10 steps, often sideways and with a railing or a cane.  Reaching at shoulder level is occasionally done for brief periods.  She cannot lift more than 3 to 4 pounds.  “In my medical opinion, I do not think Ms. Burleson is capable of working in any meaningful way at this time.” R. 552-553. Dr. Garcha corroborated his findings with citation to Mrs. Burleson’s nerve conduction studies, repetitive nerve stimulation and bloodwork. R. 552. Despite this, Dr. Garcha’s second opinion is never so much as mentioned. R. 27-28. Dr. Garcha’s third opinion letter is dated March 25, 2017, after the ALJ’s decision. R. 741-743. Dr. Garcha notes, however, that much of the information in the letter derived from a review of her medical records prior to February 2012, followed by his own direct involvement in Mrs. Burleson’s care from that time forward. R. 741. Nevertheless, SSA’s Appeals Council failed to address Dr. Garcha’s third opinion letter in denying Mrs. Burleson’s request for review. R. 1-3. Since Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 12 of 15 13 adjudicators at the hearing level or at the Appeals Council level must consider the findings from medical sources even though they are not bound by them, the SSA’s denial of Mrs. Burleson’s claim should be reversed or remanded for additional proceedings. SSR 16-3p. The ALJ only considers Dr. Garcha’s November 11, 2012 opinion statement (though the ALJ repeatedly refers to Dr. Garcha as “Dr. Garcia”), and gives the opinion little to no weight. R. 27-28. This finding is also in error. When evaluating medical opinions, the ALJ should consider, inter alia, “(1) whether the physician has examined the applicant, (2) the treatment relationship between the physician and the applicant, (3) the supportability of the physician's opinion, (4) the consistency of the opinion with the record, and (5) whether the physician is a specialist." Johnson v. Barnhart, 434 F.3d 650 (4th Cir. 2005); 20 C.F.R. § 404.1527. Courts generally accord greater weight to the testimony of a treating physician because the treating physician has necessarily examined the applicant and has a treatment relationship with the applicant. Fox v. Colvin, 632 Fed. Appx. 750, 756 (4th Cir. 2015); See also Hines v. Barnhart, 453 F. 3d 559, 563 (4th Cir. 2006); 20 CFR § 404.1527. Thus, "a treating physician's opinion on the nature and severity of the claimed impairment is entitled to controlling weight if it is well supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in the record." Mastro v. Apfel, 270 F.3d 171, 178 (4th Cir. 2001); See also 20 CFR § 404.1527(c)(2). The ALJ should have given controlling weight to Dr. Garcha’s first opinion letter. Dr. Garcha is a treating specialist, who examined Mrs. Burleson numerous times and corroborated his findings with objective, diagnostic testing, Instead, the ALJ saw fit to give more weight to Social Security’s own state Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 13 of 15 14 agency doctor, who never examined Mrs. Burleson. R. 28. Dr. Garcha’s first opinion is also not “inconsistent with the other substantial evidence in the record.” Mastro, 270 F.3d at 178. The ALJ attempts to make this case by noting that “the medical evidence has shown that the claimant had a normal gait, a negative straight leg test and negative carpal tunnel findings.” R. 27-28. But these findings are in no way inconsistent with Mrs. Burleson’s Myasthenia Gravis, which, as discussed supra, the ALJ fails to even mention in her opinion. As a result, the ALJ failed to show that Dr. Garcha’s first opinion was inconsistent with the other substantial evidence in the record and she erred in giving Dr. Garcha’s first opinion letter little to no weight. Therefore, the ALJ’s final decision should be reversed or remanded for further proceedings. VI. Conclusion and Relief Requested For all of the reasons stated above, Plaintiff prays the Court to reverse the final decision of the Defendant Commissioner and award her benefits. In the alternative, Plaintiff prays the Court to remand the cause for further proceedings. Respectfully submitted, this 5 th day of April, 2017. SASSER LAW FIRM, P.A. Attorney for Plaintiff s/Evan Metaxatos Evan Metaxatos 1011 East Morehead Street Suite 350 Charlotte, NC 28204 Phone: (704) 342-4200 Fax: (704) 342-0798 NC Bar #39918 emetaxatos@sasserlawoffice.com Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 14 of 15 15 CERTIFICATE OF SERVICE Counsel for the Plaintiff certifies that the foregoing Plaintiff’s Memorandum in Support of Her Motion for Judgment Reversing or Modifying the Decision of the Commissioner of the Social Security Administration or Remanding the Cause for a Rehearing was filed using the Court’s CM/ECF system which will send electronic notification and service of the document to: Social Security Administration (SSA) Bos.ecf.wdnc@ssa.gov This the 5 th day of April, 2017. Counsel for Plaintiff SASSER LAW FIRM, P.A. Attorney for Plaintiff s/Evan Metaxatos Evan Metaxatos 1011 East Morehead Street Suite 350 Charlotte, NC 28204 Phone: (704) 342-4200 Fax: (704) 342-0798 NC Bar #39918 emetaxatos@sasserlawoffice.com Case 5:16-cv-00195-RJC Document 11-1 Filed 04/05/17 Page 15 of 15