United States District Court, S.D. New York
REPORT AND RECOMMENDATION
Margaret Smith United States Magistrate Judge.
Jocelyn Estrella commences this action pursuant to 42 U.S.C.
§ 405(g). She seeks judicial review of the final
decision of the Commissioner of Social Security (the
"Commissioner"), which denied her application for
Supplemental Security Income ("SSI") benefits. ECF
No. 1. Each party has submitted a motion for judgment on the
pleadings pursuant to Rule 12(c) of the Federal Rules of
Civil Procedure. ECF Nos. 17, 22. For the reasons discussed
below, I conclude, and respectfully recommend that Your Honor
should conclude, that the Commissioner's motion for
judgment on the pleadings (ECF No. 22) be denied, and
Plaintiffs motion (ECF No. 17) be granted. As such, the
ALJ's decision should be vacated, and the case should be
remanded to the Agency for further proceedings consistent
with this Report and Recommendation.
objections to this thorough Report and Recommendation
("R&R") have been recieved. I have reviewed it
for clear error, and find none. Accordingly, the R&R is
adopted as the decision of the Court. Defendant's motion
for judgment on the pleadings is DENIED; Plaintiffs motion
for judgment on the pleadings is GRANTED; the ALJ's
decision is VACATED; and this case is REMANDED for further
proceedings consistent with the R&R. The Clerk of Court
is respectfully directed to terminate the pending motions,
(Docs. 17, 22) and remand the case to the Social Security
filed a claim for SSI on behalf of her infant son, M.R.E. (or
"the claimant"), on July 24, 2012. AR
178-87. By correspondence dated August 24, 2012,
the Social Security Administration (the "SSA" or
"Agency") denied Plaintiffs application. AR 94-99.
Plaintiff then requested a hearing before an administrative
law judge ("ALJ"). AR 100. The Agency conducted two
hearings, which were held on August 21 (AR 69-84) and
December 6, 2013 (AR 50-68). On January 15, 2014, the ALJ
issued an unfavorable decision. AR 29-49. Plaintiff
subsequently filed a request for review of the ALJ's
decision with the Appeals Council, which was denied on July
24, 2015. AR 1-7. Accordingly, the ALJ's January, 2014,
decision became the final action of the Commissioner.
instant lawsuit followed. See ECF No. 1. In her papers,
Plaintiff argues that the Commissioner's findings are
contrary to law and regulations promulgated pursuant to the
Social Security Act (the "Act") and not supported
by substantial evidence. ECF No. 1. She asks this Court to
reverse the Commissioner's decision and award benefits,
or in the alternative, to vacate the decision and remand the
matter to the Agency for further proceedings. ECF No. 1, at
Medical & Educational Records
Evidence Before the ALJ
Records Pre-dating Plaintiffs SSI
Steinway Child and Family Services
began receiving treatment through Steinway Child and Family
Services, Inc. ("Steinway"), a non-profit agency,
in February, 2009. AR 377. On March 19, 2009, Lauren McEvoy,
a licensed master social worker ("LMSW"), completed
an Intake Summary, which recorded M.R.E.'s educational
and developmental histories to date. AR 377-80. M.R.E., who was
then five years old, had first been referred to Steinway from
Elmhurt Hospital's Child and Adolescent Walk-In Clinic,
where he was diagnosed with attention deficit/hyperactivity
disorder ("ADHD"), combined type, and oppositional
defiant disorder ("ODD"). AR 377.
McEvoy's notes with respect to the frequency and
intensity of M.R.E.'s symptoms are somewhat equivocal. At
times, she noted, M.R.E. demonstrated the ability to follow
directions and accept limits. AR 377. On other occasions, he
was susceptible to temper tantrums and spells of yelling,
"especially when limits [were] set by his mother."
AR 377. M.R.E. displayed marked impulsivity, distractability,
and low frustration tolerance, but was able "to
appropriately take turns and to stick to a game at other
times." AR 377. She also wrote that M.R.E. appeared to
be of average intelligence and was, at times, friendly and
easily engaged, while at other times he displayed impulsive
and oppositional behavior. AR 377. Ms. McEvoy determined that
M.R.E. was in need of therapy "to support he and his
mother in decreasing his impulsivity, distractibility and
occupational behavior." AR 378. She also found that
M.R.E. would benefit from further psychiatric evaluation and
possible medication management, in order to address his
symptoms of ADHD and ODD. AR38O.
