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w . vi l l a no va . e du/thir dc ir c uit_2004/475NOT PRE CEDENT IAL IN THE UNITED STATES COURT OF APPEALS

FO R T HE TH IRD CIR CU IT

03-3690
CYNTHI A A. MAIORANO, Appellant

v. JOANNE B. BARNHART, COMM ISSI ONER

OF SOCIAL SECURITY

_____________________ On a ppeal from the Un ited States District Co urt for the Dis tri ct of New Jersey Distric t Judg e: Th e H ono rable J erom e B. S iman dle

Distri ct Court No. 01-cv-02535

______________________ Argued June 15, 2004 Be for e: A LIT O, S M ITH AN D B EC KE R, Circuit Judges (Fil ed: July 21, 2004) Robert A. Petruzzel li ( Argued) Jaco bs, Sc hw albe & Petru zelli Ten Melrose Avenue Woodcrest Pavil ion, Sui te 340 Cherry Hill, NJ 08034 Counsel for

Appellant Peter G. O’Malle y ( Argued) Office of the United State s Attorne y 970 Broad Street , Room 700 Newark, NJ 071022

Karen G. Fiszer Social Sec urit

y Adminis tration Off ice of G eneral Co unsel - Re gion II 26 Federal Pl aza New Y ork, NY 10278 Counsel for

Appellee

______________________

OPINI ON OF THE COURT

_____________________ SM ITH , Circuit

Judge. Cynthi a Maiorano appeal s from the Dis tri ct Court’ s order a ffirmi ng the deni al by the Commissione r of SocialSecurit y of her clai m for disabi lit

y benefits under

Titl e II of the S ocia l Se cur ity Ac t. Th e D istrict Co urt h ad ju risdi ction pur sua nt to 28 U .S.C
. § 1331 and 42 U .S.C
. § 405 (g). W e ex ercis e ap pella te jur isdic tion pur sua nt to 28 U .S.C
. § 129 1. Ou r review is “iden tical to tha t of the Distric t Cou rt, nam ely to determ ine w hethe r there is substantial e vidence t o support t he Commissioner’ s decis ion.” Plummer v. Apfel , 186 F.3 d 42 2, 42 7 (3 d C ir. 19 99) ; 42 U.S .C. § 405(g). In Richardson v. Perales , 402 U. S. 389, 401 (1971) , the Supreme Court expl ained that substantia l evide nce is “‘ more than a mere scintill a. It

means such rel evant evi dence as a r easonable mind might acc ept as adequate t o support a

conclusi on.’” Id. (quoti ng Conso lidated Edi son Co . v . N. L.R. B. , 305 U.S. 197, 229 ( 1938)). Because we conclude t hat the Commissioner’ s decis ion was not supported by s ubstant ial e vidence, the Dist rict Court err ed in affi rming the de nial of benefits and we w ill reverse and remand for further proceedings. Maiorano fil ed for benefi ts i n February 1998, al leging di sabil ity on the basi s of3

Thoracic Outl et Syndrome and Reflex Sympatheti c Dystrophy(“RSD”) stemming from an injur y sus taine d when a ceiling til e felland hit t he superi or aspect

of her ri ght shoul der in May 1996. Soci al Security Ruling 03-2p instruc ts that RSD is a ter m used to describe a chronic pa in sy

ndrome that

is manife sted by

“a conste llation of sy

mptoms and signs ,” of which the most c haract eris tic s ign is persi stent , int ense pain t hat appear s “out of proport ion to t

he severi ty

of the i njury

sustained by t

he indivi dual. ” Notably absent from the d iagn ostic crite ria f or th is m alad y is any la bor ator y test or diag nos tic pr oce dur e. Rath er, diag nosis is mad e bas ed on the pre senc e of c om plaints o f pain assoc iated w ith
seve ral othe r physica l findin gs, inclu ding swe lling of the affecte d extre mity, chan ges in skin c olor an d/or tem peratu re, abn orm al hair o r nail gro wth , and in volu ntary mo vem ents of th e affec ted r egio n of the in itial in

jury. Maiorano’s i niti al cours e of tre atment pr ovided some rel ief from her pain, but she was again complaining of pai n in April1997. Dr. Rosenberg, an ort hopedist , evaluated plaintiff. He documented that her neuromotor

examinati on was essenti ally normal, but noted that her “pa in and sy mptoms are way out

of proport ion to any

of her phy sical findings and concerns a bout sy mpatheti c dys trophy

are at play here.” A subsequent evalu ation a t the en d of June 199 7 by ano ther or thop edic su rgeo n, D r. Sm olens ki,
rev eale d “n o ob jectiv e fin din gs to sub stan tiate” M aior ano ’s su bjec tive c om plain ts of pain
. M aioran o’s pa in pers isted an d in S eptem ber 1 997 she c onsu lted D r. Ko rn, a pa in spec ialist wh o had initially evalu ated h er. He treated M aioran o on a w eekly ba sis w ith4

