REGGIE B. WALTON, District Judge.
For the reasons are set forth in the accompanying Memorandum Opinion, it is hereby
Plaintiff Sandra K. Jeffries brings this action on behalf of her son, T.J., against Michael J. Astrue (the "Commissioner"), in his official capacity as the Commissioner of the Social Security Administration (the "Administration"), seeking the reversal of the Administration's denial of Social Security Income Benefits to T.J. pursuant to 42 U.S.C. § 405(g) (2006). Currently before this Court are the defendant's Motion for Judgment of Affirmance and the plaintiff's Motion for Judgment of Reversal or a Remand to the Social Security Administration. After carefully considering the plaintiff's complaint, the administrative record, the parties' motions and their memoranda of law and exhibits submitted in support of their motions,
The following facts are part of the administrative record. In 1998, as a young child, T.J. was struck by a car and suffered head injuries. Administrative Record (the "A.R.") at 437-439. Although neurological examinations revealed no signs of brain
During the 2002-2005 time period, T.J.'s mother and teachers created an individualized education program for T.J. Id. at 107, 134-47, 253, 423-28. In 2004, T.J.'s special education teacher filled out a Teacher Questionnaire provided by the Administration, analyzing T.J.'s abilities in the Administration's six domains of function. Id. at 291-298. In 2007, five other teachers filled out the questionnaires, id. at 449-84, and while these evaluations were initially unavailable to the ALJ at the time of his decision, they were submitted to the Appeals Council for their consideration in reviewing the ALJ's initial determination, id. at 6-7.
The plaintiff had filed an application for supplemental security income on T.J.'s behalf on June 10, 2004. Id. at 17. The ALJ denied the initial request for a hearing at the agency level, however, the plaintiff appealed that determination to the agency's Appeals Council, which subsequently ordered the ALJ to conduct a hearing. Id. At the February 28, 2007 hearing conducted by the ALJ, T.J. and the plaintiff were represented by counsel and were permitted to provide testimony. Id. After making several findings of fact based on the evidence, the ALJ denied the T.J.'s claim for benefits. Id. at 28. Specifically, the ALJ determined that T.J. "was a school-age child [when] the application was filed"; he was "not engaged in substantial gainful activity at any time relevant to [the] decision"; he had a "severe . . . learning disorder;" but his "impairment or combination of impairments" did not "meet[ ] or medically equal one of the listed impairments" in the applicable regulations; and his "impairment or combination of impairments" were not "functionally equal[]" to those impairments listed in the applicable regulation that would entitle him to benefits. Id. at 20-21.
In determining whether T.J.'s impairments were functionally equal to those impairments entitling a person to benefits, the ALJ considered "six domains of function[ing]." Id. at 23-28. The ALJ determined that T.J. had less than marked limitations in the areas of acquiring and using information, attending and completing tasks, and health and physical well-being, but that the evidence did not support that T.J. had limitations in the remaining three areas, i.e. interacting and relating with others, moving about and manipulating objects, and caring for himself. Id. In making his findings, the ALJ determined that T.J.'s attention deficit/hyperactivity disorder diagnosis "was too heavily dependant on statements from [T.J.]'s mother and under stated the evaluation of [T.J.]'s teacher." Id. at 20. The ALJ further concluded "that [T.J.]'s medically determinable impairments could reasonably be expected to produce the alleged symptoms, but that the statements concerning the intensity, persistence and limiting effects of . . . [T.J.]'s symptoms are not entirely credible to the extent of being at a marked level." Id. at 22.
