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GONZALEZ v. BARNHART

June 25, 2004.

ISABEL GONZALEZ o/b/o FAUSTINO GONZALEZ, Plaintiff,
v.
JO ANNE BARNHART, Commissioner of Social Security, Defendant.



The opinion of the court was delivered by: LAURA TAYLOR SWAIN, District Judge

MEMORANDUM OPINION AND ORDER

Plaintiff, Isabel Gonzalez, brings this action on behalf of her brother, Faustino Gonzalez, seeking review of the final determination of the Commissioner of Social Security ("Commissioner") pursuant to § 405(g) of the Social Security Act ("Act"), 42 U.S.C.A. § 405(g) (West 2003), finding that Gonzalez had failed to establish good cause for waiver of the time limits for seeking review of 1985 and 1989 determinations by the Social Security Administration ("SSA") denying Mr. Gonzalez Supplemental Security Income ("SSI") benefits. Defendant moves for judgment on the pleadings pursuant to Rule 12(c) of the Federal Rules of Civil Procedure affirming the determination of the Commissioner that Plaintiff failed to establish good cause for waiver.

The Court has considered carefully the parties' submissions and the record below. For the following reasons. Defendant's motion for judgment on the pleadings is granted, and the decision of the Commissioner is affirmed. BACKGROUND

  Mr. Gonzalez was born in 1928, and came to the United States from Puerto Rico in the 1950s.*fn1 (Tr. at 16, 27.) He has a second-grade education and was employed for some time as a cook.*fn2 (Tr. at 17-18.) Mr. Gonzalez is illiterate in both English and Spanish but spoke both languages at the time of the 1985 and 1989 SSA determinations. (Id.)

  Mr. Gonzalez alleges that he was mentally impaired at the time of his 1985 and 1989 SSI denials. (Tr. at 118-119.) Ms. Gonzalez, the claimant's sister, asserted in an August 1998 letter that Mr. Gonzalez suffered from "alcoholism and [a] nervous condition." (Tr. at 115-116.) The record evidences only one instance of medical treatment during the relevant period, however. Mr. Gonzalez was admitted to the Bronx-Lebanon Hospital Center following a mugging on February 4, 1986, and was discharged on February 11, 1986. (Tr. at 322-323, 430.) He was treated for only physical ailments and was noted to be alert, oriented, and not confused throughout his hospitalization. (Tr. at 310, 312-315.) Hospital records indicate that he was admitted for a blunt chest trauma, and his principal diagnosis was a fractured right rib. (Tr. at 430.) Furthermore, Mr. Gonzalez indicated to hospital personnel that he had no previous illnesses or surgeries, and only drank alcohol "sometimes." (Tr. at 311, 433.) There is no evidence that he sought psychiatric treatment during the relevant period. Ms. Gonzalez provided additional evidence following the Administrative Law Judge's ("ALJ") determination in the form of two letters with attached documentation in March 2004 and April 2004. A January 1981 letter of termination of employment from Mr. Gonzalez's former employer, Maritime College, establishes that Mr. Gonzalez was terminated from his employment in 1981 for harassment of another employee and working under the influence of alcohol.

  PROCEDURAL HISTORY

  Mr. Gonzalez filed an application for Social Security Income ("SSI") in February 1981, which was denied and not appealed. (Tr. at 7.) Mr. Gonzalez filed concurrent SSI and Social Security Disability Insurance Benefits applications in September 1985 and March 1989. Both were denied initially and on reconsideration. (Id.) Mr. Gonzalez did not appeal either reconsideration determination. (Id.) He was not represented by counsel for any of these filings or appeals. On March 8, 1993, the SSA informed Mr. Gonzalez of his potential eligibility for relief in connection with the Stieberger v. Sullivan class action. See 801 F. Supp. 1079 (S.D.N.Y. 1992); (Tr. at 38, 355-357.) After review, the SSA determined that Gonzalez did not qualify for such relief and notified him of this decision in January 1997, March 1998, and July 1998. (Tr. at 39-42, 45-46, 379-380.)