trig ge r p oi ntin

je ct io ns , p er cu tane ous el ec tric alne rv e s timul at io ns , and m ed ic at io n. On January 28, 1998, Dr. Korn documented complai nts of “col dness” i n Maiorano’s r ight upper extr emity , toge ther wit h “bluis h discol orati ons” of the right hand. Physi cal
exa min ation rev eale d th at M aior ano ’s rig ht u ppe r ex trem ity had a de crea sed tem per atur e. Dr. Korn’s pr ogress not e stat ed that , “[i ]n li ght of pers ist ent ri ght upper ext remity pain, dyse sthesi as, and col or change, a consideration of chronic regionalpain sy ndrome ty

pe I ([R SD ]) is m ade .” Maiorano conti nued to exper ience pain in her right ar m accompanied byswelli ng, discoloration, and coldness. Sh e returned to D r. Korn o n a regular b asis for treatmen t. In October 1998, Dr. Korn referr ed Maiorano for a functional c apacit y evaluation. Although physical e valua tion rev ealed that M aioran o’s ran ge of mo tion an d stren gth w ere w ithin
norm al limits, he r com plaints o f pain increa sed w ith the a ctivity, and sh e am bulate d w ith her ri ght arm hel d closely t o her body . The asses sment indi cated t hat al though Maiorano “appeared motivated t o parti cipat e in the examinati on,” she “of fered a submaxi mal perform ance du ring this testing period.” T he exam iner opined , howe ver, that M aiorano’s “pain repo rts appeared c onsistent throug hout” an d that her “rep orts and be haviors w ere consistent with he r diagnos is. ” Subseq uently, Dr. Korn c omp leted a disability form, noting that M aiorano’s diagnosi s was RSD. The physic al fi ndings t o support t he diagnosi s of RSD included pain, num bness, discolora tion and co ld sensation throu ghout M aiorano’s right arm . Dr.5

Ko rn op ined th at M aioran o w as sev erely limited in her a bility to wo rk an d w as un able to per for m any re petitiv e ac ti vi ty

wit h he r r ig htarm. Dr. Korn refer

red Maiorano t o Dr. Rosen. Afte r evaluating Maiorano on December 1, 1998, Dr. Rosen agreed with Dr. Korn that “there is a hi gh likel ihood that she is s ymptomat ic from a t ype Icomplex regi onal pai n syndrome.” After a t rialperiod with a spi nal cord s timul ator s howed favorable r esult s, Dr. Rosen surgic ally implant ed a stimu lator on M arch 3 1, 199 9. M aioran o’s pre - and post-o perativ e diag nose s we re bo th RS D o f the righ t up per extr em ity. Ac cor din g to Dr . Ro sen , M aior ano had a “s upe rb re sult” fro m th e su rge ry. Approximatel y t

wo months after t

he operat ion, Dr. Rosen opined that Maiorano had “excell ent st imulat ion. . . . At rest, she has mini mal pain. ” He documented, however, that “[a]ny ty pe of sust ained activit

y i ncreases her pain. Even doing househol d chores increa ses her pa in subst antia lly . Sit ting in one position for t oo long als o increa ses her pain. She does need to c hange positions t o minimize he r persi stent pain sy ndrome.” That
sam e day, D r. Ros en co mp leted a Lum bar S pinal R esidu al Fu nction al Ca pacity Qu estionn aire, ind icating that M aioran o’s dia gno sis w as R SD of the right up per ex tremity and that the clinical find ings supp orting that diagno sis were “p ain [and] tem perature changes” of t

hat extremity . He opined t hat Maiorano was l imit ed with regard to her physi cal abi lities, parti cularly t he use of her right ar

m which restricte d lifting to l ess than ten pounds on an occ asionalbasis and preclude d the use of he r ri ght arm for r epeti tive6

activ ities d urin g an eigh t ho ur w ork day. During the hearing befor e the Administ rative Law Judge (“ALJ”), Maiorano admitt ed that

her pain was “not

as bad now with the s timul ator. ” She explai ned that her acti vity levelremained l imit ed because her right arm swelled wit

h walking and she was
esse ntial ly una ble to lift th at arm . A vocationalexpert a lso t esti fied at the ALJ heari ng. In r esponse t o a hypot hetic al posed bythe ALJ, the vocati onal expert identifie d severallight duty jobs that coul d be performed by

an indivi dual with restricti ons simi lar t o some of Maiorano’s. The hypot hetic al ass umed that t

he indivi dual was able to li ft te n pounds frequently , and the posit ions i dentif

ied by the vocat ional e xpert r equired f requent reaching, handling and fingering. The vocati onal expert conceded t hat an i nability

to use one’ s dominant hand, as D r. Ro sen had opi ned , wa s inc om patib le w ith th e po sition s sh e ha d id entified. De spite the fact th at Dr . Ros en’s o pinion limited M aioran o to less than th e full range of sedentary