The plaintiff appealed the ALJ's decision to the Appeals Council, submitting additional evidence that was unavailable before the ALJ ruling was issued. Id. at 6-7. The Appeals Council rejected the challenges to the ALJ's ruling, but provided
Pursuant to 42 U.S.C. § 405(g), a court reviewing a benefit determination by the Administration is "confined to determining whether the [ALJ's] decision . . . [was] supported by substantial evidence in the record." Brown v. Bowen, 794 F.2d 703, 705 (D.C.Cir.1986). If a district court determines that "[t]he findings of the Commissioner of Social Security as to any fact" are "supported by substantial evidence," they "shall be conclusive." § 405(g). "Substantial evidence" is "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, 28 L.Ed.2d 842 (1971) (quoting Consol, Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 83 L.Ed. 126 (1938)). Thus, "[s]ubstantial-evidence review is highly deferential to the agency fact-finder." Rossello ex. rel. Rossello v. Astrue, 529 F.3d 1181, 1185 (D.C.Cir.2008). "[W]here a claim has been denied by the Commissioner of Social Security [,] . . . the court shall review only the question of conformity with such regulations and the validity of such regulations." 42 U.S.C. § 405(g). Thus, a reviewing judge must uphold the ALJ's legal "determination if it. . . is not tainted by an error of law." Smith v. Bowen, 826 F.2d 1120, 1121 (D.C.Cir.1987). Moreover, "[j]udicial review. . . is limited to determining whether. . . the Secretary applied the correct legal standards." Scott v. Shalala, 879 F.Supp. 109, 110 (D.D.C.1995).
The first issue for the Court to consider is whether the ALJ properly assessed T.J.'s impairments, specifically whether the ALJ failed to consider a diagnosis by a reviewing doctor, Dr. Sambhu Banik, that T.J. was functioning at the borderline level of intelligence and if so, whether this constitutes reversible error.
An appendix to the Social Security Act (the "Act"), 42 U.S.C. §§ 1381-1383f (2010), provides a listing of impairments for which an individual may receive disability benefits. SSA Federal Old-Age Survivors and Disability Insurance Rule, 20 C.F.R. § 404 Subpt. P App. 1 § 112.05(c)-(e) (2010). In evaluating whether a child has a disability under Title XVI of the Act, the Commissioner of Social Security must
The plaintiff argues that the ALJ's failure to consider Dr. Banik's determination that T.J. has borderline intellect constitutes reversible error. Pl.'s Mem. at 4. However, as the defendant correctly points out, once the ALJ determined at step two that T.J. has an impairment that is severe and therefore proceeded to step three, the ALJ was not required to consider T.J.'s alleged borderline intellect at step two. Def.'s Mot. at 9.
The District of Columbia Circuit has not directly addressed to what extent an ALJ must consider all of a claimant's impairments at step two but finds that the claimant has satisfied step two's severity requirement. See Blackmon v. Astrue, No. 04-1347, 719 F.Supp.2d 80, at 89-91, 2010 WL 2607215, at *9 (D.D.C. June 30, 2010) (noting that "it appears that the [District of Columbia] Circuit has not yet addressed the question" of whether an error at step two of the evaluation process requires reversal). However, a member of this Court recently agreed with the Sixth, Ninth, and Tenth Circuits in their finding "that alleged errors at step two do not necessarily require reversal so long as the ALJ considered the omitted impairment(s) in evaluating the remaining steps in the sequential analysis."
The plaintiff also argues that the ALJ failed to consider Dr. Banik's report "at any other step of the sequential evaluation process," and because the ALJ "failed to provide any rationale for implicitly rejecting" Dr. Banik's report, the ALJ's analysis "defies review." Pl.'s Mem. at 4-5. Essentially, the plaintiff appears to be presenting two arguments: (1) that the ALJ failed to consider the report, and alternatively, (2) the ALJ considered but implicitly and improperly rejected it. The plaintiff relies on See v. Washington Metropolitan Area Transit Authority, 36 F.3d 375 (4th Cir.1994), in which the Fourth Circuit held that an ALJ, "when faced with evidence in the record contradicting his conclusion[,] . . . must affirmatively reject that contradictory evidence and explain his rationale for so doing." Id. at 384; see also Thomas v. Astrue, 677 F.Supp.2d 300, 309 (D.D.C.2010). The plaintiff's argument fails for two reasons: the record shows that the ALJ considered Dr. Banik's report, and even assuming that the ALJ implicitly rejected Dr. Banik's report, the ALJ was warranted in doing so because the evidence did not contradict his conclusion.
