Opinion
01 Civ. 7516 (SAS)
August 7, 2002
David Kuznicki, Esq., New York, NY, for Plaintiff.
Susan D. Baird, Assistant United States Attorney, New York, NY, for Respondent.
MEMORANDUM OPINION AND ORDER
Genaro Lopez brings this action under Section 205(g) of the Social Security Act, 42 U.S.C. § 405(g) (the "Act"), challenging the final determination of the Commissioner of Social Security (the "Commissioner") denying benefits for the period from June 21, 1996 to September 23, 1998. See Complaint ("Compl.") ¶¶ 1, 5; Plantiff's Memorandum of Law in Support of Motion for Judgment on the Pleadings ("Pl. Mem.") at 1. The Commissioner has cross-moved to remand these proceedings to consider new and material evidence. See Memorandum of Law in Opposition to Plaintiff's Motion for Judgment on the Pleadings and in Support of the Commissioner's Cross-Motion for Remand ("Def. app.") at 1. For the reasons set forth below, the decision of the Commissioner is vacated and the case is remanded for further administrative proceedings.
I. FACTS
On October 23, 1996, plaintiff filed an application for Disability Insurance Benefits, alleging an inability to work due to a back injury resulting from a June 21, 1996 forklift accident. See Compl. ¶ 4; Pl. Mem. at 2. The Social Security Administration ("SSA") denied both his initial application and his motion for reconsideration. Plaintiff then requested a hearing before an Administrative Law Judge ("ALJ"). See id. After a hearing on September 23, 1998, the ALJ concluded that plaintiff had "the capacity to perform light work activity" and was therefore not eligible for disability benefits. 9/23/98 SSA Decision of ALJ Irving Fliegler ("9/23/98 ALJ Decision"). Dr. Gross, plaintiff's treating physician, opined, on the other hand, that plaintiff could not perform such work. See Medical Reports of Dr. Gross, Ex. 8F to Answer, at 1-11 (stating that plaintiff had a "total disability" and had limited "sitting, bending, lifting and walking" capacities). After the Appeals Council affirmed the ALJ's decision on June 20, 2001, see 6/20/01 Action of Appeals Council on Request for Review ("Appeals Council Decision") at 1-2, plaintiff brought this action.
Prior to this action, and before the Appeals Council rendered its decision on the first application, plaintiff filed another application for disability benefits on August 25, 1999. See Def. Opp. at 4. Plaintiff alleged similar problems (e.g., back injury, hypertension) arising from the June 21, 1996 accident. See id. The SSA also denied this application originally and on reconsideration. See id. On February 3, 2000, plaintiff again filed a request for a hearing before an ALJ. See 1/24/02 Decision of ALJ Robin Arzt ("1/24/02 ALJ Decision"), Ex. A to Pl. Mem., at 1. After holding a hearing, the ALJ issued a favorable decision awarding plaintiff disability benefits from September 24, 1998 to the present. See id. at 6. The ALJ decided, however, that plaintiff's disabilities before September 24, 1998 could not be considered because of the prior ruling of the SSA. See id. at 1-2. As a result, plaintiff now seeks benefits for the period from June 21, 1996 to September 23, 1998.
II. LEGAL STANDARD
When reviewing a decision by the Commissioner, a court may enter "judgment affirming, modifying, or reversing the decision of the Commissioner, with or without remanding the cause for a rehearing." 42 U.S.C. § 405(g). A final determination by the Commissioner must be affirmed if it is based on substantial evidence. See id. (stating that a Commissioner's findings "as to any fact, if supported by substantial evidence, shall be conclusive"). "Substantial evidence `means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'" Shaw v. Chater, 221 F.3d 126, 131 (2d Cir. 2000) (quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)). A court is then limited to deciding whether an ALJ's determination is based upon appropriate legal principles and supported by substantial evidence in the record. See id. (citing 42 U.S.C. § 405(g)). "A court may not substitute its own judgment for that of the ALJ, even if it may have reached a different result upon a de novo review." Williams v. Barnhart, No. 01 Civ. 353, 2002 WL 618605, at *4 (S.D.N.Y. Apr. 18, 2002) (citing cases).
