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Nelson v. Barnhart

March 5, 2008




1. Plaintiff James Nelson challenges an Administrative Law Judge's ("ALJ") determination that he is not entitled to a period of disability insurance benefits ("DIB") or eligibility for supplemental security income benefits ("SSI") under the Social Security Act ("the Act"). Plaintiff alleges he has been disabled since August 25, 2003, because of Crohn's disease, chronic fatigue, frequent bowel movements, arthritis in his right knee, and a seizure disorder.

Procedural History

2. Plaintiff filed an application for DIB on September 25, 2003, claiming he was disabled since August 25, 2003, because of the impairments listed in Section 1 above. Plaintiff's claim for DIB was denied on December 12, 2003, and under the prototype model of handling claims without a reconsideration step, Plaintiff was permitted to appeal directly to the Administrative Law Judge (ALJ). See 65 Fed. Reg. 81553 (Dec. 26, 2000). Plaintiff filed a request for a hearing before an ALJ on December 18, 2003. On January 29, 2004, Plaintiff filed an application, this timefor SSI, claiming again thathe has been disabled since August 25, 2003. Plaintiff's claim for SSI was denied also, and he filed a request for a hearing before an ALJ on February 9, 2004. Pursuant to Plaintiff's request, an administrative hearing was held before ALJ David S. Antrobus on November 16, 2004, at which time Plaintiff and his attorney appeared. A vocational expert was also present and testified at the hearing. The ALJ considered the case de novo, and on December 22, 2004, issued a decision finding that Plaintiff was not disabled. Plaintiff timely requested review of the ALJ's decision by the Appeals Council, and on March 31, 2005, the Appeals Council denied Plaintiff's request for review.

3. On May 12, 2005, Plaintiff filed a Civil Complaint challenging Defendant's final decision and requesting the Court toreview the decision of the ALJ pursuant to Section 205(g) and 1631(c) (3) of the Act, tomodify the decision of Defendant, and grant DIB and SSI benefits to Plaintiff.*fn1 The Defendant filed an answer to Plaintiff's complaint on August 17, 2005, requesting that the Court dismiss Plaintiff's complaint. Plaintiff submitted a briefon October 11, 2005, requesting the Court set aside the Commissioner's decision, and award benefits to Plaintiff. On November 21, 2005, Defendant filed a Memorandum of Law in Support of the Commissioner's Motion for Judgment on the Pleadings*fn2 pursuant to Rule 12(c) of the Federal Rules of Civil Procedure. After full briefing, the Court deemed oral argument unnecessary and took the motions under advisement.


Legal Standards and Scope of Review

4. A court reviewing a denial of disability benefits may not determine de novo whether an individual is disabled. See 42 U.S.C. § 405(g), 1383 (c)(3); Wagner v. Sec'y of Health and Human Servs., 906 F.2d 856, 860 (2d Cir. 1990). Rather, the Commissioner's determination will only be reversed if it is not supported by substantial evidence or there has been a legal error. See Grey v. Heckler, 721 F.2d 41, 46 (2d Cir. 1983); Marcus v. Califano, 615 F.2d 23, 27 (2d Cir. 1979). "Substantial evidence" is evidence that amounts to "more than a mere scintilla," and it has been defined as "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 1427, 28 L.Ed. 2d 842 (1971). Where evidence is deemed susceptible to more than one rational interpretation, the Commissioner's conclusion must be upheld. See Rutherford v. Schweiker, 685 F.2d 60, 62 (2d Cir. 1982).

5. "To determine on appeal whether the ALJ's findings are supported by substantial evidence, a reviewing court considers the whole record, examining evidence from both sides, because an analysis of the substantiality of the evidence must also include that which detracts from its weight." Williams on Behalf of Williams v. Bowen, 859 F.2d 255, 258 (2d Cir. 1988). If supported by substantial evidence, the Commissioner's finding must be sustained "even where substantial evidence may support the plaintiff and despite that the court's independent analysis of the evidence may differ from the [Commissioner's]." Rosado v. Sullivan, 805 F. Supp. 147, 153 (S.D.N.Y. 1992). In other words, this Court must afford the Commissioner's determination considerable deference, and may not substitute "its own judgment for that of the [Commissioner], even if it might justifiably have reached a different result upon a de novo review." Valente v. Sec'y of Health and Human Servs., 733 F.2d 1037, 1041 (2d Cir. 1984).

6. The Commissioner has established a five-step sequential evaluation process to determine whether an individual is disabled as defined under the Social Security Act. See 20 C.F.R. § 404.1520, 416.920. The United States Supreme Court recognized the validity of this analysis in Bowen v. Yuckert, 482 U.S. 137, 140-142, 107 S.Ct. 2287, 2291, 96 L.Ed. 2d 119 (1987), and it remains the proper approach for analyzing whether a claimant is disabled.