First, the ALJ did consider Dr. Banik's report. See A.R. at 22. The plaintiff is correct that the Administration's regulations state that it "will evaluate every medical opinion [it] receive[s]," Pl.'s Mem. at 5 (quoting 20 C.F.R. § 416.927(d) (2009)); however, it does not follow, as plaintiff posits, that "in implicitly determining that [T.J.'s] borderline intellect was non-severe, the [ALJ] failed to evaluate the opinion of [Dr. Banik]," and that "[a]s a result, the [ALJ's] determination fails to be supported by substantial evidence," Pl.'s Mem. at 5-6. On the contrary, it is clear from the record that the ALJ considered Dr. Banik's report as he specifically cited it when determining
Dr. Banik's determination that T.J. was functioning at the borderline level was based on T.J.'s Full Scale IQ of 74, A.R. at 302, and the plaintiff argues that this determination coupled with Dr. Banik's observations that the plaintiff had "poor reading, attention and concentration ... [i]nexplicably" demonstrates that the ALJ "failed to evaluate this evidence," Pl.'s Mem. at 4. Like the other IQ scores that the ALJ relied upon, the evidence relied upon by Dr. Banik does not alone entitle T.J. to benefits, see SSA Federal Old-Age Survivors and Disability Insurance Rule, 20 C.F.R. § 404 Subpt. P App. 1 § 112.05 (2010), and it therefore does not contradict the ALJ's conclusion. Under the regulation just referenced, a claimant has the requisite level of severity to qualify as having a disability if his IQ is less than 59 or he has an IQ between 60 and 70, if coupled with other significant impairments. See id. In denying T.J.'s claim for benefits, the ALJ did not find that the objective medical evidence was insufficient to entitle T.J. to benefits; rather, the ALJ determined that "the statements concerning the intensity, persistence and limiting effects of . . . [T.J.]'s symptoms are not entirely credible to the extent of being at a marked level." A.R. at 22. And as set forth in the regulation outlining the multistep evaluation process, the ALJ must determine both that T.J. had the requisite impairment and that the impairment met the duration requirements. 20 C.F.R. § 416.924(a), (d).
Under the Administration's regulations, Dr. Banik's report is not controlling and is not entitled to significant weight. Although the Administration's regulations require the ALJ to evaluate every medical opinion, not every medical opinion is treated as controlling or given equal weight. 20 C.F.R. § 416.927(d) delineates factors to be considered in determining the weight given to any medical opinion, including how to determine if a source is controlling. A source is accorded controlling weight if it is a treating source and the "treating source's opinion on the issue(s) of the nature and severity of [the claimant's] impairment(s) is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record." 20 C.F.R. § 416.927(d)(2). If a treating source is not considered controlling, the Administration considers the following factors to determine the weight an opinion from such a source is given: the examining relationship, treatment relationship, length of treatment relationship, nature and extent of treatment relationship, supportability, consistency, specialization and other factors which tend to support or contradict the opinion. 20 C.F.R. § 416.927(d)(1)-(6). Here, Dr. Banik's opinion is not controlling and no other factors suggest giving the report significant weight.
Additionally, based on the factors listed in the regulation, Dr. Banik's report is not entitled to significant weight. First, it is unclear from his report and there is no other evidence suggesting that Dr. Banik actually examined T.J., rather, it appears he relied, at least in part, on a separate examiner. See A.R. at 299 ("Type of Report: Disability Examiner: Kramer, A."). Second, as noted above, Dr. Banik is not T.J.'s treating physician. Third, as the plaintiff argues, the report is either inconsistent with other reports and is therefore entitled to less weight, see Pl.'s Mot. at 4-6, or as the defendant argues and the ALJ concluded, it is consistent with other reports, see Def.'s Mot. at 11; A.R. at 22, and was therefore assessed in the ALJ's analysis. Finally, Dr. Banik's report was not based on a complete neuropsychological evaluation. A.R. at 302.
