Opinion
01 Civ. 518 (GEL)
October 24, 2002
David B. Thomas, Pro Se.
John E. Gura, Jr., Assistant United States Attorney, Southern District of New York (James B. Comey, United States Attorney, Of Counsel; Barbara L. Spivak, Chief Counsel — Region II, Dennis J. Canning, Assistant Regional Counsel, Office of the General Counsel, Social Security Administration), for Defendant.
OPINION AND ORDER
Plaintiff David Thomas seeks review of the final determination by the Commissioner of Social Security ("Commissioner") denying his application for Supplemental Security Income ("SSI") benefits based on disability pursuant to Title XVI of the Social Security Act ("Act"). The Commissioner has moved for judgment on the pleadings pursunt to Rule 12(c) of the Federal Rules of Civil Procedure. The issue before the Court is whether substantial evidence supports the Commissioner's most recent decision that the plaintiff was not disabled from January 20, 1995, the date of his original application, until February 12, 2002. the date of the last decision by an administrative law judge ("ALJ"). Since substantial evidence supports that finding, the Commissioner's motion will be granted, and the final determination will be affirmed.
BACKGROUND
Plaintiff filed his original application for disability benefits on January 20, 1995 (Tr. 114), and repeatedly appealed denials of that application, resulting in agency reconsideration of the initial denial (Tr. 142) and three subsequent de novo hearings before two different ALJs (Tr. 34-76, 77-113, 296-308) — once after a remand from this Court directing further proceedings for failure to seek out additional information before weighing the treating physician's opinion (Tr. 311-14). These reviews have extended overly nearly eight years and have resulted in multiple reevaluations of Thomas's medical conditions, including certain impairments which are of such a sensitive nature that the Court granted plaintiff request to seal the transcript of the administrative record and his earlier affirmation.
"Tr." references are to the numbered pages of the administrative record filed with the Court by the Commissioner.
Despite the frustrations caused by the delays in the agency process and the need to reveal private medical matters, Thomas's application has been put through the full rigors of the administrative system as well as through extensive federal court review, and in all instances, the ALJs and the Court have reached the same conclusion: although Thomas clearly suffers from numerous ailments that cause him a great deal of discomfort and limit his abilities to perform certain tasks, these limitations are not severe enough to entitle him to benefits under the Act. On this review, the Court arrives at the same conclusion and in the opinion that follows, hopes to minimize the delay and the need to rehash Thomas's medical history by focusing only on those details critical to resolution of the Commissioner's motion.
DISCUSSION
I. The Legal Framework
In order for a claimant to be deemed "disabled" under he Act, he must demonstrate his "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) (2001). Moreover, the impairment must he:
of such severity that he is not only unable to do as 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, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would he hired if he applied for work.42 U.S.C. § 423(d)(2)(A) (2001).
As promulgated in 20 C.F.R. § 404.1520 (2001), the Commissioner is required to apply a five-step procedure in evaluating disability claims. This procedure was recently articulated by the Second Circuit as follows:
First, the [Commissioner] considers whether the claimant is currently engaged in substantial gainful activity. If he is not, the [Commissioner] next considers whether the claimant has a "severe impairment" which significantly limits his physical or mental ability to do basic work activities. If the claimant suffers such an impairment, the third inquiry is whether, based solely on medical evidence, the claimant has an impairment which is listed in Appendix 1 of the regulations. If the claimant has such an impairment, the [Commissioner] will consider him disabled without considering vocational factors such as age, education, and work experience. . . . Assuming the claimant does not have a listed impairment, the fourth inquiry is whether, despite the claimant's severe impairment, he has the residual functional capacity to perform his past work. Finally, if the claimant is unable to perform his past work, the [Commissioner] then determines whether there is other work which the claimant could perform.Rosa v. Callahan, 168 F.3d 72, 77 (2d Cir. 1999) (quoting Berry v. Schweiker, 675 F.2d 464, 467 (2d Cir. 1982) (per curium)); see also Curry v. Apfel, 209 F.3d 117, 122 (2d Cir. 2000).
The disability claimant bears the burden of proof on the first four issues laid out above. Once claimant's burden has been satisfied, the burden shifts to the Commissioner to establish the fifth step, that work exists in the national economy that the claimant can perform. Perez v. Chater, 77 F.3d 41, 46 (2d Cir. 1996) ("If the claimant satisfies her burden of proving the requirements in the first four steps, the burden then shifts to the [Commissioner] to prove in the fifth step that the claimant is capable of working") (citing Carroll v. Sec'y of Health Human Servs., 705 F.2d 638, 642 (2d Cir. 1983)).
