THOMAS B. SMITH, Magistrate Judge.
Plaintiff John Patrick Adkins appeals to this Court from Defendant the Commissioner of Social Security's final decision to deny his applications for disability insurance benefits and supplemental security income. I have reviewed the record, including the administrative law judge's ("ALJ") decision, the exhibits, and the joint memorandum submitted by the parties. For the following reasons, I respectfully recommend that the Commissioner's final decision be
When the Commissioner issued her administrative decision, Plaintiff was fifty-five years old and had completed the eighth grade (Tr. 104, 352). He originally applied for benefits under Title II and Title XVI of the Social Security Act, 42 U.S.C. § 416, 423 on August 17, 2007, alleging a disability onset date of May 2, 2007 (Tr. 318-329, 343). Plaintiff's claims were denied at the initial level (on November 16, 2007) and on reconsideration (on May 21, 2008) (Tr. 144-149, 151-154). At Plaintiff's request, an ALJ conducted a hearing on July 22, 2009 (Tr. 101-119, 159, 800-817). The ALJ issued an unfavorable decision on August 17, 2009 (Tr. 128-139). Then, on January 6, 2011, the Appeals Council remanded the case for further administrative proceedings (Tr. 140-143).
A second hearing before a different ALJ was held on March 15, 2012 (Tr. 30-100, 734-790, 792-798). On April 24, 2012, the second ALJ issued another unfavorable decision (Tr. 7-28, 818-833). On September 14, 2013, the Appeals Council denied Plaintiff's request for review (Tr. 1-6).
Plaintiff appealed the Commissioner's April 24, 2012 decision to this Court.
On October 29, 2013, (while his appeal was pending at the administrative level) Plaintiff filed a new application for disability and supplemental security income benefits. This new application was denied at the initial level (on January 24, 2014) and on reconsideration (on April 7, 2014) (Tr. 908-913, 918-927). Plaintiff requested a hearing before an ALJ, and on July 8, 2014, while his request was pending, the Appeals Council remanded the original application back to the ALJ for further proceedings (Tr. 903-907). The Appeals Council also ordered the ALJ to consolidate both applications, "create a single electronic record, and issue a new decision on the consolidated claims" (Tr. 906).
After the cases were consolidated, a third administrative hearing was held on February 9, 2016 (Tr. 677-725). On March 2, 2016, the ALJ issued a partially favorable decision finding that Plaintiff became disabled on May 27, 2015, but that he was not disabled prior to that date (Tr. 643-665). The ALJ's March 2nd decision is the Commissioner's final decision and this appeal timely followed (Doc. 1). Plaintiff has exhausted his administrative remedies and his case is ripe for review.
When determining whether an individual is disabled, the ALJ must follow the Commissioner's five-step sequential evaluation process set out in 20 C.F.R. §§ 404.1520(a)(4) and 416.920(a)(4). The evaluation process requires the ALJ to determine whether the claimant: (1) is currently employed; (2) has a severe impairment; (3) has an impairment or combination of impairments that meets or medically equals an impairment listed at 20 C.F.R. Part 404, Subpart P, Appendix 1; (4) can perform past relevant work; and (5) retains the ability to perform work in the national economy.
The ALJ determined at step one that Plaintiff had not engaged in substantial gainful activity since his alleged onset date (Tr. 649). At step two, the ALJ found that Plaintiff was severely impaired by: lumbar and cervical degenerative disc disease and borderline intellectual functioning (Tr. 650). At step three, the ALJ concluded that Plaintiff did not have an impairment or combination of impairments that met or medically equaled one of the listed impairments in 20 C.F.R. Pt. 404, Subpt. P, App. 1 (the "Listing") (20 CFR §§ 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926) (Tr. 650-654). Before proceeding to step four, the ALJ decided that Plaintiff had the residual functional capacity to perform light work as defined in 20 CFR 404.1567(b) and 416.967(b), subject to certain limitations (Tr. 655-662). At step four, the ALJ found that Plaintiff was unable to perform any past relevant work (Tr. 662-663). But, the ALJ ultimately concluded at step five that there were other jobs in the national economy — like ticket taker, document preparer, and surveillance systems monitor — that Plaintiff could perform and therefore, he was not disabled (Tr. 663-664).
The scope of the Court's review is limited to determining whether the ALJ applied the correct legal standards and whether the ALJ's findings are supported by substantial evidence.
When the Commissioner's decision is supported by substantial evidence the district court will affirm even if the reviewer would have reached a contrary result as finder of fact, and even if the reviewer finds that the preponderance of the evidence is against the Commissioner's decision.
At step three of the sequential evaluation process, the ALJ determined that Plaintiff's impairments did not meet Listing-level severity (Tr. 650). Plaintiff argues that the ALJ committed reversible error because the record evidence established that he met all of the specified medical criteria of Listing 12.05C (Doc. 23 at 19-20).
At step three the ALJ is called upon to determine whether Plaintiff's impairments meet a Listing.
The claimant bears the burden of proving that his impairment meets or is medically equivalent to a listed impairment.
In order to satisfy Listing 12.05, Plaintiff must demonstrate that he has "(i) significantly subaverage general intellectual functioning[,] (ii) with deficits in adaptive functioning[,] (iii) that manifested [during the developmental period] before age twenty-two."
(Tr. 652-53).