The Court reiterates that its review of Dr. Banik's report does not lead it to the conclusion that his report contradicts the ALJ's decision. And, because the report does not "contradict[ ] his conclusion," the ALJ did not have a duty to "affirmatively reject . . . [the] evidence and explain his rationale for so doing." See, 36 F.3d at 384 (emphasis added). The Fourth Circuit in See requires an ALJ to affirmatively reject evidence and explain his or her rational for so doing only if the evidence contradicts the ALJ's conclusion, not merely if the evidence varies to any degree from evidence upon which the ALJ relies. Id. Accordingly, the Court will not overturn the ALJ's decision based on Dr. Banik's report.
The plaintiff argues that "the Appeals Council failed in its duty of explanation" regarding "new and material" evidence submitted by the plaintiff after the hearing before the ALJ. Pl.'s Mem. at 6. Specifically, the plaintiff argues that the Appeals Council failed to adequately consider five questionnaires prepared by her son's tenth grade teachers, id. at 8, and in failing to so do, the Administration's decision is not based on substantial evidence, or alternatively, that this Court cannot determine whether substantial evidence supports the Administration's decision. Id. at 6, 9.
Under the Social Security Act, the Appeals Council will review a case if, among other things,
When the Appeals Council denies review, as it did here, the ALJ's decision represents the agency's final decision. Wilkins, 953 F.2d at 96; see also 20 C.F.R. § 404.981 (2010). If the appeals council denies review despite the submission of additional evidence, a failure to address such evidence can, but does not necessarily, warrant remand to the agency.
The importance of having the Appeals Council address the impact of new and material evidence stems from the limited role Courts have in reviewing the Administration's decisions. Bryant v. Barnhart, No. 6:04-CV-17, 2005 WL 1804423, at *2 (W.D.Va. Jan. 21, 2005) (noting that "[i]n reviewing for substantial evidence, the court should not undertake to re-weigh conflicting evidence, make credibility determinations, or substitute its judgment for that of the [administrative decisionmaker]") (internal citation omitted); Harmon v. Apfel, 103 F.Supp.2d 869, 871-72 (D.S.C.2000) (noting that the "court is caught between trying to provide meaningful judicial review of evidence not considered by the fact finder, while avoiding actually performing the task of weighing and resolving conflicts in the evidence, which is, of course, the function of the ALJ"). This Court agrees with such an approach. It is the Administration's duty to determine the weight of evidence and resolve evidentiary conflicts and this Court may not substitute its judgment for that of the Administration. Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir.1990). Thus, in order for this Court to determine whether the Administration's decision is supported by substantial evidence, the Appeals Council must explain evidence which is both new and material. See Bryant, 2005 WL 1804423, at *5. On both of these prongs the plaintiff prevails.
First, it is clear that the evidence was new. The plaintiff maintains that the additional questionnaires are new because, in contrast to the one questionnaire presented to the ALJ, the additional submissions "reveal[ ] that [T.J.] has obvious to very serious problems" in multiple areas in two "domain[s] of function." Pl.'s Mem at 8. The defendant, on the other hand, argues that the evidence submitted regarding
Second, the evidence is material. The plaintiff argues that the additional questionnaires are material because they "directly contradict[ ] and undermine[ ] the [ALJ]'s conclusion that [T.J.] had less than marked limitations" in two domains of function. Pl.'s Mem. at 9. The defendant, on the other hand, argues that the evidence "does not contradict, conflict with, or call into doubt, the ALJ's decision." Def.'s Mem. at 18. However, after evaluating the additional questionnaires, the Court concludes that "there is a reasonable possibility that the new evidence would have changed the outcome," and thus the additional questionnaires are material. Wilkins, 953 F.2d at 96.
