Knox v. Comm Social Security ( 2003 )

Opinions of the United
2003 Decisions States Court of Appeals
for the Third Circuit
3-19-2003
Knox v. Comm Social Security
Precedential or Non-Precedential: Non-Precedential
Docket 02-3208
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NOT PRECEDENTIAL
UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT
No. 02-3208
KAREN MARIE KNOX,
Appellant
v.
JO ANNE B. BARNHART,
Commissioner of Social Security
On Appeal from the United States District Court
for the Eastern District of Pennsylvania
(D.C. Civil No. 01-cv-03467)
District Judge: Hon. Ronald L. Buckwalter
Submitted Under Third Circuit LAR 34.1(a)
March 10, 2003
Before: SLOVITER, NYGAARD, and ALARCÓN*, Circuit Judges
(Filed: March 19, 2003)
OPINION OF THE COURT
* Hon. Arthur L. Alarcón, Senior Judge, United States Court of Appeals for the Ninth
Circuit, sitting by designation.
SLOVITER, Circuit Judge.
Appellant Karen Marie Knox appeals from the decision of the District Court
granting summary judgment to the Commissioner of Social Security who denied Knox’s
claim for supplemental security income (SSI) under the Social Security Act. We will
remand for further proceedings.
I.
Facts and Procedural History
As the parties are familiar with the facts and the procedural history, we will refer
only to those necessary for our decision.
A.
Knox filed a claim for supplemental security income on September 30, 1997,
alleging disability beginning May 1, 1997, due to depression, an anxiety disorder, panic
attacks and agoraphobia. Her application was denied initially and again on reconsideration.
Knox appealed the denial, and the administrative law judge (ALJ) held hearings on June 9,
1999 and September 24, 1999, and found that Knox was not entitled to benefits.
B.
Knox was born on November 13, 1957 and has a tenth grade education level. Her
employment record includes work as a cashier at a Rite-Aid pharmacy four days a week for
several months during 1997 and 1998, as well as work as a housekeeper, babysitter, and in
hairdressing. She lives with her ex-husband and children, does some light household
chores, including cooking and cleaning, and goes out in public. Her medical records begin
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with an involuntary mental health commitment on November 6, 1992, based on allegations
of homicidal and suicidal conduct. Since this first admittance, Knox has been hospitalized
on numerous occasions. She has been hospitalized following a suicide attempt and for
intoxication, and she has gone to the Emergency Room when she had feelings of anxiety.
She has also been admitted into both inpatient and outpatient mental health treatment
centers for anxiety, depression, and panic attacks, and has attended detoxification centers.
She has a twenty-year history of alcohol abuse.
Knox has been diagnosed with depression, panic disorder, acute alcoholic hepatitis,
major depression, anxiety, and a history of alcohol and drug abuse. In fact, physicians at the
numerous centers at which Knox has received treatment have noted incidents of substance
abuse, with numerous physicians prescribing a detoxification program. Treatment notes
from her participation in the Milestones Community Healthcare Drug and Alcohol Program
partial hospitalization program indicate that Knox frequently failed to attend meetings of
Alcoholism Anonymous and had problems with her attendance in the partial program. Dr.
Giannasio, her treating physician, diagnosed her with major depression, psychosis, and
continuous alcohol dependence.
Dr. Giannasio completed interrogatories in which he answered that Knox’s
psychoses would not change even without the influence of drugs and alcohol. At the
hearing before the ALJ, a non-treating medical expert, Dr. Cohen, testified that Knox’s
primary problem was a substance addiction disorder, but he was unable to say if there was
“an affective disorder going on.” Transcript at 405. He also stated that while alcoholism
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and drug abuse can cause depression, persons suffering from depression and other
disorders may self-medicate with alcohol. Transcript at 407-08.
The ALJ issued an opinion on January 24, 2000, finding that although Knox suffers
from a severe impairment, she is not disabled because substance abuse is a factor material
to the determination of her disability. This decision was adopted as the final decision of
the Commissioner. Knox filed suit seeking judicial review of the final decision of the
Commissioner under 42 U.S.C. § 405(g). The District Court granted the Commissioner’s
motion for summary judgment for the closed period at issue,
from September 30, 1997 through July 10, 2001. Knox had filed a new claim for SSI on
July 11, 2001, for which Knox has been determined to be qualified. Knox appeals from the
order granting summary judgment for the Commissioner for the earlier period. We have
jurisdiction pursuant to 28 U.S.C. § 1291.
II.
Discussion
To prove disability under the Social Security Act, Knox must demonstrate that there
is a “medically determinable basis for an impairment” that prevents her from engaging in
“substantial gainful activity.” Stunkard v. Sec. of Health and Human Servs., 841 F.2d 57, 59
(3d Cir. 1988); see also 20 C.F.R. § 404.1505(a) (providing basic definition of disability
under SSA). A claimant is not considered disabled “if alcoholism or drug addiction would
(but for this subparagraph) be a contributing factor material to the Commissioner’s
determination that the individual is disabled.” 42 U.S.C. § 423(d)(2)(C) (Supp. 2002).
