JOHN M. CONROY, Magistrate Judge.
Plaintiff Evaline M. brings this action pursuant to 42 U.S.C. § 405(g) of the Social Security Act, requesting review and remand of the decision of the Commissioner of Social Security denying her application for Disability Insurance Benefits (DIB) and Supplemental Security Income (SSI). Pending before the Court are Plaintiff's motion to reverse the Commissioner's decision (Doc. 12), and the Commissioner's motion to affirm the same (Doc. 13). For the reasons stated below, Plaintiff's motion is GRANTED, the Commissioner's motion is DENIED, and the matter is REMANDED for further proceedings and a new decision.
Plaintiff was 51 years old on her alleged disability onset date of December 2, 2011. She has a GED and a bachelor's degree, and experience working as a secretary and a retail sales associate. She is single, and lives with her adult son.
Plaintiff suffers from back pain, leg pain, right shoulder pain, carpal tunnel syndrome (CTS), cardiopulmonary obstructive disorder (COPD), incontinence, depression, and anxiety. She has had surgery on her shoulder and multiple surgeries on her hands. She uses a prescribed cane every day because she feels unstable when standing or walking. Her daily activities consist of cooking simple meals, watching movies, and reading. She spends more than half of each day laying down due to pain and fatigue resulting from prescribed medications.
In December 2011, Plaintiff filed her first claim for SSI and DIB, alleging disability beginning on April 30, 2008. (AR 81.) The claim was denied initially and upon reconsideration; and on June 26, 2013, Administrative Law Judge (ALJ) Matthew Levin issued an unfavorable decision, finding that Plaintiff "has not been under a disability . . . from April 30, 2008, through the date of this decision." (Id.; AR 89.) In August 2014, the Appeals Council denied Plaintiff's request for review of ALJ Levin's decision, making the decision final. (AR 95-97.) Plaintiff did not appeal the decision.
Approximately six months later, in February and March 2015, Plaintiff filed her second claim for SSI and DIB, this time alleging disability beginning on December 2, 2011. (AR 250-60.) In this more recent claim — which is the subject of the instant lawsuit — Plaintiff asserts that she stopped working on April 5, 2008, and has been unable to work since then, due to degenerative disc disease, arthritis, gastroesophageal reflux disease, CTS, sleep apnea, and COPD. (AR 270.) Like her first claim, this one was denied initially and upon reconsideration. On July 7, 2016, ALJ Joshua Menard conducted a hearing on the claim. (AR 36-77.) Plaintiff appeared and testified, as did a vocational expert (VE). At the hearing, Plaintiff's counsel: (a) requested that ALJ Levin's June 2013 decision be reopened under 20 C.F.R. §§ 404.988(c)(8) and 416.1489(a)(3) due to error on its face,
On August 15, 2016, ALJ Menard issued a decision denying Plaintiff's request to reopen the 2013 decision (AR 20), overruling Plaintiff's objection to the four Disability Determination Explanations (id.), and finding that Plaintiff "has not been under a disability . . . from December 2, 2011, through the date of this decision" (AR 21, 29). Thereafter, the Appeals Council denied Plaintiff's request for review, rendering the ALJ's decision the final decision of the Commissioner. (AR 1-3.) Having exhausted her administrative remedies, Plaintiff filed the Complaint in this action on February 20, 2018. (Doc. 3.)
The Commissioner uses a five-step sequential process to evaluate disability claims. See Butts v. Barnhart, 388 F.3d 377, 380-81 (2d Cir. 2004). The first step requires the ALJ to determine whether the claimant is presently engaging in "substantial gainful activity." 20 C.F.R. §§ 404.1520(b), 416.920(b). If the claimant is not so engaged, step two requires the ALJ to determine whether the claimant has a "severe impairment." 20 C.F.R. §§ 404.1520(c), 416.920(c). If the ALJ finds that the claimant has a severe impairment, the third step requires the ALJ to make a determination as to whether that impairment "meets or equals" an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1 (the Listings). 20 C.F.R. §§ 404.1520(d), 416.920(d). The claimant is presumptively disabled if his or her impairment meets or equals a listed impairment. Ferraris v. Heckler, 728 F.2d 582, 584 (2d Cir. 1984).
If the claimant is not presumptively disabled, the ALJ is required to determine the claimant's residual functional capacity (RFC), which means the most the claimant can still do despite his or her mental and physical limitations based on all the relevant medical and other evidence in the record. 20 C.F.R. §§ 404.1520(e), 404.1545(a)(1), 416.920(e), 416.945(a)(1). The fourth step requires the ALJ to consider whether the claimant's RFC precludes the performance of his or her past relevant work. 20 C.F.R. §§ 404.1520(f), 416.920(f). Finally, at the fifth step, the ALJ determines whether the claimant can do "any other work." 20 C.F.R. §§ 404.1520(g), 416.920(g). The claimant bears the burden of proving his or her case at steps one through four, Butts, 388 F.3d at 383; and at step five, there is a "limited burden shift to the Commissioner" to "show that there is work in the national economy that the claimant can do," Poupore v. Astrue, 566 F.3d 303, 306 (2d Cir. 2009) (clarifying that the burden shift to the Commissioner at step five is limited, and the Commissioner "need not provide additional evidence of the claimant's [RFC]").