In most cases, the Commissioner attempts to satisfy his burden in the final step by reference to the medical vocational guidelines ("the grids") laid out in 20 C.F.R. Part 404, Subpart P. Appendix 2 (2001). See Bapp v. Bowen, 802 F.2d 601, 604 (2d Cir. 1986); see also Rosa, 168 F.3d at 78 (2d Cir. 1999) (quoting Bapp). "The grids `take into account the claimant's residual functional capacity in conjunction with the claimant's age, education and work experience.' Based on these considerations, the grids indicate whether the claimant can engage in any substantial gainful work existing in the national economy." Rosa, 168 F.3d at 78 (quoting Zorilla v. Chater, 915 F. Supp. 662, 667 (S.D.N.Y. 1996)). Generally, when the grid analysis adequately describes a particular claimant's profile, grid determinations are dispositive on the issue of disability. However, as in Thomas's case, "exclusive reliance on the grids is inappropriate where the guidelines fail to describe the full extent of a claimant's physical limitations." Id. For instance, "sole reliance on the [grids] max' he precluded where the claimant's exertional impairments are compounded by significant nonexertional impairments that limit the range of sedentary work that the claimant can perform." Zorilla, 915 F. Supp. at 667. When the grids do not adequately describe a particular claimants profile the Commissioner must "introduce the testimony of a vocational expert (or other similar evidence) that jobs exist in the economy which claimant can obtain and perform." Bapp, 802 F.2d at 603. Such vocational expert testimony was obtained by the ALJ in this case.
Exertional limitations are defined as those that "affect only [claimant's] ability to meet the strength demands of jobs (sitting, standing, walking, lifting, carrying, pushing, and pulling)." 20 C.F.R. § 404.1569a(b) (2001). A nonexerrional limitation is one that affects the claimant's "ability to meet the demands of jobs other than the strength demands" 20 C.F.R. § 404.1569a(c)(1) (2001).
II. Review of the ALJ's Determination
A. ALJ's Findings
In this case, the ALJ in the third de novo hearing evaluated plaintiff's claim pursuant to the procedure set forth in 20 C.F.R. § 404.1520 (2001) and applying the burden of proof described above. He found that plaintiff had not engaged in substantial gainful activity since filing his application in 1995, and did suffer from a series of "severe" impairments that imposed "more than just minimal work-related limitations." including congenital hip and testicular abnormalities, Reiter's syndrome, depression. and anxiety disorders. (Tr. 287, 292.) Despite finding that the medical evidence supports a long history of impairments and that these impairments limit Thomas's ability to perform certain work, the ALJ concluded that plaintiff's impairments were not equal in severity to one listed in 20 C.F.R. Pt. 404, Subpt. P, App. 1 (2001). (Id.) The ALJ also found that plaintiff had the residual capacity to perform a wide range of sedentary work as he is able to lift up to 25 pounds, carry up to 10 pounds, walk or stand for 2 hours of an eight-hour workday, and sit for 6 hours at a time followed by 5 to 10 minutes of standing before sitting again. (Id.) While Thomas cannot perform work involving high levels of stress or requiring more than occasional bending, squatting, climbing, or reaching, the ALJ concluded that these limitations do not bar all types of sedentary work, although they do prevent him from performing his past relevant work as a stockbroker, which is too stressful. The ALJ also found, based on the testimony of a vocational expert, that appropriate positions exist in the national economy for a person of Thomas's age, education, and vocational experience. (11.) In sum, the ALJ concluded that Thomas is not disabled under the Act. (Id.)
B. Standard of Review
Under the Act, the findings of the Commissioner as to any fact are conclusive if supported by "substantial evidence." 42 U.S.C. § 405 (g) (2001). Thus, a district court may remand, modify, or reverse an ALJ's decision only if the ALJ has misapplied the appropriate legal standard, or if his finding is not supported by substantial evidence.Balsamo v. Chater, 142 F.3d 75, 79 (2d Cir. 1998) ("We set aside the ALJ's decision only where it is based upon legal error or is not supported by substantial evidence.") (citing Berry v. Schweiker, 675 F.2d 464, 467 (2d Cir. 1982) (per curium)).
The statutory standard of substantial evidence in the Social Security benefits context has been defined as "`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) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)). The substantial evidence standard applies not only to the Commissioner's findings of fact, but also to his inferences and conclusions. See Figueroa v. Apfel, 99 Civ. 8185, 2000 U.S. Dist. LEXIS 5759 at *16-*17 (S.D.N.Y. Apr. 28, 2000) (LAP) (KNF). Moreover, such inferences and conclusions must be affirmed even where the Court's own analysis may differ. See Jones v. Sullivan, 949 F.2d 57, 59 (2d Cir. 1991) ("`[T]he court may not substitute its own judgment for that of the [Commissioner], even if it might justifiably have reached a different result upon a de novo review'") (quoting Valente v. Sec'y of Health Human Servs., 733 F.2d 1037, 1041 (2d Cir. 1984)).