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Our review of the Commissioner’s final decision is limited to determining whether
it is supported by substantial evidence. Hartranft v. Apfel, 181 F.3d 358, 360 (3d Cir.
1999). Substantial evidence “‘does not mean a large or significant amount of evidence, but
rather such relevant evidence as a reasonable mind might accept as adequate to support a
conclusion.’” Id. (quoting Pierce v. Underwood, 487 U.S. 552, 565 (1988)). The
Commissioner does not contest Knox’s challenge that the ALJ’s decision was not
supported by substantial evidence in the record. Rather, the Commissioner requests
remand to the ALJ because of conflicting evidence in the record and to more fully develop
the record.
Knox argues that instead of remanding we should reverse the ALJ’s denial of her SSI
application. However, the record does not contain substantial evidence to support a finding
that Knox suffers from a disability independent of her substance abuse. The most
significant evidence Knox produced, the testimony of her treating physician, Dr. Giannasio,
does not provide a sufficient evidentiary basis to support such a determination. Although
the ALJ should give great weight to the opinions of a treating physician, if the opinion of
the treating physician and the non-treating physician conflict, the ALJ may “choose whom
to credit but ‘cannot reject evidence for no reason or for the wrong reason.’” Morales v.
Apfel, 225 F.3d 310, 317 (3d Cir. 2000) (citation omitted). The ALJ may even choose to
reject the treating physician’s opinion on the basis of contradictory medical evidence. Id.The ALJ rejected Dr. Giannasio’s testimony based on the testimony of Dr. Cohen, a
non-treating medical expert, and on other evidence in the record. First, the ALJ found that
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the questions asked of Dr. Giannasio were leading. Second, Dr. Giannasio failed to provide
support for his conclusions. Third, the responses he gave were inconsistent with his own
contemporaneous findings. Finally, Dr. Giannasio’s opinions were based on a lack of full
disclosure by Knox about her history of drug and alcohol abuse.
Furthermore, the record is not fully developed. Presently, the only expert evidence
that the ALJ cited in support of the conclusion that there would be no psychiatric
impairment of any kind “but for” active substance abuse, is that of the non-examining
medical expert, Dr. Cohen. The Commissioner notes that Dr. Cohen offered conflicting
testimony about whether Knox would suffer from these impairments if she stopped abusing
drugs and alcohol. At one point in the hearing, Dr. Cohen testified that substance addiction
was Knox’s sole impairment. Transcript at 405, 407. Later, however, he stated that he did
not know and “can’t even say” if Knox suffered from depression independent of her drug
and alcohol dependence. Transcript at 405, 407-08.
This case is unlike our decision in Podedworny v. Harris, 745 F.2d 210(3d Cir. 1984), where we reversed an adverse disability determination without requiring
additional hearings because there had already been two proceedings before the ALJ and we
concluded that “it would be virtually impossible to adduce new. . .evidence that would be
necessary to support a finding that [the appellant] is not disabled.” 745 F.2d at 223. In the
present case, as the Commissioner agrees, additional expert testimony, as well as other
supplemental evidence, is necessary to develop a record upon which Knox’s disability
application can be analyzed. Allowing further evidence to be adduced will enable the ALJ,
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the designated fact-finder, to make a finding whether Knox’s impairment was induced by
substance abuse.
Knox asserts that an accurate assessment of her condition can only be made by an
examining or treating physician, and that additional testimony from a non-treating medical
expert will be unclear and uncertain. Admittedly, Dr. Cohen stated he could do little more
than “guess” as to the effects of Knox’s substance abuse upon her potential underlying
mental impairments. Transcript at 368. Nonetheless, remand is still appropriate.
The regulations provide that if the Commissioner finds the evidence provided by the
claimant to be inadequate in determining whether the claimant is disabled, the
Commissioner can take a variety of steps to augment the medical evidence, 20 C.F.R. §
416.912(e), including affirmatively seeking clarification from the treating physician, 20
C.F.R. § 416.912(e)(1), and/or calling another expert, 20 C.F.R. § 416.927(f)(2)(iii). A
remand will provide the ALJ and the Commissioner with the opportunity to seek further
clarification and to allay some of the concerns with Dr. Giannasio’s prior testimony.
Although Knox has already received a favorable decision for the period beyond that
at issue here, from September 30, 1997 through July 10, 2001, that does not signify that
Knox was disabled for the earlier period. Only a new determination based on substantial
evidence in a supplemented record can so determine.
III.
Conclusion
For the reasons set forth, we will vacate the District Court’s order granting summary
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judgment for the Commissioner and will remand to the District Court with directions to
remand to the Commissioner for further proceedings.
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_______________________
TO THE CLERK:
Please file the foregoing opinion
/s/ Dolores K. Sloviter
Circuit Judge
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