22, 2011, Dr. Salvacion Bonete, a psychiatrist at Steinway,
evaluated the claimant. AR 369. M.R.E. was six years old at
the time, and had previously been diagnosed with ADHD,
combined type, and ODD, rule out bipolar disorder, by Dr.
Jose Vito on March 21, 2009. AR 369. M.R.E. was prescribed
Concerta, 72 mg, and Risperidone, 2 mg. AR 369. Despite these
medications, Plaintiff reported that M.R.E.'s ADHD
symptoms had escalated; M.R.E. was constantly provoked and
provocative of other students in his school, and prone to
aggressive outbursts. AR369;
Bonete found that M.R.E. was cooperative and relatable
throughout much of the evaluation, but could be resistant and
oppositional to direction at times. AR 370. Generally, the
claimant appeared to be in an excited mood - he was fidgety,
restless, talkative, and unable to sit still - and was easily
distracted. AR 370. Although he was fully oriented and
displayed an appropriate affect, M.R.E.'s concentration
was impaired, and he demonstrated poor judgment, insight, and
impulse control. AR 371-72. Dr. Bonete diagnosed M.R.E. with
ADHD, combined type, and ODD, rule out bipolar disorder. AR
373. She also assigned him a global assessment of functioning
("GAF") score of 48, which indicates a serious
impairment in social, occupational, or school functioning. AR
373. Dr. Bonete added a prescription for
Ritalin, 5 mg, in response to an exacerbation of M.R.E.'s
ADHD symptoms. She also recommended that he continue
with behavioral therapy and, if practicable, be placed in a
smaller class setting with more structure and supervision, as
well as a school bus with fewer children and a school bus
monitor. AR 373.
30, 2011, Ms. McEvoy noted that the claimant continued to
struggle with aggressive outbursts. AR 374. Additionally,
M.R.E. demonstrated difficulty accepting limits, managing his
responses to provocation, and was often provocative in his
interactions with classmates. AR 374. Ms. McEvoy found that
the claimant was intelligent, curious, and capable of
interacting in a friendly and engaging manner, but struggled
with impulsivity, hyperactivity, and difficulty focusing,
while also exhibiting oppositional behavior. AR 374, Although
M.R.E. made progress toward decreasing the intensity of these
symptoms, Ms. McEvoy found that he continued to struggle
"significantly with aggression at school, which [was]
getting in the way of overall functioning and peer
relationships." AR 376.
August 16, 2011, Dr. Bonete and Ms. McEvoy wrote to the New
York City Department of Education ("DOE")
concerning M.R.E.'s academic placement. AR
263. They indicated that M.R.E. continued to
struggle with aggressive outbursts and had difficulty
managing his behavior. AR 63. They believed that he would
benefit from a smaller educational setting which could
provide "more intensive, hands-on support [.]"
was discharged from Steinway on September 14, 2011. AR
367-68. According to a summary prepared by Ms. McEvoy on the
same date, M.R.E.'s symptoms "fluctuated
significantly" over the course of treatment. AR 367.
After a period of sustained improvement, M.R.E. began
displaying increased aggression, difficulty accepting limits,
and poor frustration tolerance. AR 368. The claimant was
therefore transferred to Bellevue Hospital's Child and
Adolescent Day Treatment Program (the "Bellevue
Program"), where he could receive a higher level of
care. AR 368. The final diagnoses rendered by Ms. McEvoy was
consistent with the prior findings: ADHD, combined type, and
ODD, rule out bipolar disorder. AR 368. At the time of his
discharge from Steinway, M.R.E. had been prescribed Concerta,
72 mg, Ritalin, 5 mg, and Risperidone, 2.5 mg. AR 374,
ii. Bellevue Hospital's Child and Adolescent Day
Treatment Program 
enrolled in the Bellevue Program in the Fall of 2011, through
which he was placed in a highly structured educational
setting at PS 35, and was provided psychiatric care and
individual therapy on a weekly basis. ECF Nos. 19, at 13-14;
23, at 7. On December 15, 2011, M.R.E. met with Debra McVey,
a licensed clinical social worker (" LCSW"). AR
434. Ms. McVey noted that the claimant could follow
directions, did not "boss other peers, " and was
able to complete his school work. AR 434. On the following
day, December 16, M.R.E. saw Dr. Eric Alcera, who reported
that M.R.E. had been struggling to follow directions at
school. AR 435. Dr. Alcera noted that the claimant was
cooperative, well-related, oriented, alert, and possessed
normal judgment and insight. AR 435. He diagnosed M.R.E. with
ADHD, with significant hyperactivity and inattention, as well
as a history of aggression, AR 436.
