Opinion
05 Civ. 5797 (DLC).
May 22, 2006
Appearances:
For Plaintiff: Victoria Negron, pro se
For Defendant: Susan D. Baird Assistant United States Attorney Southern District of New York New York, NY.
OPINION and ORDER
Plaintiff Victoria Negron ("Negron") brings this action to recover Supplemental Security Income ("SSI") benefits that she claims were wrongly denied her between February 8, 1980 and March 14, 1985. Although Negron did not appeal the determination of ineligibility when it was initially rendered, she does so now as a class member covered by the remedial order entered in Dixon v. Sullivan, 792 F. Supp. 942 (S.D.N.Y. 1992) ("Dixon I"),aff'd, Dixon v. Shalala, 54 F.3d 1019 (2d Cir. 1995) ("Dixon II"), which allows for readjudication of certain SSI applications filed between 1976 and 1983. The Commissioner of Social Security ("Commissioner") brings this motion for judgment on the pleadings affirming the denial of benefits. For the reasons set forth below, the motion is granted.
Negron did not file any papers in opposition to the Commissioner's motion.
Background
Negron was born on November 17, 1933 in Puerto Rico. She was educated in both Puerto Rico and the mainland United States, and reads, writes, and understands English. Negron initially applied for SSI benefits on February 8, 1980, claiming that she suffered from depression and anxiety. She was not employed at the time of her application. Negron's claim was denied on March 12, 1980, on the ground that her impairment was not severe. She did not appeal that determination.
Negron again applied for SSI benefits in 1982 and 1985. When both applications were rejected, she began working as a home health care aide. From 1985 to 1988, Negron earned between $2,250.10 and $11,189.50 annually. From 1989 to 1994, she earned between $20,230.80 and $32,456.50 annually, and appears to have been working on a full-time basis. In 1995, she cut back on her hours, apparently in part because of a hernia. She again applied for SSI benefits in 1995, on two separate occasions. Both applications were denied. In 1998, Negron filed another application for SSI benefits and was found to be disabled as of October 1, 1997. She has received various forms of government assistance since that time.
It is not immediately evident from the record whether the SSA determined that Negron was disabled because of depression, anxiety, or another ailment.
In or around 2000, Negron applied to reopen her 1980 application for SSI benefits. On September 13, 2000, the SSA determined that Negron had not been disabled as of the time of first denial. Negron requested a hearing before an administrative law judge ("ALJ"). Prior to the hearing, the SSA subpoenaed records from a doctor identified by Negron as an examining physician, and requested records from two hospitals at which she had been treated. The doctor produced notes showing that he had seen Negron on three occasions: once in 1998 and twice in 2000. The notes indicate that Negron complained of physical ailments, such as heart palpitations and asthma. The hospitals did not produce any records in response to the SSA's requests.
The record reflects Negron's application for reconsideration of the Commissioner's first denial of benefits. It appears, however, that the ALJ treated the claim as though it pertains to the second denial as well. The Commissioner seems to accept this interpretation: In her motion papers, she states that the period in question extends from February 8, 1980 until March 14, 1985, the first date after the class period on which the Commissioner determined that Negron was not disabled. The Court need not determine the precise dates covered by Negron's application, since, as discussed more fully below, her claim fails regardless of whether she is challenging one or both of the denials.
At the hearing held by the ALJ on September 9, 2002, Negron testified that she had been treated for anxiety and depression at two clinics in the early 1980's. She did not remember the name of either clinic, and she stated that at least one no longer existed. She also recalled being treated by a "Dr. Jaggerbeach," who gave her medicine for her nerves, which helped "a little." Negron said the doctor no longer worked at the clinic at which she had seen him.
On September 25, 2002, the ALJ denied Negron's claim based on the Dixon "rebuttable presumption" framework described below. He also concluded that, in the alternative, she was ineligible for benefits during the relevant period because she did not have a severe impairment. Negron filed this action on June 22, 2005. The Commissioner brings this motion for judgment on the pleadings affirming the ALJ's determination. The Commissioner argues that the ALJ properly applied the Dixon framework and that his independent determination that Negron was ineligible for benefits was correct.
