Opinion
1:20-CV-00644 EAW
2021-06-28
QUALEN C., Plaintiff, v. COMMISSIONER OF SOCIAL SECURITY, Defendant.
Justin M. Goldstein, Kenneth R. Hiller, Law Offices of Kenneth Hiller, PPLC, Amherst, NY, for Plaintiff. Ariella Renee Zoltan, Social Security Administration Office of General Counsel, New York, NY, for Defendant.
Justin M. Goldstein, Kenneth R. Hiller, Law Offices of Kenneth Hiller, PPLC, Amherst, NY, for Plaintiff.
Ariella Renee Zoltan, Social Security Administration Office of General Counsel, New York, NY, for Defendant.
DECISION AND ORDER
ELIZABETH A. WOLFORD, United States District Judge
INTRODUCTION
Represented by counsel, Plaintiff Qualen C. ("Plaintiff") brings this action pursuant to Titles II and XVI of the Social Security Act (the "Act"), seeking review of the final decision of the Commissioner of Social Security (the "Commissioner," or "Defendant") denying his applications for child's disability benefits ("CIB"), disability insurance benefits ("DIB"), and supplemental security income ("SSI"). (Dkt. 1). This Court has jurisdiction over the matter pursuant to 42 U.S.C. § 405(g). Presently before the Court are the parties’ cross-motions for judgment on the pleadings pursuant to Rule 12(c) of the Federal Rules of Civil Procedure (Dkt. 7; Dkt. 8), and Plaintiff's reply (Dkt. 9). For the reasons discussed below, Plaintiff's motion (Dkt. 7) is granted to the extent that the matter is remanded to the Commissioner for further administrative proceedings consistent with this Decision and Order, and the Commissioner's motion (Dkt. 8) is denied.
BACKGROUND
Plaintiff protectively filed his applications for SSI and DIB on July 12, 2016, and protectively filed his application for CIB on August 5, 2016. (Dkt. 6 at 171, 323-37). In his applications, Plaintiff alleged disability beginning June 30, 2016. (Id. at 171, 351). Plaintiff's applications were initially denied on November 21, 2016. (Id. at 171, 262-77). At Plaintiff's request, a hearing was held before administrative law judge ("ALJ") Timothy M. McGuan in Buffalo, New York, on November 8, 2018. (Id. at 191-220). On December 26, 2018, the ALJ issued an unfavorable decision. (Id. at 168-88). Plaintiff requested Appeals Council review; his request was denied on March 31, 2020, making the ALJ's determination the Commissioner's final decision. (Id. at 5-11). This action followed.
LEGAL STANDARD
I. District Court Review
"In reviewing a final decision of the [Social Security Administration ("SSA")], this Court is limited to determining whether the SSA's conclusions were supported by substantial evidence in the record and were based on a correct legal standard." Talavera v. Astrue , 697 F.3d 145, 151 (2d Cir. 2012) (quotation omitted); see also 42 U.S.C. § 405(g). The Act holds that a decision by the Commissioner is "conclusive" if it is supported by substantial evidence. 42 U.S.C. § 405(g). "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." Moran v. Astrue , 569 F.3d 108, 112 (2d Cir. 2009) (quotation omitted). It is not the Court's function to "determine de novo whether [the claimant] is disabled." Schaal v. Apfel , 134 F.3d 496, 501 (2d Cir. 1998) (quotation omitted); see also Wagner v. Sec'y of Health & Human Servs. , 906 F.2d 856, 860 (2d Cir. 1990) (holding that review of the Secretary's decision is not de novo and that the Secretary's findings are conclusive if supported by substantial evidence). However, "[t]he deferential standard of review for substantial evidence does not apply to the Commissioner's conclusions of law." Byam v. Barnhart , 336 F.3d 172, 179 (2d Cir. 2003) (citing Townley v. Heckler , 748 F.2d 109, 112 (2d Cir. 1984) ).