7. This five-step process is detailed below:

First, the [Commissioner] considers whether the claimant is currently engaged substantial gainful activity. If he is not, the [Commissioner] next considers whether the claimant has a "severe impairment" which significantly limits his physical or mental ability to do basic work active-ties. If the claimant has such an impairment, the third inquiry is whether, based solely on medical evidence, the claimant has an impairment which is listed in Appendix 1 of the regulations. If the claimant has such an impairment, the [Commissioner] will consider him disabled without considering vocational factors such as age, education, and work experience; the [Commissioner] presumes that a claimant who is afflicted with a "listed" impairment is unable to perform substantial gainful activity. Assuming the claimant does not have a listed impairment, the fourth inquiry is whether, despite the claimant's severe impairment, he has the residual functional capacity to perform his past work. Finally, if the claimant is unable to perform his past work, the [Commissioner] then determines whether there is other work which the claimant could perform. Berry v. Schweiker, 675 F.2d 464, 467 (2d Cir. 1982) (per curiam); see also Rosa v. Callahan, 168 F.3d 72, 77 (2d Cir. 1999); 20 C.F.R. § 404.1520.

8. While the claimant has the burden of proof as to the first four steps, the Commissioner has the burden of proof on the fifth and final step. See Bowen, 482 U.S. at 146 n.5; Ferraris v. Heckler, 728 F.2d 582 (2d Cir. 1984). The final step of this inquiry is, in turn, divided into two parts. First, the Commissioner must assess the claimant's job qualifications by considering his physical ability, age, education, and work experience. Second, the Commissioner must determine whether jobs exist in the national economy that a person having the claimant's qualifications could perform. See 42 U.S.C. § 423(d)(2)(A); 20 C.F.R. § 404.1520(f); Heckler v. Campbell, 461 U.S. 458, 460, 103 S.Ct. 1952, 1954, 76 L.Ed. 2d 66 (1983).

9. In this case, the ALJ made the following findings with regard to factual information as well as the five-step process set forth above: (1) Plaintiff met the non-disability requirements for a period of disability and Disability Insurance Benefits set forth in Section 216(i) of the Social Security Act and is insured for benefits through December 31, 2008 (R. at 21)*fn3; (2) Plaintiff has not engaged in substantial gainful activity since the alleged onset of disability (R. at 21); (3) Plaintiff's Crohn's disease and a possible seizure disorder are considered "severe" based on the requirements in the Regulations 20 C.F.R. §§ 404.1520(c) and 416.920(b) (R. at 21); (4) These medically determinable impairments do not meet or medically equal one of the listed impairments in Appendix 1, Subpart P, Regulation No. 4 (R. at 21); (5) The ALJ found the Plaintiff's allegations regarding his limitations not totally credible for the reasons set forth in the body of the decision (R. at 21); (6) Plaintiff has the following residual functional capacity: exertionally, he can sit up to six hours in an eight-hour workday, stand and walk up to six hours in an eight-hour workday, and lift weights of ten pounds frequently and twenty pounds occasionally. Nonexertionally, due to his history of a seizure disorder, he should avoid heights and moving machinery (R. at 21); (7) Plaintiff's past relevant work as a customer service representative/store clerk and assistant manager for a hardware store did not require the performance of work-related activities precluded by his residual functional capacity (20 C.F.R §§ 404.1565 and 416.965) (R. at 21); (8) Plaintiff's medically determinable Crohn's disease and a possible seizure disorder do not prevent him from performing his past relevant work (R. at 21); (9) Plaintiff was not under a "disability" as defined in the Social Security Act, at anytime through the date of the decision (20 C.F.R. §§ 404.1520(f) and 416-920(f) (R. at 22). Accordingly, the ALJ determined Plaintiff was not entitled to a period of disability, Disability Insurance Benefits, or supplemental security income payments under Sections 216(i), 223, 1602 and 1614(a)(3)(A), respectively, of the Social Security Act (R. at 22).

Plaintiff's Allegations

10. Plaintiff challenges the ALJ's determination that Plaintiff is not disabled and asserts the ALJ's decision is not supported by the substantial evidence of record. Specifically Plaintiff alleges that (1) the ALJ ignored the assessments of Plaintiff's treating physicians, as well as the opinion of a State agency examining physician, with regard to Plaintiff's limitations and his residual functional capacity to perform the requirements of light work*fn4, (2) the ALJ did not properly consider Plaintiff's subjective complaints, and (3) reversal of the ALJ's decision is mandated because persuasive proof of disability is contained in Plaintiff's record. The Court will address each of Plaintiff's allegations in sequence.

ALJ Ignored the Assessment of Plaintiff's Treating Physicians and the Opinion of a State agency examining physician

11. Plaintiff's first challenge to the ALJ's decision is that he ignored the assessment of Plaintiff's treating physicians with regard to Plaintiff's pain and limitations resulting from Crohn's disease, and the opinion of the State agency examining physician with regard to Plaintiff's fatigue and knee pain, when he determined Plaintiff had the residual functional capacity to perform his past relevant employment as a store clerk, customer service representative, or assistant store manager on a sustained basis. See Plaintiff's Brief, p. 1-2, 6-8. Specifically, Plaintiff claims the record does not contain substantial ...

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