December 19, 2011, Courtney Karp, a social work intern, met
with M.R.E. for a weekly therapy session. AR 431. M.R.E.
reported that he was "fine, " but provided poor eye
contact. AR 431. Otherwise, he was cooperative, alert, and
oriented, and his insight and judgment were both intact. AR
431. On December 20, 2011, Dr. Kathryn Kavanaugh, a
psychologist, and Christina Laitner, a psychology extern,
co-authored notes which described M.R.E.'s struggles in
the classroom. AR 433. He had difficulty waiting his turn and
frequently requested to be called on by his teachers before
other students. AR 43. When he was not, he became
"vocal." AR 433. Ms. Karp and M.R.E. met once again
on December 22, 2011. AR 437. M.R.E. had been "acting
out" in class, and was very upset when confronted about
his behavior. AR 437. The claimant also reported that he and
his family would soon be moving to the Bronx, which made him
feel overwhelmed and anxious. AR437.
January 3, 2012, Dr. Kavanaugh and Ms. Laitner described that
M.R.E. often "pout[ed] and whine[d]" when he was
not called on before other students. AR 439-40. The claimant
could also "be bossy with his peers." AR 440. At
the same time, Dr. Kavanaugh and Ms. Laitner noted, M.R.E.
actively sought interpersonal connections with his
classmates, and was motivated by the point system in place at
school, which rewarded good behavior. AR 440.
January 10, 2012, Dr. Alcera wrote that M.R.E. continued to
exhibit "some oppositional behavior, " although the
intensity and frequency of such outbursts had decreased.
AR443. Citing a recent school report, Dr. Alcera noted that
M.R.E. performed adequately academically. AR 443. Results
from a mental status examination were also unremarkable. AR
443. Dr. Alcera diagnosed ADHD, but noted
that, generally, M.R.E.'s symptoms continued to improve,
as demonstrated by the decreased frequency and intensity of
his outbursts. AR 444. On January 20, Ms. Karp and M.R.E. met
for a weekly therapy session. AR 457. M.R.E. reported being
"happy, " and that he was in a good mood, excited
for his upcoming eighth birthday. AR 457. He had also been
performing well and behaving in class. AR 457.
January 24, 2012, Dr. Kavanaugh, along with Debroh Zlotnik, a
psychology extern, noted that M.R.E, participated actively
and appropriately in group activities. AR 445. Indeed, he
"encourage[d] his peers not to get upset when they were
not winning" during a class exercise. AR 445. On January
26, Ms. Karp reported that M.R.E. had "been doing really
well and will soon be ready to move on to a new school."
AR 459. On January 27, Dr. Kavanugh and Ms. Zlotnik wrote
that M.R.E. demonstrated good behavioral control, was not
disruptive, and appeared fully engaged in group activities.
AR 447. Once again, on February 3, M.R.E. was an active, and
appropriately behaved, participant in group activities. AR
February 3, 2012, M.R.E. met with Ms. Karp, appearing in a
good mood, and with a cooperative attitude. AR 453. Ms. Karp
noted that M.R.E. spoke at a normal rate and rhythm,
"varying between a normal volume and very loud outbursts
when [he became] excited." AR 453. The claimant sat
still in his chair during the session, and demonstrated sound
insight and judgment. AR 455. On February 9, however, he
apparently regressed; as Dr. Kavanaugh and Ms. Zlotnik noted,
M.R.E. exhibited hyperactive behavior, impulsivity, and
difficulty focusing during group exercises. AR 450.
Nevertheless, they noted, M.R.E. could be redirected to
engage in appropriate behavior when instructed to do so. AR
February 13, 2012, Dr. Alcera reported that M.R.E. was
compliant with his medications. AR 465. A mental status
examination was normal, and Dr. Alcera noted that
M.R.E.'s aggression and outbursts in class had improved.
AR465. As of February 16, M.R.E, was once again comporting
himself well in the classroom. AR 461. Dr, Kavanaugh and Ms.