The ALJ determined T.J.'s "medically determinable impairments could reasonably be expected to produce the alleged symptoms, but that the statements concerning the intensity, persistence and limiting effects of the [plaintiff]'s symptoms are not entirely credible to the extent of being at a marked level." A.R. at 22. Further, the ALJ accorded the 2004 teacher evaluation, the only evaluation available to the ALJ, "significant weight," A.R. at 22, having relied upon it in analyzing T.J.'s six domains of function, A.R. at 22-28.
In the domain of "attending and completing tasks" the ALJ concluded that T.J. had a less than marked limitation. A.R. at 24. The ALJ's conclusion was based on the 2004 teacher evaluation, which "reflect[ed] his questionable diagnosis of attention deficit/hyperactivity disorder." Id. This evaluation placed T.J. in the slight to obvious problem range for the attending and completing tasks domain. A.R. at 293. In contrast, the additional questionnaires put T.J. in the obvious to serious range for this domain, A.R. at 451, 459, 467, 475, 482, with one evaluation placing him in the very serious problem range for this domain, A.R. at 467. This evidence, if given significant weight, can be seen to contradict the ALJ's conclusion that T.J. has a less than marked limitation in the domain of attending and completing tasks; therefore, the evidence is material.
While this evidence may not have been accorded significant weight by the ALJ (if it had been available to him) or by the Appeals Council and the evidence may not have changed the Administration's decision to deny benefits, it is not within the province of this Court to determine how this evidence should have been evaluated by the Commissioner. Therefore, the Court must remand this case to the agency so it can evaluate the additional evidence that was not available to the ALJ, and in conducting this analysis, more than the boilerplate language that the "information does not provide a basis for changing the [ALJ]'s decision," A.R. at 6-7, must be provided. Bryant, 2005 WL 1804423, at *5 (noting that "[w]hile the Appeals Council is not required by its regulatory scheme to provide a detailed statement of reasons regarding late breaking evidence, its failure
Finally, the Court must address the plaintiff's contention that the ALJ had a duty to adequately develop the administrative record and that the ALJ failed in this duty by not obtaining updated evidence from T.J.'s teachers. Absent proper record development at a Social Security Administration hearing, "the [Commissioner]'s decision cannot stand." Poulin v. Bowen, 817 F.2d 865, 871 (D.C.Cir.1987). While the "[ALJ] has an affirmative duty to develop a complete administrative record, including arguments both for and against granting benefits," Krishnan v. Barnhart, 328 F.3d 685, 695 (D.C.Cir.2003) (internal quotations and citations omitted),
Here, the plaintiff argues that the record before the ALJ was devoid of evidence or observations from any of T.J.'s teachers for a period of thirty four months and that, "the [ALJ] failed to attempt to obtain any updated evidence from any of the [p]laintiff's teachers, or from any of the [p]laintiff's schools." Pl.'s Mem. at 11. The record before the Court, however, indicates that the ALJ granted several continuances specifically for the purpose of obtaining this evidence. A.R. at 17. Further, as already discussed, this evidence was available when the Appeals Council made its decision and was therefore incorporated into the record. See Simms v. Sullivan, 877 F.2d 1047, 1050-51 (D.C.Cir. 1989) (finding that where claimant was unrepresented at administrative hearing, "the ALJ was not remiss when, upon being informed that one of appellant's treating physicians was still `doing' some testing,' he did not suspend the proceedings to await new test results" and "moreover . . . not[ing] that the Appeals Council had the new test data before it when it declined to review the ALJ's decision"). Because this evidence was available to the Appeals Council, and the Court is remanding this case for the Commissioner to evaluate the teacher's questionnaires that were unavailable to the ALJ, the claim that the ALJ failed to develop the record must be rejected.
For the forgoing reasons, the Court finds that the ALJ properly considered Dr. Banik's report and properly developed the administrative record; however the Court must remand the case to the Commissioner to evaluate the teacher's questionnaires that were not available to the ALJ.