HON. MICHAEL A. TELESCA, United States District Judge.
Represented by counsel, Matthew James Gibbs ("plaintiff") brings this action pursuant to Title XVI of the Social Security Act ("the Act"), seeking review of the final decision of the Commissioner of Social Security ("the Commissioner") denying his application for supplemental security income ("SSI"). The Court has jurisdiction over this 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. For the reasons discussed below, plaintiff's motion is granted, and the matter is reversed and remanded solely for the calculation and payment of benefits.
The record reveals that in May 2011, plaintiff (d/o/b June 28, 1989) applied for SSI, alleging disability as of May 13, 2011. After his application was denied, plaintiff requested a hearing, which was held before administrative law judge Timothy M. McGuan ("the ALJ") on November 15, 2012. The ALJ issued an unfavorable decision on November 30, 2012. The Appeals Council denied review of that decision and this timely action followed.
Medical records from Batavia Neurology ("Batavia"), which begin in May 2000 and
Medical records from General Physician Sub I, PLLC indicated diagnoses of mental retardation and convulsive epilepsy. In March 2012, plaintiff reported having petit mal seizures daily. In April 2012, plaintiff reported to sources at Batavia that, despite compliance with medications, he had four seizures in the last several weeks, three of which were categorized as grand mal. An EEG was performed in May 2012, which revealed "an epileptiform brain disorder with a seizure focus in the left hemisphere." T. 316. In August 2012, plaintiff's mother reported that plaintiff had suffered two seizures in the last several months. His mother described him as "acting strangely," stated that he did not appear to understand what she was saying, and reported that he was "confused for a long time afterwards." T. 348. She also reported that he had not missed any doses of medication. Dr. Hilburger diagnosed breakthrough seizures and increased his medication dosage. An October 2012 EEG once again confirmed epileptiform brain disorder. The EEG was noted to be abnormal "due to poorly organized background activity, and what appear[ed] to be bifrontal spike and sharp wave discharges." T. 352.
Dr. Harbinder Toor performed a consulting neurological examination in August 2011. Plaintiff reported having "many petit mal seizures," and two grand mal seizures in 2011. T. 263. He reported that his seizures varied in intensity and frequency. Dr. Toor also noted plaintiff's diagnoses of learning disability and Ollier's disease, the latter of which caused "a benign tumor in the right ankle, which [gave] him a dully, achy, on-and-off pain" and occasionally caused difficulty standing and walking for long periods.
Dr. Sandra Jensen performed an intelligence evaluation in August 2011. Dr. Jensen noted that plaintiff was 22 years old and had a history of epilepsy, a brain disorder, developmental delay, and Ollier's disease. He had previously received SSI benefits, which were terminated upon his attaining age 18. His mother reported that he had seizures and had been diagnosed with Ehler's disease. Plaintiff received a local high school diploma at age 21. He reported being unable to work "because of seizures and inability to understand job rules." T. 267. Plaintiff's reading skills tested at a third grade level, but did not indicate the presence of a reading disorder.
T. 269. Dr. Jensen diagnosed plaintiff with a learning disability, borderline intellectual functioning, brain damage, seizures, and Ollier's disease.
In September 2011, non-examining consultant Dr. C. Butensky completed a psychiatric review technique and mental RFC. Dr. Butensky found that plaintiff had mild restriction in activities of daily living ("ADLs") and social functioning and moderate difficulty in maintaining attention, concentration, persistence, or pace. Dr. Butensky noted that his review of the record indicated that plaintiff had borderline intellectual functioning "with non-verbal skills superior to verbal skills." T. 285. Dr. Butensky opined that plaintiff "retain[ed] the capacity to perform simple job tasks; he [had] mild to moderate limitations in his ability to sustain attention/concentration, adapt to changes in a routine work setting and interact appropriately with coworkers and supervisors."
In a mental RFC, Dr. Butensky opined that plaintiff was moderately limited in his ability to understand, remember, and carry out detailed instructions; sustain an ordinary routine without special supervision; work in coordination with or proximity to others without being distracted by them; complete a normal workday or week without interruptions from psychologically-based symptoms and perform at a consistent pace without an unreasonable number and length of rest periods; get along with coworkers or peers without distracting them or exhibiting behavioral extremes; respond appropriately to changes in the work setting; travel in unfamiliar places or use public transportation; and set realistic goals or make plans independently of others.