Zlotnik described his euthymic mood and active, appropriate
behavior, as well as his positive responses to verbal praise
and reinforcement. AR 461. Also on February 16, M.R.E. met
with Ms. Karp; although he appeared calm, he was easily
distracted and had to be redirected multiple times throughout
the session. AR 463. Ms. Karp indicated that M.R.E. had
"done very well behaviorally in school over the past
month, earning [moderate scores] on the behavioral point
sheet." AR 463. When they met again on the following
day, February 17, Ms. Karp noted that the claimant was calm,
cooperative, alert and oriented. AR 468. His mood was
euthymic and he required little redirection throughout the
therapy session. AR 468.
to notes prepared by Ms. Zlotnik on March 1, 2012, M.R.E. was
generally on task during class exercises. Ar 470, Although he
demonstrated hyperactivity and impulsivity, the claimant
participated actively and appropriately with his classmates.
AR 470. Additionally, Ms. Zlotnik noted, M.R.E. was
responsive to positive reinforcement of his good behavior,
and generally well behaved. AR 471. Ms. Zlotnik's notes
from March 8 are substantively indistinguishable from the
above. AR 475,  On March 9, Ms. Karp and M.R.E.
discussed a recent altercation in which he bullied a
classmate on the school bus. AR 473. M.R.E. was calm and
cooperative; he understood that his actions were unnecessary
and hurtful. AR 473. On March 19, Dr. Alcera noted that
M.R.E. was "doing well, with no noted difficulties at
home and at school." AR 479. A mental status examination
was once again normal. AR 479.
March 22, Ms. Zlotnik provided an apparently conflicting
account of M.R.E.'s behavior in class. On the one hand,
she noted, he was generally on task and well behaved; at the
same time, however, M.R.E. "often told tangential
stories that were not on topic and it was difficult to
redirect him." AR 481. On March 23, Ms. Karp met with
M.R.E. to discuss a recent threat he had made to a fellow
classmate while on the school bus. AR 484. M.R.E.
explained that he threatened the other student because he was
annoyed with her and wanted to scare her. AR 484. He made
sparse eye contact during the session, but was readily
redirected. AR 484.
met with Ms. Karp once again on March 30, 2012, at which time
he admitted that his threatening actions the previous week
were "wrong" and that he and his classmate were
"fine." AR 486. Although M.R.E. appeared happy at
the beginning of the meeting, he grew upset after discussing
his transition to a new school. AR 486-87. On April 3,
the claimant met once again with Ms. Karp for an individual
therapy session. AR 492. M.R.E.'s mood vacillated over
the course of the session, "ranging from happy when
discussing [his] good behavior to depressed when upcoming
transitions were discussed." AR 493. The claimant was
otherwise alert and oriented, with his thought process
coherent and goal-directed. AR 492.
presented to Ms. Zlotnik on April 5, 2012, in an irritable
mood; he had continuously been provoked by one of his
classmates. AR 490. M.R.E. threatened to fight the classmate,
and Ms. Zlotnik noted that he demonstrated hyperactivity and
impulsivity throughout the group meeting. AR 490. On April
9, 2012, Dr. Alcera reported that the claimant
remained compliant with his medication, and that both home
and school reports showed that M.R.E.'s attention and
focus had improved. AR 494, M.R.E. was also less irritable
and argumentative, and "more flexible", complying
"without difficulty with staff, teachers and [his]
mom." AR 494. A mental status examination was normal. AR
494. Dr. Alcera observed that M.R.E. was generally doing
better but still suffered from significant hyperactivity and
inattention. AR 495.
April 13, 2012, Plaintiff informed Ms. Kaip that M.R.E., who
was home from school at the time on a scheduled break, had
been "difficult" but "not out of
control." AR 496. Indeed, Plaintiff was capable of
redirecting M.R.E. to behave appropriately, but it often
required threatening to call the police or a hospital to calm
him down. AR 496. Upon his return to school, on April 16,
M.R.E. met with Ms. Karp for an individual therapy session.
AR 500. Although the claimant remained cooperative and calm
throughout the session, he told Ms. Karp that he sometimes
felt as though he was incapable of controlling himself. AR
500. On April 19, Ms. Zlotnik noted that M.R.E. had been
verbally aggressive toward a classmate, but "responded
well to redirection and was [thereafter] able to use
effective problem solving skills to resolve peer
conflict." AR 498. Aside from the initial conflict,
M.R.E. was generally on task and well-behaved. AR 498.
Karp, who was leaving the Bellevue Program at the end of the
month, met with M.R.E. for the final time on April 27, 2012.