Discussion
In reviewing a decision of the Commissioner, a court may "enter, upon the pleadings and transcript of the record, a 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). This Court may set aside a determination of the ALJ only if it is based upon legal error or is not supported by substantial evidence. Rosa v. Callahan, 168 F.3d 72, 77 (2d Cir. 1999). "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." Jaskinski v. Barhhart, 341 F.3d 182, 184 (2d Cir. 2003) (citation omitted). Furthermore, the findings of the Commissioner as to any fact, if supported by substantial evidence, are conclusive, Diaz v. Shalala, 59 F.3d 307, 312 (2d Cir. 1995), and thus, the reviewing court does not decide the case de novo. Halloran v. Barnhart, 362 F.3d 28, 31 (2d Cir. 2004) (citation omitted).
Here, the Court's task is simplified by the Dixon decisions. In Dixon I, the Honorable William Conner determined that between 1976 and 1983, the Social Security Administration ("SSA") had "systematically misapplied" the disability regulation regarding the severity of claimants' ailments. Dixon I, 792 F. Supp. at 953. In Dixon II, the Second Circuit upheld Judge Conner's remedial order allowing claimants whose applications had been denied during the relevant period based on the severity regulation to have their claims reopened and readjudicated.Dixon II, 54 F.3d at 1021.
Because the remedial order covers many decades-old claims, it sets out a series of rebuttable presumptions to be used when a claimant's records cannot be found. As described by the Second Circuit:
A class member whose records cannot be located will be presumed to be disabled if he or she received a decision awarding disability benefits for any period of disability subsequent to the one that forms the basis of class membership, and (1) it is medically reasonable to presume that he or she was disabled as of the date of the prior denial, or (2) he or she was 55 years of age or older at the time of the denial. Conversely, there will be a rebuttable presumption that a class member is not disabled if (1) he or she received a denial or termination of benefits subsequent to the one that forms the basis of class membership; [or] (2) he or she was employed for at least six months following the denial or termination . . .Id. at 1034-35 (citation omitted). The SSA is also required to "use its regular policies on evidence development" to assist applicants in obtaining evidence relevant to their claims. Id. at 1035.
Importantly, the Second Circuit noted that while the remedial order obligates the SSA to make efforts to develop the record, it "does not relieve plaintiffs of the ultimate burden of proof."Id. at 1037. The SSA is not required to "reconstruct the names of doctors or medical centers which a particular claimant visited when the claimant is now unable to recall that information."Id. Rather, the SSA must request records from only those doctors and medical facilities that have been identified by claimants. And if those efforts yield nothing to support an applicant's claim, "it is the class member, not the government, who loses." Id.
Here, because Negron's original claim file was unavailable, the ALJ rightly applied the Dixon decisions. Pursuant to this framework, there is a rebuttable presumption that a claimant is not disabled if she was employed for at least six months following the denial at issue, or she was subsequently denied benefits after the class period. Dixon II, 54 F.3d at 1034. Negron meets both of these criteria: She worked for well over a decade after the SSA denied her applications in the early 1980's; and she was denied coverage three times after the Dixon class period — once in 1985 and twice in 1995. Conversely, Negron does not meet either criterion necessary to establish the presumption that she was disabled: She was under 55 years old throughout the Dixon class period; and, although she was granted SSI benefits after that time, it would not be medically reasonable to presume that she was disabled at the time of the prior denial, since she was subsequently found to be ineligible on three separate occasions. Id.
Neither the ALJ nor the Commissioner explicitly state that the documents relating to Negron's initial applications were unavailable. Both, however, analyze Negron's claim as though her file could not be found, and no such documents appear in the record.
As noted above, under these circumstances the burden falls on the claimant to produce evidence to rebut the presumption that she was not disabled. Negron has not done so here. The only medical evidence in the record pertains to physical aliments apparently unrelated to depression and anxiety, which arose approximately 15 years after the relevant period. Furthermore, the SSA has fulfilled its responsibility to assist Negron in developing the record. There is no indication that the agency failed to request records from any doctor or medical facility identified by Negron. Because the ALJ properly applied theDixon presumptions, and because the record lacks any evidence to support Negron's claim of disability between February 8, 1980 and March 14, 1985, the Commissioner's motion for judgment affirming the denial of SSI benefits is granted. Conclusion
For the reasons explained above, defendant's motion for judgment on the pleadings is granted. The Clerk of Court shall enter judgment for the Commissioner and close the case.
SO ORDERED.