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Tellone v. Commissioner of Social Security

February 16, 2010

JEANNE TELLONE, ON BEHALF OF CHARLES TELLONE, DECEASED, PLAINTIFF,
v.
COMMISSIONER OF SOCIAL SECURITY, DEFENDANT.



The opinion of the court was delivered by: David N. Hurd United States District Judge

MEMORANDUM-DECISION and ORDER

I. INTRODUCTION

Jeanne Tellone brings this action pursuant to 42 U.S.C. §§ 405(g), 1383(c)(3) on behalf of her deceased husband, Charles Tellone ("plaintiff"), to review a final decision of the Commissioner of Social Security ("Commissioner") denying plaintiff's application for Social Security disability insurance ("DI") and supplemental security income ("SSI") benefits. The parties filed their briefs, including the Administrative Transcript on Appeal (cited to as "Tr."), and the matter was submitted for decision without oral argument.

II. BACKGROUND

Plaintiff first filed an application for SSI benefits on September 29, 1981. His application was denied on November 3, 1981, and he did not seek an appeal. Nevertheless, plaintiff's SSI application was reopened pursuant to the settlement order entered in Stieberger v. Sullivan, 801 F. Supp. 1079 (S.D.N.Y. 1992). (Tr. 397.)

While the Stieberger review of his initial SSI application was still pending, plaintiff filed concurrent applications for DI and SSI benefits on January 20, 2000 in which he alleged a disability onset date of December 2, 1999. (Tr. 479-81, 978.) The Commissioner denied plaintiff's concurrent applications on April 21, 2000. Id. at 430. Plaintiff's initial application for SSI benefits dating back to November 3, 1981 was again denied on May 29, 2001 after reconsideration. Id. at 961-63. Afterwards, plaintiff made a timely request for a hearing before an Administrative Law Judge ("ALJ"). Id. at 30.

Plaintiff died on May 10, 2003 prior to his hearing before the ALJ on February 3, 2004. Id. at 977-80. At the hearing, his former wife, Ms. Tellone, testified in support of his application for benefits. On February 19, 2004, the ALJ determined plaintiff was not entitled to DI and SSI benefits after making several findings, including: (1) plaintiff met the special insured status requirements of the Social Security Act from the alleged onset date of his disability, December 2, 1999, until his date last insured, March 30, 2000; (2) he had a history of alcohol and drug abuse, a heart valve replacement in 1981, alcoholic Hepatitis B and C, hypertension, and dysthymic disorder; (3) his medical conditions did not meet or equal in severity the clinical criteria of impairment provided in 20 C.F.R. Pt. 404, Subpt. P, App. 1; (4) plaintiff had the residual functional capacity ("RFC") to perform light work if he refrained from using alcohol; and (5) plaintiff was not disabled in light of his age, education, and past work experience pursuant to 20 C.F.R. Pt. 404, Subpt. P, App. 2 §§ 202.10 & 202.17. (Tr. 35.) On plaintiff's behalf, Ms. Tellone made a timely appeal of the ALJ's decision to the Appeals Council.

On July 19, 2007, the Appeals Council issued separate decisions as to plaintiff's applications for DI and SSI benefits. With respect to the DI benefits claim, the Appeals Council determined there was no reason to review the ALJ's decision because, inter alia, the determination was supported by substantial evidence. (Tr. 3.) However, in consideration of plaintiff's SSI benefits applications, the Appeals Council retroactively dismissed his prior request for a hearing after determining that the ALJ should have declined to consider either of the SSI claims. According to the Appeals Council, Ms. Tellone was not entitled to a hearing in connection with plaintiff's SSI applications because plaintiff had died, he had not been living with Ms. Tellone during the six months prior to his death, and he never filed an interim assistance agreement. Id. at 7; see also 20 C.F.R. § 416.1457(c)(4). As a result, the Appeals Council determined that the ALJ's consideration of plaintiff's SSI claims was "of no effect," and the Commissioner's determination made on May 29, 2001 was therefore "final and binding." (Tr. at 7.)

III. SOCIAL SECURITY DISABILITY CLAIM DECISIONS

A. Standard of Review of a Final Decision

The scope of a court's review of the Commissioner's final decision is limited to determinating whether the decision is supported by substantial evidence and whether the correct legal standards were applied. Poupore v. Astrue, 566 F.3d 303, (2d Cir. 2009) (per curiam) (citing Machadia v. Apfel, 276 F.3d 103, 108 (2d Cir. 2002)); Martone v. Apfel, 70 F. Supp. 2d 145, 148 (N.D.N.Y. 1999) (citing Johnson v. Bowen, 817 F.2d 983, 985 (2d Cir. 1987)). "Substantial evidence means 'more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'" Poupore, 566 F.3d at 305 (quoting Consol. Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 217 (1938)). "To determine on appeal whether an ALJ's findings are supported by substantial evidence, a reviewing court considers the whole record, examining the evidence from both sides, because an analysis of the substantiality of the evidence must also include that which detracts from its weight." Williams v. Bowen, 859 F.2d 255, 258 (2d Cir. 1988) (citing Universal Camera Corp. v. NLRB, 340 U.S. 474, 488, 715 S.Ct. 456, 464 (1951)). If the disability determination is supported by substantial evidence, that determination is conclusive. Id. However, "where there is a reasonable basis for doubting whether the appropriate legal standards were applied," the decision should not be affirmed even though the ultimate conclusion reached is arguably supported by substantial evidence. Martone, 70 F. Supp. 2d at 148 (citing Johnson, 817 F.2d at 986).

A reviewing court may enter "a judgment affirming, modifying, or reversing the decision of the Commissioner of Social Security, with or without remanding the cause for a rehearing." 42 U.S.C. § 405(g); see Martone, 70 F. Supp. 2d at 148. "Remand is appropriate where there are gaps in the record or further development of the evidence is needed," such as where new, material evidence has become available. 42 U.S.C. § 405(g); Martone, 70 F. Supp. 2d at 148 (citing Parker v. Harris, 626 F.2d 225, 235 (2d Cir. 1980)). A remand for rehearing directing the taking of additional evidence is warranted only if it is shown that there is new, material evidence "'and that there is good cause for the failure to incorporate such evidence into the record'" at the administrative hearing. Carroll v. Sec'y of Health and Human Servs., 705 F.2d 638, 643-44 (2d Cir. 1983) (quoting 42 U.S.C. § 405(g), as amended in 1980)). Remand may also be appropriate if the Commissioner "misapplies the law or failed to provide a fair hearing." Id. at 644. However, where the underlying administrative decision is not supported by substantial evidence, reversal is appropriate because there would be no useful purpose in remanding the matter for further proceedings. Id. (reversing and remanding solely for calculation of benefits, subject to determination by the district court of any motion by the agency to remand to consider new evidence); Parker, 626 F.2d at 235 (reversing and remanding solely for calculation and payment of benefits); Simmons v. United States R.R. Ret. Bd., 982 F.2d 49, 57 (2d Cir. 1992) (same); Williams, 859 F.2d at 261 (same).

B. The Five Step Evaluation Process

The Social Security Act defines "disability" to include the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment 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." 42 U.S.C. ยง 423(d)(1)(A). In addition, the Act requires that a claimant's physical or mental impairment or impairments [must be] of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, ...


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