During their meeting, they discussed a minor altercation
between the claimant and other students on the bus, and went
out for ice cream to celebrate M.R.E.'s otherwise good
behavior. AR 502. Ms. Karp noted that, in general, the
claimant got along well with his peers and was well-behaved.
AR 502, During the meeting M.R.E. interacted with Ms. Karp in
a friendly and appropriate manner. AR 502.
group sessions on both April 26 and May 3, 2012, M.R.E.
became verbally aggressive toward a classmate, but responded
well to redirection. AR 504, 506. As Ms. Zlotnik wrote,
M.R.E. appropriately sought extra help from the staff and
generally behaved well after the initial conflict. AR 504,
506. On May 10, Ms. Zlotnik reported that M.R.E. was
generally on task and interacted well with his peers. AR 488.
The claimant responded well to redirection from his teachers
and demonstrated "good team work." AR 488.
May 10, 2012, M.R.E. met with Debra McVey, who had replaced
Ms. Karp as his therapist at the Bellevue Program. AR 508.
Ms. McVey noted that M.R.E, had a short temper in the
classroom, and was incapable of responding to redirection
from his teachers. AR 508. Less than one week later, on May
16, Dr. Alcera wrote that M.R.E. was doing well in the
program, remaining "engaged academically with minimal to
nil tantrums or outbursts." AR 509. M.R.E. exhibited
good behavior at home and continued to demonstrate improved
frustration tolerance at school. AR 509. A mental status
examination was unremarkable; M.R.E. was alert, oriented, and
24, 2012, Ms. Zlotnik rendered an apparently conflicting
account of M.R.E.'s behavior during group activities. AR
512. She began her narrative by stating that the claimant was
generally on task and well behaved during the group activity,
but wrote in the next sentence that he "demonstrated
bossy behavior towards group members." AR
512. On May 25, Plaintiff spoke with Ms.
McVey to inform her that M.R.E. was having trouble getting
along with two peers in his after school program. AR512.
told Ms. McVey on June 1, 2012, that he felt "in
control" and did not think he required more medication.
AR 515. He reported that two students in his after school
program were being provocative by "always saying bad or
mean things" about his mother, but he was able to ignore
them. AR 515. On June 8, Ms. McVey noted that M.R.E. behaved
well in class over the previous week, AR 515. According to
Ms. Zlotnik's notes of June 14, 2012, M.R.E. was
generally on task and interacted well with his peers. AR 517.
On the following day, June 15, Ms. McVey noted that M.R.E.
was "doing better" in the after school program. AR
518. Plaintiff also reported that the claimant's behavior
at home had improved. AR 518. On June 22, Ms. Mcvey wrote
that M.R.E. had a good week, and was able to play with a
classmate without "being too bossy[.]"AR 519.
Alcera, writing on July 11, 2012, noted that M.R.E. did not
have any tantrums or aggressive outbursts in the previous
month. AR 520. The claimant continued to show improvement in
his behavior at school; his attention, focus, and mood were
each considered "good" as well. AR 520. M.R.E. was
compliant with his medications, and a mental status
examination was normal. AR 520. On the same day, July 11, Ms.
McVey met with M.R.E. for an individual therapy session. AR
523. They discussed a recent altercation between the claimant
and a classmate of his during an after school program,
wherein the claimant threatened to hit the peer for jumping
ahead of him in line, AR 523. M.R.E., according to Ms. McVey,
"agreed that learning is more important... than being
the first on line." AR 523.
20, 2012, Ms. McVey wrote that M.R.E.'s anger management
had improved. AR 524. She had also spoken with Plaintiff, who
confirmed that the claimant would begin attending PS 96 in
the fall and receiving additional care from Astor Services
for Children and Families, a clinic located in the Bronx, New
York, AR 524. Both Ms. McVey and Plaintiff "agreed that
[M.R.E.] improved and he did great in the [Bellevue
Program]." AR 524.
PS 35 Riverview School 
end of the Spring Term of 2012, M.R.E.'s principal at PS
35, Marta Bamett, completed a report card which detailed the
claimant's social behavior, AR 260. According to Ms.
Bamett, M.R.E. demonstrated a low threshold and tolerance for
others, and got "set off very easily." AR 260. She
also noted that M.R.E. had a difficult time recovering from
spells of frustration. AR 260. Although he had good friends
in the class, with whom he interacted on a daily basis, he
could, according to Ms. Bamett, stand to "learn to keep
an indoor voice and how to keep himself together in a group
setting." AR 260.
