Opinion ID: 744156
Heading Depth: 2
Heading Rank: 2

Heading: Claimant's Psychiatric Condition

Text: 32 As a fact-finder, the ALJ has the discretion to evaluate the credibility of a claimant and to arrive at an independent judgment, in light of medical findings and other evidence. McLaughlin v. Secretary of Health, Ed. and Welfare, 612 F.2d 701, 704 (2d Cir.1980)(quoting Marcus v. Califano, 615 F.2d 23, 27 (2d Cir.1979)). Credibility findings of an ALJ are entitled to great deference and therefore can be reversed only if they are patently unreasonable. Lennon v. Waterfront Transport, 20 F.3d 658, 661 (5th Cir.1994). An ALJ is nonetheless bound by the expert opinion of a treating physician as to the existence of a disability unless contradicted by substantial evidence to the contrary. Alston v. Sullivan, 904 F.2d 122, 126 (2d Cir.1990)(citing Bastien v. Califano, 572 F.2d 908, 912 (2d Cir.1978)). See also Rivera v. Harris, 623 F.2d 212, 216 (2d Cir.1980)(opinions of treating physicians entitled to considerable weight). Moreover, an ALJ cannot arbitrarily substitute his own judgment for competent medical evidence. McBrayer v. Secretary of Health and Human Services, 712 F.2d 795, 798 (2d Cir.1983). 33 The ALJ found that the Pietrunti's stress symptoms [we]re subjective and that Pietrunti merely reports these symptoms of sleep and appetite disturbance [ ] and the psychiatric examiners merely accept and conclude that these assertions are true. (App. at 18). It was the ALJ's opinion that Pietrunti's reported mental health problems were not caused by the injury to his right arm, but were in fact related to earlier problems he experienced at Thames Valley Steel, an environment which Pietrunti himself characterized to Dr. Aberger, a psychiatrist, as abusive and highly stressful. The ALJ further found that Pietrunti's testimony during the hearing as to pain and discomfort he experiences in his right arm is not credible. Id. Overall, the ALJ concluded that Pietrunti was not a credible witness. 34 The ALJ refused to credit the testimony of Dr. Ruggiano, Pietrunti's treating psychiatrist, because he found that his diagnosis simply accepted Pietrunti's asserted symptoms as true. This was the only reason given by the ALJ for rejecting Dr. Ruggiano's testimony. In our judgment such a reason for dismissing the findings of Dr. Ruggiano had no substantial evidentiary foundation. 35 On deposition, Dr. Ruggiano testified that he observed that Mr. Pietrunti had a rigid posture and flat affect and that from his observation of Mr. Pietrunti over a two-year period, he believed that the problems that Mr. Pietrunti describes are genuine. (App. at 9). Dr. Ruggiano's treatment notes document Pietrunti's problems over a seventeen-month period from August 1991 until February 1993. Dr. Ruggiano's treatment notes report Pietrunti as agitated, hyperkinetic and tearful. In December 1991, Dr. Ruggiano wrote that Pietrunti had totally regressed [;][h]e is sobbing and trembling and holding his arm by his side in gesture of paralysis and helplessness. (App. at 289). Dr. Ruggiano's notes for the period between December 1991 and September 1992 paint a similar picture of Pietrunti's depression. In September 1992, Dr. Ruggiano wrote that Pietrunti's condition had become much worse. Dr. Ruggiano prescribed Thorazine and arranged to have him hospitalized at a psychiatric inpatient unit at St. Joseph Hospital that same day. 36 Dr. Ruggiano testified that it was his opinion that Pietrunti's arm injury precipitated his mental health problems after which he then just fell apart and decompensated. (App. at 140). He stated that over the course of treatment he observed Pietrunti as a person who can't face people, was withdrawn, was very limited in I.Q. and was someone who expects ridicule and [ ] very sensitive to it. (App. at 136-37). When cross-examined as to whether Pietrunti might be fabricating his symptoms, Dr. Ruggiano testified that it was his belief that even if it were true that Pietrunti were misrepresenting his physical symptoms, he would nevertheless conclude that Pietrunti was psychologically impaired but would change his diagnosis to major depression or somatic form disorder. 37 Dr. Ruggiano's opinion of Pietrunti was supported by several other doctors. To begin, the doctor who evaluated Pietrunti at the inpatient psychiatric unit at St. Joseph Hospital concluded that Pietrunti is still depressed and needs to be hospitalized. In addition, Dr. Edward W. Aberger of the Institute for Behavioral Medicine who evaluated Pietrunti on October 10, 1991, reported that Pietrunti's MMPI test results demonstrated a level of acute disturbance. His conclusion was that Pietrunti was experiencing a full-fledged chronic pain syndrome. (App. at 9). Dr. Aberger noted that Pietrunti was experiencing substantial emotional distress associated with his chronic pain and disability. (App. at 267). He further reported that Pietrunti's pain problem has led to his increased dependence upon his wife, but has also been associated with increased marital arguments. (App. at 268). Dr. Aberger recommended that Pietrunti be admitted to an inpatient rehabilitation program. 38 Given the uncontroverted and unanimous evidence of Pietrunti's treating physicians, the ALJ's decision is somewhat suspect. The opinion of Dr. Ruggiano was entitled to great weight, as Pietrunti's treating physician. Contrary to the ALJ's finding, Dr. Ruggiano's diagnosis of Pietrunti was based on numerous evaluations, as well as a course of treatment for several prescriptive medications, including Thorazine. The ALJ appeared to be of two minds regarding the testimony of Dr. Ruggiano: for purposes of reviewing the employer's Labor Market Survey, the ALJ credited Dr. Ruggiano's testimony, commenting that Dr. Ruggiano describes a man who is nervous, unable to sleep, often out of control and agitated and placed him on Thorazine ... this is not the picture of a man who is marketable in the labor market. Dr. Ruggiano's same findings, however, were rejected as mere restatements of Pietrunti's complaints for purposes of reviewing his mental health claim. Such a wavering estimate of Dr. Ruggiano's credibility may have led the ALJ to the puzzling conclusion that Dr. Ruggiano should be paid for Pietrunti's prior psychiatric treatment but not for future treatment. 39 We conclude that the ALJ substituted his own medical judgment of Pietrunti for that of the uncontradicted medical record. The ALJ merely overrode the medical opinions of Dr. Ruggiano and Dr. Aberger, each of whom concluded that Pietrunti was experiencing some form of an adjustment disorder as a result of his work-related injury, with his own finding that Pietrunti's symptoms were subjective and not credible. This determination not only ignored the testimony of several doctor-witnesses and almost two years of medical records documenting Pietrunti's illness, but it also failed to consider the most obvious indicator of Pietrunti's condition: his continued treatment on Thorazine, a powerful anti-depressant. Indeed, the ALJ's summary dismissal of the relevance of Pietrunti's having been medicated for depression since August 1991 calls into question his finding that Pietrunti's symptoms were merely subjective. As the Seventh Circuit recently noted in Wilder v. Chater, 64 F.3d 335, 337 (7th Cir.1995), [s]evere depression is not the blues. It is a mental health illness; and health professionals, in particular psychiatrists, not lawyers or judges, are the experts on it. 40 The findings of the ALJ are reversed and the case is remanded for calculation of permanent total disability benefits, not inconsistent with this opinion.