III. DISCUSSION
Plaintiff argues that his treating physician's opinion warranted "controlling weight" in the first ALJ's decision. See Pl. Mem. at 8. A treating physician's opinion is given controlling weight in a hearing when it "is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence" in the record. Shaw, 221 F.3d at 143 (citing 20 C.F.R. § 416.927(d)(2)) and (citing cases). If such an opinion is not given controlling weight, the ALJ must consider: "`(i) the frequency of examination and the length, nature, and extent of the treatment relationship; (ii) the evidence in support of the opinion; (iii) the opinion's consistency with the record as a whole; and (iv) whether the opinion is from a specialist.'" Id. at 134 (quoting Clark v. Comm'r of Soc. Sec., 143 F.3d 115, 118 (2d Cir. 1998)). Finally, the ALJ must "set forth [his] reasons for the weight [he] assigns to the treating physician's opinion." Id. (citing Clark, 143 F.3d at 118).
Plaintiff makes two further arguments: (1) that "the ALJ's credibility finding [was] fundamentally flawed" and; (2) that the Commissioner failed to show that "there is other work in the national economy that Mr. Lopez can perform." Pl. Mem. at 16, 19. These arguments, however, are without merit. The ALJ's decision noted specific observations of and actions by plaintiff which led to his conclusions about plaintiff's credibility. See 9/23/98 ALJ Decision at 18. Plaintiff's argument about "other work" relies on Dr. Gross's assessment of plaintiff's capacity to perform work. See Pl. Mem. at 20. Because I find that the ALJ correctly assessed plaintiff's work capacity, I need not consider this argument.
The ALJ was not required to give Dr. Gross's opinion controlling weight in this instance. As the Commissioner notes, Dr. Gross formed opinions which were contradictory to other substantial evidence in the record. See Def. Opp. at 5-6. Specifically, Dr. Mario Mancheno, a consulting physician, found that plaintiff retained the ability to perform some light work activities, including lifting, standing, walking and operating hand and foot controls. See 2/6/97 Functional Capacity Assessment of Plaintiff by Dr. Manchero, Ex. 6F to Answer, at 2.
The ALJ's decision in this matter reflects a thoughtful and thorough consideration of all the medical opinions. Specifically, the ALJ found that Dr. Gross's diagnosis and conclusions about plaintiff's condition were "not supported by the objective clinical findings" and were "inconsistent with the clinical findings" in his reports. 9/23/98 ALJ Decision at 17. The ALJ reached this conclusion after a review of relevant reports, tests, x-ray exams and observations. See id. at 16-18. While the ALJ states that plaintiff's injury "resulted in an impairment which is severe," the impairment "does not meet or equal the criteria" for the award of full benefits. Id. at 18. Accordingly, the ALJ's decision afforded Dr. Gross's opinion the proper weight.
The Commissioner argues, however, that this case should be remanded to the SSA for further consideration. In order to remand a disability claim for further administrative procedures, a court must find "that there is new evidence which is material and that there is good cause for the failure to incorporate such evidence into the record in a prior proceeding." 42 U.S.C. § 405(g). Remand is an appropriate remedy in two situations: (1) where the Commissioner requests a remand before answering the complaint; or (2) where new, material evidence is adduced that was not produced before the agency. See Raitport v. Callahan, 183 F.3d 101, 104 (2d Cir. 1999) (citing Shalala v. Schaefer, 509 U.S. 292, 297 n. 2 (1993)).
Here, the Commissioner requests remand due to the inconsistency between the second ALJ decision awarding full benefits to plaintiff, and the first decision, which denied benefits for the same injury. See Def. Opp. at 3. The Commissioner argues that the second decision reflects new, material evidence that was previously unavailable. See id. I agree. The SSA has reached two diametrically opposed conclusions based on the same facts. Because the second ALJ decision was only made recently, further examination of the first decision by the SSA is warranted. The SSA must "reconcile the two decisions by different ALJs" and determine whether "evidence considered in connection with the second application demonstrates that plaintiff was disabled" prior to the September 23, 1998 decision. Id. at 5. Thus, the Commissioner's motion for remand is granted.
It is unclear whether the second ALJ decision can be considered "evidence" for the purposes of a sentence six remand. However, both parties cite the second decision as evidence. See Plaintiff's Reply Brief at 5 (alleging that the second ALJ decision is evidence which "further supports an award of benefits"); Def. Opp. at 5 (referring to the second ALJ decision as "new, material evidence that was for good cause not presented before the [SSA]"). Because there is no dispute between the parties, I need not reach this issue.
IV. CONCLUSION
For the foregoing reasons, defendant's cross-motion for remand, pursuant to sentence six of 42 U.S.C. § 405(g), is granted. The above-captioned case, hereby remanded pursuant to the Act, is closed subject to reinstatement by either party upon completion of administrative proceedings whereupon the Court will enter final judgment. Such reinstatement shall be effected by letter application to this Court without need for filing a new action or obtaining a new docket number. The Clerk of the Court is directed to close this case.