Records Post-dating Plaintiffs SSI
Bellevue Hospital's Child and Adolescent Day
27, 2012, Ms. McVey noted that the claimant had another good
week in school, where he continued to display behavioral
improvement. AR 525. M.R.E. acknowledged that he was in
better control of his anger, and that he had made many
friends at the Bellevue Program whom he would miss upon
leaving. AR 525. Ms. McVey, speaking on behalf of the staff,
wrote that "we will miss him also, and it's nice to
see him mature so nicely." AR 525.
August 14, 2012, Dr. Alcera noted that M.R.E. had continued
to do well behaviorally, and did not exhibit any tantrums or
outbursts over the prior month. AR 527. A mental status
examination revealed that M.R.E. had a good mood and full
affect. AR 527. The claimant was compliant with his
medications and treatment, and got along well with his
classmates. AR 527. Writing on August 16, Ms. McVey indicated
that M.R.E. had perfect attendance over the previous two
weeks, and had "matured as a person" over the
course of the Bellevue Program. AR529.
PS 35 Riverview School
Susan Berman, the claimant's second grade teacher at PS
35, noted on a report card that M.R.E had "come a long
way since the beginning of the year." AR 289. Although
M.R.E. was still working on certain behavioral issues - using
his "indoor voice" within the classroom -he was,
"for the most part, " able to control himself. AR
August 8, 2012, Ms. Berman completed a questionnaire at the
request of the SSA. AR 248. She first found that M.R.E.'s
ability to acquire and use information was not impaired. AR
249, Next, she found that, generally, M.R.E. had no
difficulty attending and completing tasks, but had some
trouble finishing his work within a reasonable period of
time. AR 250.With respect to interacting and relating
with others, M.R.E. had "slight problems" in the
categories of playing cooperatively with classmates, seeking
attention and expressing anger appropriately, and taking
turns in conversation. AR 251,  Ms. Berman explained that
M.R.E. often helped others in his class, "however
sometimes [his] tone need[ed] to be adjusted." AR 251.
She found that he could benefit from learning how to use an
"indoor voice and a friendly tone when conversing with
others." AR 251. Ms. Berman then indicated that M.R.E.
had no problems in the domain of moving about and
manipulating objects. AR 252.
respect to the final domain of functioning, caring for
himself or herself, Ms. Berman found that M.R.E. had an
"obvious problem" being patient when necessary, and
a "slight problem" with respect to handling his
frustration and responding appropriately to changes in his
mood. AR 253. She noted that M.R.E. "can become
very frustrated and drastic changes can occur. He becomes
sullen when he doesn't get his way... he has been able to
control this more but it's still present." AR 253.
On a separate form, also signed and dated August 8, 2012, Ms.
Berman indicated that M.R.E.'s reading, writing, and math
skills were commensurate with his grade level. AR 256.
October 21, 2012, Heather Sutorius, M.R.E.'s third grade
teacher at PS 96, completed a questionnaire at the request of
the SSA. AR 410. M.R.E. was in an integrated co-teaching
("ICT") class, with twenty-nine other students and
two teachers. AR 410. At the time she completed the report
Ms. Sutorius had taught the claimant for a period of roughly
two months. AR 410.
Sutorius found that M.R.E. exhibited "slight
problems" in nine of the ten categories listed under the
domain of acquiring and using information. AR 411,
He had one "obvious problem" with respect to his
ability to express ideas in the written form. AR 411. With
respect to the domain of attending and completing tasks, Ms.
Sutorius indicated that M.R.E. had obvious difficulties
working without distraction and in sustaining attention
during sports or play activities. AR 412. Generally, however,
she indicated that the claimant could be re-focused to task,
and had no problems completing his assignments or carrying
out simple instructions. AR 412. Otherwise, Ms. Sutorius
found that M.R.E. had "slight problems" in a number
of other categories, such as paying attention when being
spoken to directly and waiting to take turns. AR
respect to interacting and relating with others, M.R.E.