  Mr. Gonzalez filed an action in Federal district court for review of the SSA's decision relating to the Stieberger v. Sullivan class action. (Tr. at 375-378.) On April 27, 2001, Judge Sand of this court dismissed Mr. Gonzalez's claims under the class action with prejudice. (Tr. at 58-59.) Gonzalez and the government therefore entered into a stipulation providing that the SSA would consider whether Mr. Gonzalez qualified for an extension of the deadline for requesting administrative review of the 1981, 1985, and 1989 final decisions under Social Security Ruling ("SSR") 91-5p. Id.; SSR 91-5p, 1991 WL 208067 (S.S.A. July 1, 1991).

  Although the stipulation provided that the SSA was to review the 1981, 1985, and 1989 dismissals, and an initial letter reviews all three, only the 1985 and 1989 denials were pursued at the hearing before the ALJ. (Tr. at 14, 7-11, 58-61.) On January 30, 2003, the ALJ issued a decision finding that Mr. Gonzalez failed to prove good cause for waiver of the time limits to request review of the 1985 and 1989 SSA determinations. The Appeals Council denied Mr. Gonzalez's request for review on June 30, 2003, pursuant to 20 C.F.R. § 416.1467,*fn3 making the Commissioner's determination the final decision of the agency. (Tr. at 3-4.) Mr. Gonzalez's sister then filed the present pro se action for review of the Commissioner's 1985 and 1989 final determinations. Defendant has moved for judgment on the pleadings, arguing that the Commissioner's determination was supported by substantial evidence and should therefore be affirmed.

  DISCUSSION

  A. Standard of Review

  The Act provides that the Commissioner's determination of fact is conclusive if it is supported by substantial evidence. 42 U.S.C.A. § 405(g) (West 2003). The Court will only set aside a decision "where it is based upon legal error or is not supported by substantial evidence." Balsamo v. Chater, 142 F.3d 75, 79 (2d Cir. 1998). The Court must therefore uphold the Commissioner's decision if it finds that the decision is based on substantial evidence, regardless of the existence of substantial evidence supporting the claimant's position. Alston v. Sullivan, 904 F.2d 122, 126 (2d Cir. 1990). The Supreme Court defined substantial evidence as "more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)); Schaal v. Apfel, 134 F.3d 496, 501 (2d Cir. 1998). The substantial evidence test applies to findings of fact as well as inferences and conclusions drawn from basic evidentiary facts. Levine v. Gardner, 360 F.2d 727, 730 (2d Cir. 1968); Murphy v. Secretary of Health and Human Serv., 62 F. Supp.2d 1104, 1006 (S.D.N.Y. 1999). Thus, the Commissioner's determination of fact is controlling even if the reviewing court's analysis differs from the Commissioner's findings of fact. Rutherford v. Schweiker, 685 F.2d 60, 62 (2d Cir. 1982). Accordingly, the Court cannot decide the case de novo. Schaal, 134 F.3d at 501; Jones v. Sullivan, 949 F.2d 57, 59 (2d Cir. 1991).

  B. Requirements for Waiver of Review Request Time Limit under Social Security Ruling 91-5P

  Pursuant to 20 C.F.R. § 416.1433, a request for a hearing by an ALJ must be made within 60 days of receipt of notice of the determination. However, under SSR 91-5p, the SSA may review final administrative decisions if it finds good cause for extension of the review deadline. To establish good cause for an extension under SSR 91-5p, the claimant must provide:
[E]vidence that mental incapacity prevented him or her from timely requesting review of an adverse determination, decision, dismissal, or review by a Federal district court, and the claimant had no one legally responsible for prosecuting the claim (e.g., a parent of a claimant who is a minor, legal guardian, attorney, or other legal representative) at the time of the prior administrative action.
Social Security Ruling 91-5p, 1001 WL 208067, *2 (S.S.A. July 1, 1991). To prove mental incapacity, the claimant must establish that he lacked the mental capacity to ...

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