Despite this apparently deferential standard of review, administrative decisions regarding claimants' eligibility for disability benefits have proven surprisingly vulnerable to judicial reversal. This vulnerability results primarily from the creation by the Commissioner, and the enforcement by the courts, of a variety of procedural obligations to which ALJs must scrupulously adhere. Failure to do so is treated as "legal error"permitting reversal of the ALJ's decision. For example, the substantial evidence standard might lead one to expect that a district court must affirm the decision of an ALJ who accepts the medical judgment of a consultative physician who unequivocally finds a claimant fit for work. Yet, the Commissioner has adopted regulations that give greater, and under some circumstances controlling, weight to the opinion of a claimant's treating physician, and set forth a particular methodology that must be followed in deciding whether to accept or reject such an opinion. 20 C.F.R. § 404.1527 (d)(2) (2001). These regulations will be enforced by courts. See Rosa, 168 F.3d at 78-79: Clark v. Comm'r of Soc. Sec., 143 F.3d 115, 118 (2d Cir. 1998). Moreover, an ALJ may not rely, as factfinders in adversarial proceedings customarily do. on the absence of probative evidence supporting the opinions of a claimant's expert, without making an affirmative effort to fill any gaps in the record before him.See Schaal v. Apfel, 134 F.3d 496, 505 (2d Cir. 1998) ("[E]ven if the clinical findings were inadequate, it was the ALJ's duty to seek additional information from [the treating physician] sua sponte.") (citations omitted). "In fact, where there are deficiencies in the record, an ALJ is under an affirmative obligation to develop a claimant's medical history." Rosa, 168 F.3d at 79.
In light of rules such as these, a district court reviewing a benefits denial may not simply accept the administrative determination because a cursory review of the record reveals plausible testimony or documentary evidence or expert opinion that supports the administrative determination. Rather, the record must be carefully evaluated to determine whether the Commissioner fully complied with all the relevant regulations. Thomas's case, in fact, was already returned once to the Commissioner for a de novo hearing because of possible failure to correctly weigh the medical evidence of Thomas's treating physician. In remanding the case to the Commissioner for a new hearing, Thomas received the benefit contemplated by the many procedural obligations imposed on the ALJs — full and thorough review of the medical evidence.
C. Thomas's Objections
Contrary to Thomas's assertion, the ALJ's findings are amply supported by the record. In objecting to this motion, Thomas relies on his earlier submissions to the Court. Read generously, these papers make two challenges to the sufficiency of the evidence.
1. Duty to Develop the Record
Thomas argues that the ALJ failed to satisfy his duty to develop the record. The Court's Order dated October 4, 2001, remanded Thomas's case to the Commissioner, ordering requests for additional information if available and a new hearing within four months. In response, the ALJ subpoenaed both the Harlem Hospital psychiatric center and Thomas's treating physician, Dr. Andrew Schiff at the Cornell Internal Medical Association. (Tr. 326, 330.) Since neither responded to the subpoenas, the ALJ held a new hearing and reevaluated the existing evidence. (Tr. 288.) Guided by factors developed in regulations, the ALJ concluded that to the extent that Dr. Schiff's reports were inconsistent with other findings, his conclusions were "unsupported by the record and contradicted by more credible evidence," and that while the information from Harlem Hospital did not provide details of Thomas's psychiatric condition, other evidence of claimant's mental disorders existed in the record and sufficiently described claimant's severe depression and anxiety disorders. (Tr. 289-90.) See also 20 C.F.R. § 416.927 (d)(2) (describing the weight accorded to treating physician's evaluations).
Thomas claims that because Dr. Schiff and the Harlem Hospital psychiatric clinic did not respond to the ALJ's subpoenas. the ALJ failed to follow this Court's order and fulfil its duty to affirmatively develop the record. (Pl. Letter dated May 10, 2002.) As noted above, the ALJ must "seek additional information from [the treating physician] sua sponte."Schaal v. Apfel, 134 F.3d 496, 505 (2d Cir. 1998), and make "every reasonable effort" to help the plaintiff get the required medical reports, 20 C.F.R. § 404.1512 (d). "Every reasonable effort" includes issuing subpoenas as authorized by 42 U.S.C. § 405 (d).