II. Disability Determination
An ALJ follows a five-step sequential evaluation to determine whether a claimant is disabled within the meaning of the Act. See Bowen v. City of New York , 476 U.S. 467, 470-71, 106 S.Ct. 2022, 90 L.Ed.2d 462 (1986). At step one, the ALJ determines whether the claimant is engaged in substantial gainful work activity. See 20 C.F.R. §§ 404.1520(b), 416.920(b). If so, the claimant is not disabled. If not, the ALJ proceeds to step two and determines whether the claimant has an impairment, or combination of impairments, that is "severe" within the meaning of the Act, in that it imposes significant restrictions on the claimant's ability to perform basic work activities. Id. §§ 404.1520(c), 416.920(c). If the claimant does not have a severe impairment or combination of impairments, the analysis concludes with a finding of "not disabled." If the claimant does have at least one severe impairment, the ALJ continues to step three.
At step three, the ALJ examines whether a claimant's impairment meets or medically equals the criteria of a listed impairment in Appendix 1 of Subpart P of Regulation No. 4 (the "Listings"). Id. §§ 404.1520(d), 416.920(d). If the impairment meets or medically equals the criteria of a Listing and meets the durational requirement (id. §§ 404.1509, 416.909), the claimant is disabled. If not, the ALJ determines the claimant's residual functional capacity ("RFC"), which is the ability to perform physical or mental work activities on a sustained basis, notwithstanding limitations for the collective impairments. See id. §§ 404.1520(e), 416.920(e).
The ALJ then proceeds to step four and determines whether the claimant's RFC permits the claimant to perform the requirements of his or her past relevant work. Id. §§ 404.1520(f), 416.920(f). If the claimant can perform such requirements, then he or she is not disabled. If he or she cannot, the analysis proceeds to the fifth and final step, wherein the burden shifts to the Commissioner to show that the claimant is not disabled. Id. §§ 404.1520(g), 416.920(g). To do so, the Commissioner must present evidence to demonstrate that the claimant "retains a residual functional capacity to perform alternative substantial gainful work which exists in the national economy" in light of the claimant's age, education, and work experience. Rosa v. Callahan , 168 F.3d 72, 77 (2d Cir. 1999) (quotation omitted).
DISCUSSION
I. The ALJ's Decision
In determining whether Plaintiff was disabled, the ALJ applied the five-step sequential evaluation set forth in 20 C.F.R. §§ 404.1520 and 416.920. Initially, the ALJ determined that Plaintiff had not attained the age of 22 as of June 30, 2016, the alleged onset date. (Dkt. 6 at 174). At step one, the ALJ determined that Plaintiff had engaged in substantial gainful work activity during the first and second quarters of 2018, but that prior to 2018, there had been a continuous 12-month period during which Plaintiff had not engaged in substantial gainful work activity. (Id. at 174-75). The remainder of the ALJ's decision addressed this period. (Id. ).
At step two, the ALJ found that Plaintiff suffered from the severe impairments of drug induced psychotic disorder, schizophrenia, and alcohol and marijuana dependence. (Id. at 175).
At step three, the ALJ found that Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of any Listing. (Id. ). The ALJ particularly considered the criteria of Listings 12.02 and 12.03 in reaching his conclusion. (Id. at 175-77).
Before proceeding to step four, the ALJ determined that Plaintiff retained the RFC to perform a full range of work at all exertional levels, but with the non-exertional limitations that he "can perform simple, unskilled work" and "can have occasional interaction with the public and no interaction limitations interacting with coworkers of supervisors." (Id. at 177). At step four, the ALJ found that Plaintiff could not perform any past relevant work. (Id. at 182).
At step five, the ALJ relied on the testimony of a vocational expert ("VE") to conclude that, considering Plaintiff's age, education, work experience, and RFC, there were jobs that exist in significant numbers in the national economy that Plaintiff could perform, including the representative occupations of marker, garment sorter, and press tender. (Id. at 183). Accordingly, the ALJ found that Plaintiff was not disabled as defined in the Act. (Id. at 184).