Employing this sequential analysis, in his August 2016 decision, ALJ Menard first determined that Plaintiff had not engaged in substantial gainful activity since her alleged disability onset date of December 2, 2011. (AR 23.) At step two, the ALJ found that Plaintiff had the severe impairments of degenerative disc disease, obesity, and COPD.
The Social Security Act defines the term "disability" as the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 423(d)(1)(A). A person will be found disabled only if it is determined that his "impairments are of such severity that he is not only unable to do his previous work[,] but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy." 42 U.S.C. § 423(d)(2)(A).
In considering the Commissioner's disability decision, the court "review[s] the administrative record [de novo] to determine whether there is substantial evidence supporting the . . . decision and whether the Commissioner applied the correct legal standard." Machadio v. Apfel, 276 F.3d 103, 108 (2d Cir. 2002) (citing Shaw v. Chater, 221 F.3d 126, 131 (2d Cir. 2000)); see 42 U.S.C. § 405(g). The court's factual review of the Commissioner's decision is thus limited to determining whether "substantial evidence" exists in the record to support such decision. 42 U.S.C. § 405(g); Rivera v. Sullivan, 923 F.2d 964, 967 (2d Cir. 1991); see Alston v. Sullivan, 904 F.2d 122, 126 (2d Cir. 1990) ("Where there is substantial evidence to support either position, the determination is one to be made by the factfinder."). "Substantial evidence" is more than a mere scintilla; it means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Richardson v. Perales, 402 U.S. 389, 401 (1971); Poupore, 566 F.3d at 305. In its deliberations, the court should bear in mind that the Social Security Act is "a remedial statute to be broadly construed and liberally applied." Dousewicz v. Harris, 646 F.2d 771, 773 (2d Cir. 1981).
Plaintiff argues that remand is required because ALJ Menard's decision is ambiguous regarding whether Plaintiff's prior claim was reopened. According to Plaintiff, if the ALJ constructively reopened the prior claim, he erred by failing to address whether Plaintiff's shoulder impairment improved after the initial ALJ decision; and if the ALJ did not reopen the prior claim, he erred by relying on the agency consultant opinions because the record does not contain the medical evidence on which these consultants relied in making their opinions. The Court agrees on all points, as discussed below.
Where a claimant seeks to reopen a claim after a final decision has been rendered on that claim, the Commissioner may refuse under the doctrine of res judicata. Saxon v. Astrue, 781 F.Supp.2d 92, 99 (N.D.N.Y. 2011) (citing Dunn v. Astrue, No. 08-CV-0704-C, 2010 WL 376390, at *3 (W.D.N.Y. Jan. 27, 2010)). The Commissioner's refusal to reopen the prior claim is not a final decision for the purposes of 42 U.S.C. § 405(g), and thus federal courts lack jurisdiction to review it. Byam v. Barnhart, 336 F.3d 172, 179 (2d Cir. 2003) (citing Califano v. Sanders, 430 U.S. 99, 107-09 (1977)). There are two circumstances, however, in which the federal courts may review the Commissioner's decision not to reopen a disability application: (1) where the Commissioner has constructively reopened the case; and (2) where the claimant has been denied due process. Byam, 336 F.3d at 179. The ALJ "constructively reopens" a decision if he reviews the entire record and renders a decision on the merits. Id. at 180 ("If the Commissioner reviews the entire record and renders a decision on the merits, the earlier decision will be deemed to have been reopened, and any claim of administrative res judicata to have been waived and thus, the claim is . . . subject to judicial review." (alteration in original) (internal quotation marks omitted)). In contrast, a matter is not constructively reopened when the ALJ merely discusses prior proceedings and evidence to describe a claimant's background. Grant v. Shalala, No. 93-CV-0124E(F), 1995 WL 322589, at *7 (W.D.N.Y. Mar. 13, 1995).