work, the ALJ concluded that she was capable of performi ng the li ght leve l po sition s ide ntifi ed b y the v oca tion al ex per t as e xistin g in the n ation al ec ono my. The ALJ explained that he di scounted t he opinions of both Dr. Korn and Dr. Rosen because they were no t supported b y medically acceptable clinical and laboratory diagn ostic ev idenc e. In ad dition, th e A LJ f oun d their a ssessm ents to b e “m erely
conc lusory state men ts base d on [M aioran o’s] su bjectiv e com plaints.” The Ap peals Council deni ed Maiorano’s r equest for review, t

hereby rendering the ALJ’s deci sion the7

final decision o f the Co mm issioner. Maiorano appeale d, but t he District Court

affirmed t

he Commissioner’ s final decisi on denying her cla im for benefi ts. Maiorano’s appea l to t his Court argues t hat the AL J improp erly discounted the op inions of h er treating physicians, Dr. K orn and Dr. Rosen. As a result, Maior ano asserts, the ALJ erred in determi ning that she had the resi dual funct ional c apacit y t o perform certain l ight l evel work. We agree
. In Ferguson v. Schweiker , 765 F .2d 31 , 37 (3 d C ir. 1985 ), we a ckno wled ged th at subjective complaints may support a

clai m for disabi lit

y benefits. We instructed that when such complaint s are suppor ted by medical evi dence, t

hey s hould be give n great
we igh t. Id. In Plummer , we declar ed that great wei ght shoul d also be ac corded to “[t]r eati ng physi cians’ report s . . . especi ally ‘when their

opinions refle ct expert judgment based on a cont inuing obs ervati on of the pat ient’ s condition over a prolonged peri od of time. ’” 186 F.3d at

429 (quoti ng Rocco v. Heckler , 826 F.2 d 13 48, 1 350 (3d Cir . 198 7)). We explained that a treating physi cian’s opinion may be reje cted “only on t

he basis of contradictory

medical evidence,” although the opinion may be accorded “more or less weight dependi ng upon the ext ent to whic h supporting explanat ions ar e provided. ” Plummer , 186 F.3d at

429. After revi ewing the re cord, we conclude that the ALJ fail ed to comply with the standar ds set f

orth i n Ferguson and Plummer beca use h e disco unted , witho ut an a dequ ate explanat ion, t

he uncontra dicte d opinions of Dr. Korn and Dr. Rosen t hat Maiorano was8

afflicte d w ith RS D a nd w as un able to use h er righ t arm for rep etitive ac tivity. Both physician s had treated M aioran o fo r a sub stantial p eriod o f time , docu men ting no t only her pers ist ent complaints of pain, which were char acter ist ic of RSD, and the r esulting limitations, but also the other symp toms of RSD that she ma nifested. D r. Rosen’s progress notes and r eports also document ed: (1) the addi tionaltesting that was performed to dete rmine if

the impl antat ion of a spinal cord s timul ator was warr anted; (2) her favo rable re spon se to the surgic al imp lantation ; and (3 ) the fa ct that M aioran o’s ab ility to use h er righ t arm re main ed se verely restric ted af ter surg ery, particula rly with res pect to lifting an d rep etitive ac tivity. Yet the AL J failed to eve n disc uss this limitation in his dete rmin ation that s he w as a ble to per for m c ertai n lig ht lev el w ork
. We recognize that the ALJ cited the opinions of two non-examini ng consult ants as evidence t o support hi s decis ion. Nei ther opinion, however, supports the ALJ’s re asoning because each fa iled to address Maior ano’s di agnosis of RSD and preceded her surger y by alm ost f iftee n m ont hs. N or d id th e ne gativ e rep orts o f se ver al dia gno stic te sts, e.g. , M RIs, a bon e scan and a n EM G, u pon wh ich the AL J relied, ru n cou nter to th e diag nosis of R SD . Tho se clinic al tests, no ne of wh ich are defin itive fo r diagn osing RS D, m erely confirmed the absence of other causes for plaintiff’s pai n and limitati ons. It is signif

icant th at M aioran o’s testim ony that sh e rem ained limited w ith resp ect to the use of

her right arm w as consistent w ith not only the opinions o f Dr. K orn and Dr. Rosen , but also their docu mentation b efore an d after surge ry. Thus, under Ferguson , 765F.2d at 37, the ALJ should have a ccorded gre at weight to Maiorano’s subjective tes tim on y in de ter m in in g h er re sid ua l fu nc tio na l ca pa cit y. In sum, because the ALJ fai led to a dequately expl ain why he di scounted t he opin ions o f M aioran o’s trea ting ph ysicians tha t the use of h er righ t arm w as sev erely limite d w ith re spe ct to h er ab ility to lift and to en gag e in r epe titive activ ity, we conclude that t he ALJ’s decis ion is not supported by s ubstantial e vidence. We will rever se and remand f or fur ther proce edin gs so t

hat t he ALJ mayrecon sid er whet her Maio rano’ s RSD is disab ling fo r purp oses o f the S ocial S ecurity A ct.

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