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Pike v. Barnhart

August 28, 2008




1. Plaintiff Michelle Pike challenges an Administrative Law Judge's ("ALJ") determination that she is not entitled to supplemental security income benefits ("SSI"), or disability insurance benefits ("DIB"), under the Social Security Act ("the Act"). Plaintiff alleges she has been disabled since January 25, 2001, because of depression, anxiety, migraine headaches, a broken left shoulder, memory problems, and hernia surgery. Plaintiff hasmet the disability insured status requirements of the Act at all times pertinent to this claim.

Procedural History

2. Plaintiff filed an application for SSI and DIB on December 16, 2002, alleging an onset of disability of January 25, 2001. Her application was denied initially and, under the prototype model of handling claims without requiring a reconsideration step, Plaintiff was permitted to appeal directly to the ALJ. See 65 Fed. Reg. 81553 (Dec. 26, 2000). Plaintiff filed a timely request for a hearing before an ALJ, and on March 23, 2004, Plaintiff, accompanied by her attorney, appeared and testified before ALJ Charles R. Boyer. The ALJ considered the case de novo and on August 16, 2004, issued a partially favorable decision finding that Plaintiff became disabled on October 14, 2004, but was not disabled within the meaning of the Act prior to that date. Plaintiff submitted additional evidence after the date of the ALJ's decision and requested the Appeals Council review the decision. On August 5, 2005, the Appeals Council denied Plaintiff's request for review.

3. On October 3, 2005, Plaintiff filed a Civil Complaint challenging Defendant's final decision and requesting the Court review the decision of the ALJ pursuant to Section 205(g) and 1631(c) (3) of the Act, modify the decision of Defendant, and grant SSI or DIB benefits to Plaintiff for the period claimed prior to October 14, 2004.*fn1 The Defendant filed an answer to Plaintiff's complaint on February 2, 2006, requesting the Court todismiss Plaintiff's complaint. Plaintiff submitted Plaintiff's Brief requesting that the Commissioner reverse and remand the ALJ's decision on March 20, 2006. On October 30, 2007, Defendant filed a Memorandum of Law in Support of Her 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 Standard 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's 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 the date of this decision (R. at 27);*fn3 (2) Plaintiff has not engaged in substantial gainful activity since the alleged onset of disability (R. at 27); (3) Plaintiff has a severe mental impairment (affective disorder, personality disorder and addiction disorder) (R. at 27); (4) Since October 14, 2003, Plaintiff's affective disorder has satisfied the requirements of section 12.04 of Appendix 1, Subpart P, Regulation No. 4. Prior to October 14, 2003, the Plaintiff abused drugs and alcohol so heavily that she could not maintain employment, but if she had abstained from drugs and alcohol, she would not have had an impairment that satisfied the requirements of any section of Appendix 1, Subpart P of Regulations No. 4 (R. at 27); (5) Plaintiff's allegations are not totally credible for the reasons set forth in the body of the decision (R. at 27); (6) All of the medical opinions in the record have been considered in assessing the severity of the Plaintiff's impairments and limitations (20 C.F.R. §§ 404.1563 and 416.963) (R. at 27); (7) Prior to October 14, 2003, if Plaintiff had abstained from drugs and alcohol, she would have had the residual functional capacity for work that involved simple repetitive tasks (R. at 27); (8) Plaintiff is 43 years old (20 C.F.R. §§ 404.1563 and 416.963) (R. at 27); (9) Plaintiff has a high school education (20 C.F.R §§ 404.1564 and 416.964) (R. at 27); (10) Transferability of work skills is not a determinative factor in this case (20 C.F.R. §§ 404.1568 and 416.968) (R. at 27); (11) Prior to October 14, 2003, if Plaintiff had abstained from drugs and alcohol, she would have had the residual functional capacity to perform a significant range of work at all levels of exertion (20 C.F.R. §§ 404.1567 and 416.967) (R. at 27); and (12) Prior to October 14, 2003, Plaintiff was not under a "disability," as defined in the Social Security Act (20 C.F.R. §§ 404.1520(f) and 416.920(f)) (R. at 27). Ultimately, the ALJ determined Plaintiff was entitled to a period of disability, and disability insurance benefits, based on a disability that began October 14, 2003 (R. at 28). Because of Plaintiff's history of drug and alcohol addiction, the ALJ recommended Plaintiff's benefit payments be made through a representative payee. Id. The ALJ further noted that Plaintiff's condition would likely improve with treatment, and a review of Plaintiff's disability should be performed annually. Id.

Plaintiff's Allegation

10. Plaintiff's alleges that the Appeals Council failed to review the ALJ's decision even after she submitted what she considers to be new and relevant evidence specific and material to the time period of her claim. Plaintiff claims this new and relevant establishes her onset of disability date as January 25, 2001, rather than October 14, 2003, as determined by the ALJ. The regulations provide that the Appeals Council will consider new and material evidence only when it relates to the period on or before the date of the ALJ's decision. See 20 C.F.R. §§ 404.970(b) and 416.1470(b); see also Accord Perez v. Chater, 77 F.3d 41, 45 (2d Cir. 1996).

Prior to addressing Plaintiff's challenge, the Court will present a summary of her medical history, as an awareness of this history is essential to ...

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