Here, it is unclear whether ALJ Menard constructively reopened Plaintiff's prior claim: although the ALJ explicitly adjudicated a period that overlapped with the period adjudicated in the prior claim, he does not appear to have reviewed the records relevant to that claim. Specifically, ALJ Levin's 2013 decision adjudicates the period from April 30, 2008 through June 26, 2013 (AR 81-89); and ALJ Menard's 2016 decision adjudicates the period from December 2, 2011 through August 15, 2016 (AR 20-30). Therefore, the decisions overlap for the period from December 2, 2011 through June 26, 2013. The Commissioner argues that ALJ Menard did not adjudicate this period, but rather, adjudicated the period from June 27, 2013 through the date of his decision, August 15, 2016. (Doc. 13 at 6.) But that is not what ALJ Menard's decision states: the decision explicitly states — twice — that the period under review is "December 2, 2011, through the date of this decision." (AR 21, 29.) The Commissioner apparently expects the Court to accept her assertion that the ALJ made a "clerical error" (Doc. 13 at 5) — in two different sections/pages of his decision (AR 21, 29) — in stating that the period under review began on December 2, 2011 instead of on June 27, 2013. This would be a glaring "clerical error," and overlooking it would require the Court to abandon the longstanding principal that the Social Security Act is "a remedial statute, to be broadly construed and liberally applied in favor of beneficiaries," Gutierrez v. Bowen, 898 F.2d 307, 310 n.3 (2d Cir. 1990) (quoting McCuin v. Sec'y of Health & Human Servs., 817 F.2d 161, 174 (1st Cir. 1987) and citing Cutler v. Weinberger, 516 F.2d 1282, 1285 (2d Cir. 1975)), and the more general canon that "deference is to be paid to the plain meaning of the language of a [decision] and the normal usage of the terms selected," Berger v. Heckler, 771 F.2d 1556, 1568 (2d Cir. 1985). The Court is unwilling to do so.
If ALJ Menard constructively reopened the prior claim, he erred by failing to address whether Plaintiff's shoulder impairment improved between the 2013 decision and the 2016 decision. As noted above, the two decisions differ greatly regarding their treatment of Plaintiff's shoulder impairment: in the 2016 decision, ALJ Menard does not find the impairment to be severe and includes no functional limitations due to the impairment (AR 23-24); while in the 2013 decision, ALJ Levin finds the impairment to be severe and limits Plaintiff to only occasional overhead, forward, and lateral reaching with her right upper extremity as a result of the impairment (AR 83-85).
Generally, in a situation like this, principles of collateral estoppel and res judicata
Given the ambiguity regarding the ALJ's constructive reopening of the prior claim — and the fact that the ALJ explicitly considered Plaintiff's impairments dating back to December 2011, which time period was included in the prior claim — the ALJ should have admitted into evidence the records from the prior claim, especially since he relied on agency consultant opinions that relied on those records. See HALLEX I-2-6-58, 1993 WL 643036 (last update 5/1/17) (an ALJ "will generally admit into the record any evidence that he or she determines is material to the issues in the case," including "[e]vidence dated within a time[] period covered by a prior application that may be subject to reopening"). The prior claim contained 29 exhibits in the medical records section, covering the period from June 2007 to April 2013. (AR 92-94.) The current claim, on the other hand, contains only nine exhibits in the medical records section, covering the period from April 2013 to June 2016. (AR 33-34, 321-452.) Although the ALJ adjudicated the period beginning in December 2011, there are no records from before April 2013 in the current file. This was discussed at the administrative hearing (AR 40-42), but the ALJ did not assure that the relevant records were added to this file. The ALJ thus failed to properly develop the record. See Klemens v. Berryhill, 703 F. App'x 35, 36 (2d Cir. 2017) ("Because a hearing on disability benefits is a non-adversarial proceeding, the ALJ generally has an affirmative obligation to develop the administrative record." (internal quotation marks omitted)).
ALJ Menard gave "great weight" to the opinions of nonexamining agency consultants Geoffrey Knisely, MD and Carl Runge, MD (AR 28, 29), despite the fact that both physicians had reviewed medical records that were not included in the record before the ALJ. At the July 2016 hearing, Plaintiff's counsel objected to the ALJ's consideration of these opinions on this ground, explaining that Drs. Knisely and Runge "looked at a whole pile of records that are just not in [the current record]." (AR 41; see also AR 40 (Plaintiff's attorney advising ALJ Menard at the hearing that the consultants had reviewed exhibits listed on a seven-page document, and that most of those exhibits are "not in the record").) Also noteworthy, it appears that the opinions of Drs. Knisely and Runge relate to the period beginning on June 27, 2013 rather than on December 2, 2011, which period the ALJ adjudicated. (See AR 111, 127, 143.) Considering these deficiencies, it is impossible to determine whether the opinions of Drs. Knisely and Runge are consistent with the record as a whole and thus whether they constitute substantial evidence to support the ALJ's decision for the adjudicated period. See Babcock v. Barnhart, 412 F.Supp.2d 274, 280 (W.D.N.Y. 2006) (agency consultant opinions "may constitute substantial evidence if they are consistent with the record as a whole" (internal quotation marks omitted)); Albalos v. Sullivan, 907 F.2d 871, 874 (9th Cir. 1990) ("it is erroneous to rely on items not in the record").
For these reasons, the Court GRANTS Plaintiff's motion (Doc. 12), DENIES the Commissioner's motion (Doc. 13), and REMANDS for further proceedings and a new decision in accordance with this ruling. On remand, the ALJ shall clarify the dates of the adjudicated disability period, properly develop the record for the relevant period, consider the precedential effect of the prior (2013) ALJ decision, consider Plaintiff's right shoulder impairment during the relevant period, and reassess the medical evidence and opinions in light of the above.
Dated at Burlington, in the District of Vermont.