II. Remand of this Matter for Further Administrative Proceedings is Required
Plaintiff asks the Court to remand this matter to the Commissioner for further administrative proceedings, arguing that (1) the ALJ failed to comply with the so-called "Five-Day Rule" and further failed to satisfy his affirmative duty to develop the record; (2) the Appeals Council failed to properly consider additional evidence submitted to it by Plaintiff; (3) the ALJ's RFC finding is unsupported by substantial evidence; and (4) the ALJ failed to apply the appropriate legal standard in evaluating Plaintiff's subjective complaints. (Dkt. 7-1). For the reasons set forth below, the Court agrees with Plaintiff that the Appeals Council failed to appropriately consider the additional evidence before it and that this error necessitates remand.
A. Appeals Council Assessment of Additional Evidence
Plaintiff submitted substantial additional evidence to the Appeals Council, including most significantly treatment notes from Spectrum Human Services covering the period between November 7, 2017, and November 17, 2018. (Dkt. 6 at 6, 29-162). In denying Plaintiff's request for review, the Appeals Council found that there was not a "reasonable probability that [this evidence] would change the outcome of the decision." (Id. at 6).
"[T]he Appeals Council, in reviewing a decision based on an application for benefits, will consider new evidence only if (1) the evidence is material, (2) the evidence relates to the period on or before the ALJ's hearing decision, and (3) the Appeals Council finds that the ALJ's decision is contrary to the weight of the evidence, including the new evidence." Rutkowski v. Astrue , 368 F. App'x 226, 229 (2d Cir. 2010) (citing 20 C.F.R. § 416.1470 ); see also Graham v. Berryhill , 397 F. Supp. 3d 541, 557 n.10 (S.D.N.Y. 2019) (when faced with an argument that the Appeals Council failed to appropriately consider the new evidence submitted to it, "the court is expected to determine if the new evidence results in the ALJ's decision not being supported by substantial evidence or otherwise runs afoul of [ 42 U.S.C.] section 405(g)").
Here, the Court agrees with Plaintiff that the additional records submitted to the Appeals Council render the ALJ's decision unsupported by substantial evidence. In particular, in assessing Plaintiff's subjective complaints, the ALJ found Plaintiff's testimony not fully credible because of "a gap in treatment for mental services from October 2016 through May 2018." (Dkt. 6 at 179). However, the additional records submitted to the Appeals Council shows that Plaintiff was actively seeking mental health treatment during a substantial portion of that time. The ALJ's credibility assessment was thus based on a misapprehension of the medical record, and is unsupported by substantial evidence. Further, the Court is unable to conclude that this error is harmless. Had the ALJ given greater credence to Plaintiff's subjective complaints, he might well have included additional limitations in the RFC finding; any suggestion to the contrary by the Commissioner is merely speculation. Accordingly, remand of this matter for further administrative proceedings is necessary. See, e.g., Drake v. Saul , 839 F. App'x 584, 588 (2d Cir. 2020) (substantial evidence did not support the ALJ's "negative credibility determination" because the reasons relied upon by the ALJ in reach such determination were erroneous); Walsh v. Colvin , No. 3:13-CV-00687 (JAM), 2016 WL 1626817, at *8 (D. Conn. Apr. 25, 2016) (remanding for further proceedings because "the ALJ's adverse credibility finding was affected by an incomplete account of the medical record").
B. Plaintiff's Remaining Arguments
To the extent Plaintiff identifies other reasons why he contends the ALJ's decision should be vacated, the Court need not reach those arguments because the Court has already determined, for the reasons previously discussed, that remand of this matter for further administrative proceedings is necessary. See, e.g., Samantha D. v. Comm'r of Soc. Sec. , No. 3:18-CV-1280 (ATB), 2020 WL 1163890, at *10 (N.D.N.Y. Mar. 11, 2020) ; Raymond v. Comm'r of Soc. Sec. , 357 F. Supp. 3d 232, 240-41 (W.D.N.Y. 2019) ; Walsh , 2016 WL 1626817, at *9.
CONCLUSION
For the foregoing reasons, Plaintiff's motion for judgment on the pleadings (Dkt. 7) is granted to the extent that the matter is remanded for further administrative proceedings. Defendant's motion for judgment on the pleadings (Dkt. 8) is denied.
SO ORDERED.