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Diaz v. Commissioner of Social Security

March 21, 2008


The opinion of the court was delivered by: John T. Curtin United States District Judge

Plaintiff Elizabeth Diaz initiated this action pursuant to the Social Security Act, 42 U.S.C. § 405(g), to review the final determination of the Commissioner of Social Security ("Commissioner") denying plaintiff's application for Supplemental Security Income ("SSI") benefits made on behalf of her minor child, E.G. Both parties have moved for judgment on the pleadings pursuant to Rule 12(c) of the Federal Rules of Civil Procedure. For the following reasons, plaintiff's motion is granted, and the Commissioner's motion is denied.


Plaintiff filed an application on November 8, 2001 for SSI benefits on behalf of E.G., alleging disability based on behavior problems and emotional disturbance (Tr. 67-71).*fn1 E.G. was born on January 9, 1996, and was five years old at the time the application for SSI benefits was filed. After denial of the application at the initial level (Tr. 57-61), plaintiff filed a timely request for a hearing before an Administrative Law Judge ("ALJ") (Tr. 63). The hearing was held on May 2, 2003, before ALJ Benjamin F. Parks (Tr. 31-32). At the time of the hearing, E.G. was seven years old, and was in a special education class in the first grade. Plaintiff and E.G. testified at the hearing, and they were represented by attorney Ryan L. Everhart, Esq.

In a decision dated August 26, 2003, ALJ Parks found that E.G. was not disabled within the meaning of the Social Security Act (Tr. 13-18). Following the sequential evaluation process for determining disability for children, as outlined in the Social Security regulations at 20 C.F.R. § 416.924, the ALJ determined that E.G.'s behavioral disorder, while severe, did not meet, medically equal, or functionally equal the severity of any impairment listed at 20 C.F.R. Part 404, Subpart P, Appendix 1 (the "Listings") (Tr. 15-17).

Plaintiff filed a timely administrative appeal (Tr. 9), and subsequently submitted to the Appeals Council additional evidence consisting of E.G.'s medical and school records developed after the August 26, 2003 hearing determination. In a Notice of Decision dated June 14, 2006 (Tr. 4-8), the Appeals Council indicated that it had considered the additional evidence, but found that it did not provide a basis for changing the ALJ's determination.

Plaintiff then filed this action on August 8, 2006 seeking review of the Commissioner's decision, and the parties moved for judgment on the pleadings. In support of her motion, plaintiff contends that the Commissioner failed to properly evaluate the evidence in the record from several sources indicating that E.G. suffered from a marked impairment in two domains of functioning--attending and completing tasks, and interacting and relating with others--and failed to adequately develop the record in this regard. The Commissioner contends that the ALJ's determination is supported by substantial evidence, and should be affirmed.


I. Scope of Judicial Review

The Social Security Act provides that, upon district court review of the Commissioner's decision, "[t]he findings of the Commissioner . . . as to any fact, if supported by substantial evidence, shall be conclusive . . . ." 42 U.S.C. § 405(g). Substantial evidence is defined as evidence which "a reasonable mind might accept as adequate to support a conclusion." Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938), quoted in Richardson v. Perales, 402 U.S. 389, 401 (1971); see also Tejada v. Apfel, 167 F.3d 770, 773-74 (2d Cir. 1999). The substantial evidence test applies not only to findings on basic evidentiary facts, but also to inferences and conclusions drawn from the facts. Stupakevich v. Chater, 907 F. Supp. 632, 637 (E.D.N.Y. 1995); Smith v. Shalala, 856 F. Supp. 118, 121 (E.D.N.Y. 1994). Under these standards, the scope of judicial review of the Commissioner's decision is limited, and the reviewing court may not try the case de novo or substitute its findings for those of the Commissioner. Richardson, 402 U.S. at 401. The court's inquiry is "whether the record, read as a whole, yields such evidence as would allow a reasonable mind to accept the conclusions reached" by the Commissioner. Sample v. Schweiker, 694 F.2d 639, 642 (9th Cir. 1982), quoted in Winkelsas v. Apfel, 2000 WL 575513, at *2 (W.D.N.Y. February 14, 2000).

In addition, "[b]efore the insulation of the substantial evidence test comes into play, it must first be determined that the facts of a particular case have been evaluated in the light of correct legal standards." Klofta v. Mathews, 418 F. Supp. 1139, 1411 (E.D.Wis. 1976), quoted in Sharbaugh v. Apfel, 2000 WL 575632, at *2 (W.D.N.Y. March 20, 2000).

The Commissioner's determination cannot be upheld when it is based on an erroneous view of the law that improperly disregards highly probative evidence. Grey v. Heckler, 721 F.2d 41, 44 (2d Cir. 1983); see also Shaw v. Chater, 221 F.3d 126, 131 (2d Cir. 2000) (district court may set aside Commissioner's determination that claimant is not disabled only if factual findings are not supported by substantial evidence or if decision is based on legal error).

In this case, plaintiff primarily contends that the Commissioner's determination is not supported by substantial evidence, and that review of the record as a whole shows that E.G.'s impairments are sufficiently severe to be disabling within the meaning of the Act.

II. Standards for Determining Eligibility for Childhood SSI Benefits

The SSI program, 42 U.S.C. § 1381, et seq., is a federal program providing benefits to needy aged, blind, or disabled individuals who meet statutory income and resource limitations. With respect to claims filed on behalf of children, the Act provides:

(i) An individual under the age of 18 shall be considered disabled for the purpose of this title if that individual has a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

(ii) Notwithstanding clause (i), no individual under the age of 18 who engages in substantial gainful activity. . . ...

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