Treating physician Dr. Hilburger submitted an RFC questionnaire, specific to seizures, dated October 2012. Dr. Hilburger noted that plaintiff had a history of generalized tonic-clonic seizures, which included loss of consciousness. He estimated that these seizures occurred approximately once per month and came on without warning. Dr. Hilburger indicated that the seizures resulted in confusion, exhaustion, and irritability, which symptoms lasted for approximately two hours following a seizure. In Dr. Hilburger's opinion, these seizures interfered "very much" with plaintiff s ADLs following a seizure. He also noted that plaintiff had a history of injury as well as fecal or urinary incontinence during a seizure. In Dr. Hilburger's opinion, plaintiff's seizures were likely to disrupt coworkers and would require plaintiff to receive more supervision at work than
The ALJ followed the well-established five-step sequential evaluation promulgated by the Commissioner for adjudicating disability claims. See 20 C.F.R. § 404.1520. At step one, the ALJ determined that plaintiff had not engaged in substantial gainful activity since May 27, 2011, the application date. At step two, the ALJ found that plaintiff suffered from the following severe impairments: organic mental disorder (learning disability and borderline intellectual functioning) and epilepsy (generalized epileptiform brain disorder). At step three, the ALJ found that plaintiff did not have an impairment or combination of impairments that met or medically equaled a listed impairment. The ALJ stated, without elaborating, that he had "specifically considered the listings in 12.00 and 11.00 and [found] the criteria [were] not met." T. 13. The ALJ also stated, again unsupported by any reasoning, that he had considered listing 12.02 and found it not met. The ALJ made no specific mention of listing 12.05. In assessing plaintiff's mental functioning, the ALJ found that plaintiff had mild limitations in ADLs, mild difficulties in social functioning, and moderate difficulties in concentration, persistence, or pace.
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 following nonexertional limitations: plaintiff must avoid all exposure to heights, dangerous machinery, and concentrated exposure to loud noise; plaintiff could not understand, remember, and carry out complex and detailed tasks; plaintiff could not operate motor vehicles; and plaintiff was limited to simple, unskilled work. After finding that plaintiff had no past relevant work, the ALJ determined that, considering plaintiff's age, work experience, and RFC, jobs existed in significant numbers in the national economy that plaintiff could perform. The ALJ thus found that plaintiff was not disabled.
A district court may set aside the Commissioner's determination that a claimant is not disabled only if the factual findings are not supported by "substantial evidence" or if the decision is based on legal error. 42 U.S.C. § 405(g); see also
Plaintiff's primary argument is that the ALJ failed to properly consider listing 12.05(C). Plaintiff contends that the ALJ failed to provide any reasoning for finding that plaintiff was not disabled under that listing, and that substantial evidence in the record establishes that plaintiff is presumptively disabled under that listing. Because the Court finds that plaintiff suffered from mental retardation as defined by listing 12.05(c), the Court will not address plaintiff's further argument that the
Listing 12.05(C) was amended in August 2013 to change the phrase "mental retardation" to "intellectual disability."
Plaintiff argues that his verbal comprehension IQ score of 70, along with his impairment of epilepsy, combined to satisfy the criteria of listing 12.05(C). The Court agrees. The Commissioner's argument, that the verbal IQ score assessed by Dr. Jensen was an "index" rather than a "score" and therefore did not satisfy the definition of the listing, is unavailing. Dr. Jensen's report specifically delineates the verbal comprehension result as a "standard score," and plaintiff points out in his reply that the terms "score" and "index" are interchangeable under the WAIS-IV framework, which Dr. Jensen used. Therefore, the Court finds that plaintiff's verbal comprehension IQ score, as found by the state agency consultant, satisfied the first prong of listing 12.05(C).
As for the second prong, plaintiff suffered from epilepsy, a seizure disorder which, in treating physician Dr. Hilburger's opinion, limited him so severely that it would cause him to miss more than four days of work per week, required constant supervision, and precluded plaintiff from performing even low-stress jobs.
The ALJ gave Dr. Hilburger's opinion "only some weight," finding that the limitations noted were "not supported by any medical evidence in the record and were never mentioned in any examinations." T. 16. This statement by the ALJ was clear error. Plaintiff's neurological treatment records consistently note the occurrence of petit and grand mal seizures, which occurred with increasing frequency as breakthrough seizures despite plaintiff's medication regimen. The treatment notes also document that these seizures were attended by incontinence and subsequent confusion on plaintiff's part. There is nothing in the record which substantially contradicts Dr. Hilburger's treating source opinion as to the functional limitations resulting from plaintiff's epilepsy. The Court therefore finds that the ALJ failed to provide good reasons for rejecting Dr. Hilburger's treating source opinion, which was supported by substantial evidence in the record. See, e.g.,
Given the controlling weight to which it was entitled, Dr. Hilburger's opinion establishes that plaintiff's epilepsy constituted a "physical or other mental impairment imposing an additional and significant work-related limitation of function,"
The Court notes that the standard for directing a remand for calculation of benefits is met when the record persuasively demonstrates the claimant's disability, see
For the foregoing reasons, the Commissioner's motion for judgment on the pleadings (Doc. 13) is denied and plaintiff's motion (Doc. 8) is granted. This matter is reversed and remanded solely for the calculation and payment of benefits. The Clerk of the Court is directed to close this case.