exhibited "slight problems" in five categories:
playing cooperatively with classmates; seeking attention;
expressing anger; asking permission appropriately; as well as
following rules. AR 413, Otherwise, M.R.E. had "no
problem" in each of the eight remaining categories
listed on the form. AR 413. Like Ms. Berman, Ms. Sutorius
found that M.R.E. had no difficulty in the domain of moving
about and manipulating objects. AR 414. As to his ability to
care for himself, however, Ms. Sutorius noted that M.R.E. had
"slight problems" in five categories, with "no
problems" in five others. AR 415, He had slight
difficulties handling frustration appropriately; being
patient when necessary; identifying and appropriately
asserting emotional needs; responding appropriately to change
in his mood; and using appropriate coping skills to meet
daily demands of the school environment. AR
Astor Services for Children and Families
September 13, 2012, staff members at Astor Services for
Children and Families ("Astor Services") in the
Bronx, New York, prepared an intake form in connection with
M.R.E.'s admission into their comprehensive outpatient
program. AR 404. Upon admission, M.R.E. was diagnosed with
disruptive behavior disorder and ADHD. AR 404. Atara Hiller,
a doctoral intern in psychology with Astor Services, met with
M.R.E. for weekly therapy sessions. AR 422. On April 3, 2013,
she authored a letter which indicated that the claimant had
been diagnosed with ADHD and disruptive behavior disorder; he
was then taking Vyvanse, 60 mg, to address these conditions.
AR 422. According to Ms. Hiller, although M.R.E.
continued to make progress, he still had some difficulty
managing his anger, impulsivity, hyperactivity, and ability
to focus at home and at school. AR 422. On November 6, 2013,
an Astor Services nurse whose name is illegible completed a
treatment plan. AR 539. The nurse indicated that M.R.E.
possessed a good attitude and was able to complete his work,
but continued to suffer from hyperactivity, impulsivity,
inattention, irritability, and a labile mood. AR 539.
SSA Consultant: Dr. Altmansberger
August 20, 2012, Dr. R. Altmansberger, a non-examining Agency
consultant, considered the record that was submitted to date
and determined that M.R.E. was not disabled. AR 91. Relying
on Ms. Berman's responses to the teacher questionnaire,
Dr. Altmansberger determined that M.R.E. had no limitation in
the domain of acquiring and using information. AR 89. He then
found that M.R.E. suffered from less than marked restrictions
in the domain of attending and completing tasks. AR 90. Once
again, he based this determination on Ms. Berman's
responses to the teacher questionnaire. AR 90. He also relied
on notes from the Bellevue Program, citing to a mental status
examination on May 16, 2012, wherein Dr. Alcera found that
M.R.E. was doing well and was stable on his medication
regimen. AR 90. Dr. Altmansberger found that the claimant
possessed less than marked restrictions in the domains of
interacting and relating with others, health and physical
well-being, and caring for himself. AR 90. The consultative
doctor concluded that M.R.E. was not limited in the domain of
moving about and manipulating objects. AR 90.
narrative section of his report, Dr. Altmansberger explained
that by most accounts M.R.E. was doing well, had improved at
the Bellevue Program, and was stable on his medication. AR
90. M.R.E.'s mental status examination results, moreover,
fell within normal limits. AR 90. The claimant was repeatedly
found to be cooperative, not aggressive, and in a euthymic
mood. AR 90. In addition to Dr. Alcera's notes, Dr.
Altmansberger relied heavily on Ms. Berman's teacher
questionnaire. AR 91. Otherwise, the consultative doctor
noted, the record lacked any opinionative evidence form any
other sources. AR 91.
24, 2012, Plaintiff completed a Function Report in connection
with her son's application for SSI
benefits. She indicated that M.R.E, had difficulty
making new friends and getting along with her and other
adults. AR 230. He would often hit, argue, and lose control,
but Plaintiff noted that the program he was then attending -
Bellevue - was helping him resolve these issues. AR23O.
Plaintiff indicated that M.R.E.'s ability to care for
himself was unimpaired. AR 231. She described slight
difficulties in M.R.E.'s capacity to pay attention and
adhere to tasks; he could keep busy on his own, finish things
he started, work on projects, and complete most chores, but
not his homework. AR 232.
August 21, 2013, Hearing
first of two administrative hearings was held on August 21,
2013. AR 71. Both Plaintiff and Dr. Sriti Vishan Resicart, a
medical expert, testified at the hearing. AR 70. Plaintiff
and the claimant did not appear with counsel. AR 72.
ALJ first informed Plaintiff of her right to proceed with an
attorney, and gave her the option to adjourn the hearing so
that she may attempt to find counsel. AR 72. ...