The ALJ satisfied his duty to develop the record here. First, he issued the subpoenas five weeks prior to the hearing giving Harlem Hospital and Dr. Schiff amble time to respond with additional information if such information was available. (Tr. 326, 330.) Since no further information was forthcoming, the ALJ reevaluated the reports that were already part of the administrative record. (Tr. 288.) This case is not one where the ALJ set his own expertise against that of the treating physician or rejected the treating doctor's findings before attempting to fill any possible gaps. Since no additional medical evidence was produced upon the final set of subpoenas, the ALJ looked to the record as it already stood. This is also not a case where the ALJ reached his conclusions on an incomplete record. The record contained extensive information on Thomas's medical conditions covering the full period in dispute, including medical opinions of several physicians under contract with the Commissioner and the transcripts of three separate administrative hearings.
Although Harlem Hospital did not produce additional records, the record included a statement from Harlem Hospital describing Thomas as a weekly patient receiving treatment for "a [p]sychiatric disorder." (Tr. 274, 290.) While that document did not provide any specifics about Thomas's mental conditions, the ALJ found that other evidence in the record sufficiently demonstrated that Thomas suffered from severe depression and anxiety disorders but that while severe, his impairments due to mental illness did not equal to those required for disability benefits. (Tr. 290-92.)
The ALJ also reevaluated the reports by Dr. Schiff — one dated February 27, 1996, summarizing three visits over the prior year (Tr. 187-94) and one dated April 16, 1998, summarizing plaintiff's course of treatment via seven visits through February 9, 1998 (Tr. 263-73). (See also Tr. 288-89.) While the 1996 report notes that Thomas has various impairments that are "sporadic and sometimes unremitting" and that "each flare . . . is sufficiently debilitating to prevent him from working at that time," Dr. Schiff concludes in that same report that sitting, standing, and walking are not affected by Thomas's impairments and that he can climb, balance, stoop, crouch, and crawl frequently. (Tr. 191-94.) The 1998 report also does not explicitly describe Thomas as disabled, but instead notes impairments including difficulty moving due to congenital hip dysplasia, possible Reiter's Syndrome, and depression. In the 1998 report, Dr. Schiff found additional limitations on Thomas's abilities, concluding that plaintiff could sit for no more than 4 hours, stand for 30-40 minutes continuously for up to 2 to 3 hours in an eight-hour day, and walk up to 2 to 3 hours in an eight-hour day. Since these limitations are more severe than those suggested by the "voluminous evidence from other treating and consultative examining sources" in the record (Tr. 289-290). the ALJ considered that other evidence and concluded that Dr. Schiff's "assessment is unsupported by the record and contradicted by more credible evidence." (Tr. 290.) The Appeals Council agreed (Tr. 279), and that determination was not only supported by sufficient evident but was in accord with the ALJ's procedural obligations.
2. Previous Receipt of SSI Benefits
In his initial motion for reversal of the Commissioner's decision, Thomas also challenged the sufficiency of the evidence by relying on his receipt of past SSI benefits from mid-1984 until 1991 as proof of current disability. (Pl. Mem. at 9-11.) To the extent that claimant reasserts this position, it is not persuasive. First, the record contains substantial medical evidence that plaintiff is not disabled. To the extent that prior receipt of SSI benefits demonstrates past disability, plaintiff's own account of his work history reveals that those impairments were not severe enough to prevent him from being gain fully employed after the termination of his benefits. He held various positions from 1992 until 1994, working for short periods on Wall Street in New York as a stockbroker, in Akron, Ohio, at a Living Trust firm, in Atlanta, Georgia, at a brokerage firm, and as an extra on television shows. Although Thomas was unable to maintain any of those positions for more than five months due to the burden of his "physical and emotional baggage," his "emotional [i]nstab[ilty]," and his "anxiety and panic attacks," he did demonstrate an ability to perform a range of sedentary work during that period. (Id. at 11-13.) At any rate, neither the receipt of SSI benefits nor his ability to work during that short period are relevant here, as this action only concerns the period between filing his application in 1995 and the last ALJ determination in 2002. If the record supports the Commissioner's conclusion that Thomas was not disabled during this period — as it does — the fact that Thomas was unable to work at some prior time cannot defeat that determination.
CONCLUSION
While the Court is sympathetic to the limitations caused by claimant's impairments and the additional stress generated by the long and often emotional process of pursuing benefits, the ALJ's determination is supported by substantial evidence, and the ALJ did comply with the procedural obligations imposed on him. The defendant's motion for judgment on the pleadings is therefore granted, and the Commissioner's decision is affirmed.