Contrary to the ALJ's findings, the record evidence depicts Plaintiff's childhood as more troublesome and impactful than one affected by simple bullying or "mild functional impairment." The ALJ refers first to exhibit 33E, which is more than just a "one page incomplete document," as she described (Tr. 652). It is a discharge summary from a psychiatric hospital where Plaintiff was a patient for more than a year and a half (from October 18, 1971 to June 21, 1973) beginning when he was 11 years old (Tr. 1124-1125). Plaintiff was admitted on referral from Dr. Bajjaly of the Jefferson County Mental Health Clinic, and diagnosed as having Adjustment Reaction of Childhood with Mild Mental Retardation (Tr. 1125). Plaintiff had been a patient of the Jefferson County Mental Health Clinic since 1967 (
The ALJ dismissed Exhibit 34E as being unreadable, but I find that part of the exhibit is legible. On March 26, 2014, the Watertown City School District Administrative Offices provided a report detailing the results of the Wechsler Intelligence Scale for Children and Peabody Individual Achievement Test that was administered on September 10, 1973, when Plaintiff was 13 1/2 years old (Tr. 1126). According to the report, in November, 1970, a consultant evaluated Plaintiff and concluded that he was "a very slow, sluggish, dull child, who cannot keep up . . . he is illiterate . . . with some organic disturbances at high level . . . He is multiply handicapped . . . a simple schizophrenic . . . totally impoverished . . . His social environment is a disaster and he should be removed from the [illegible]" (
In Exhibit 35E, the Catholic Charities responded to Plaintiff's request for information from his records regarding his stint at St. Patrick's Children's Home in Watertown, New York (Tr. 1127). The letter states that Plaintiff was admitted to the children's home in 1969, at the age of 9, by Child Protective Services (
(
When the evidence in Exhibits 33E, 34E, and 35E is properly characterized and considered, it is sufficient that a reasonable person would accept as adequate to support the conclusion that Plaintiff had deficits with adaptive functioning that manifested before age 22. Given the overwhelming evidence of Plaintiff's problems with adaptive functioning in his developmental years, and the ALJ's errors discussed above, I conclude that the ALJ's finding is not based on substantial evidence.
A claimant is presumptively disabled under subsection C if in addition to establishing all the basic requirements of Listing 12.05 he also establishes evidence of (i) a valid IQ score between 60 and 70, and (ii) a physical or other mental impairment that imposes an additional and significant work-related functional limitation. 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.05C;
The ALJ made the following determination regarding Listing 12.05C:
(Tr. 651).
The ALJ does not discuss Plaintiff's IQ scores as part of her subsection C analysis. Instead, she spends the bulk of her time explaining her conclusion that Plaintiff did not have a physical or other mental impairment that imposed significant work-related limitations on his functioning (Tr. 651). I find this to be error. The record is clear that Dr. Paul S. Suich assigned Plaintiff a valid IQ score of 67 (Tr. 410, 568-569). Based on this result and the Commissioner's acknowledge in her subsection B analysis that Plaintiff has a "full scale IQ of 67" (Tr. 651), I find as conclusive evidence that Plaintiff had a valid IQ score between 60 and 70.
The ALJ determined that Plaintiff's back and spine disorders were not debilitating enough to preclude him from all work activity and therefore not debilitating enough to satisfy the requirements of 12.05C (Tr. 651-652). Plaintiff's argument is simple: the ALJ's step two determination that Plaintiff suffered from the severe impairments of lumbar and cervical degenerative disc disease and borderline intellectual functioning necessarily satisfies the second requirement of Listing 12.05C (Doc. 23 at 23). I find this argument persuasive.
The introductory paragraph for the 12.00 series listings states that for consideration of 12.05C claims, the Commissioner "will assess the degree of functional limitation the additional impairment(s) imposes to determine if it significantly limits your physical or mental ability to do basic work activities, i.e., is a `severe' impairment(s), a
At step two of the sequential evaluation process, the ALJ determined that since Plaintiff's onset date of May 2, 2007 he has suffered from the following severe impairments: lumbar and cervical degenerative disc disease and borderline intellectual functioning (Tr. 650). The ALJ's conclusion that Plaintiff's impairments do not pose an additional and significant work-related limitation of function is not based on substantial evidence and is contradicted by the record evidence and the ALJ's own written findings.
For these reasons I respectfully recommend that the district judge reverse the ALJ's decision regarding Plaintiff's disability status prior to May 27, 2015 and remand the case for further administrative proceedings.
Because remand is required based upon Plaintiff's first argument, it is unnecessary to review his remaining objections to the ALJ's decision.
Upon consideration of the foregoing, I respectfully recommend that:
(1) The Commissioner's final decision be
(2) The Commissioner's favorable decision regarding Plaintiff's disability status after May 27, 2015 remain undisturbed.
(3) The Clerk be directed to enter judgment accordingly and CLOSE the file.
(4) Plaintiff be advised that the deadline to file a motion for attorney's fees pursuant to 42 U.S.C. § 406(b) shall be thirty (30) days after Plaintiff receives notice from the Social Security Administration of the amount of past due benefits awarded.
(5) Plaintiff be directed that upon receipt of such notice, she shall promptly email Mr. Rudy and the OGC attorney who prepared the Commissioner's brief to advise that the notice has been received.
A party has fourteen days from this date to file written objections to the Report and Recommendation's factual findings and legal conclusions. A party's failure to file written objections waives that party's right to challenge on appeal any unobjected-to factual finding or legal conclusion the district judge adopts from the Report and Recommendation.