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Oakes v. Astrue

October 5, 2009


The opinion of the court was delivered by: Terrence F. McVerry United States District Court Judge


I. Introduction

Now pending before the court are cross-motions for summary judgment based on the administrative record: PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT (Document No. 13) with brief in support (Document No. 14), and DEFENDANT'S MOTION FOR SUMMARY JUDGMENT (Document No. 15) with brief in support (Document No. 16). The motions have been fully briefed and are ripe for resolution.

Plaintiff, Dulcina M. Oakes, (hereinafter "Plaintiff") brought this action pursuant to 42 U.S.C. § 405(g) to seek review of the October 28, 2008, final determination of the Commissioner of Social Security (hereinafter "Commissioner") which denied her application for Disability Insurance Benefits ("DIB") and supplemental security income ("SSI") under Titles II and XVI respectively of the Social Security Act ("Act"), 42 U.S.C. §§ 401-433, 1381-1383f.The Commissioner's final determination resulted from the Appeals Council having declined to review the March 27, 2007, decision of the Administrative Law Judge that Plaintiff was not disabled.

II. Background*fn1

A. Facts

Plaintiff was born on March 14, 1979, was 23 years old on her date last insured for DIB and 28 years old on the date of the ALJ's decision. As such, she was considered to be a "younger individual" as defined in 20 C.F.R. § 404.1563(b). R. 6, at 61. Plaintiff completed high school and worked as a cashier and as an aide in a senior citizens center. R. 6, at 80.

B. Procedural History

Plaintiff alleges disability, as of January 1, 2002, due to pain in her back, pelvic region, and left hip following the birth of her two children, and also for having difficulties with memory, comprehension, and learning. R. 6, at 72, 75, and 79. The protective filing date for Plaintiff's Title XVI application for SSI was September 10, 2003. R. 6, at 59-60, 68. The protective filing date for Plaintiff's Title II application for DIB was September 15, 2003. R. 6, at 63. Plaintiff's Title II claim was denied on January 15, 2004, and her Title XVI claim was denied on January 29, 2004. R. 6 at 19, 50-53. On March 19, 2004, Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"). R. 6 at 54. On April 13, 2005, without conducting a hearing and relying on the evidence contained within the record, the ALJ awarded Plaintiff SSI, finding that Plaintiff satisfied the criteria of Listing 12.05C (mental retardation) as contained in Appendix 1 of the Social Security Regulations (20 C.F.R., Part 404, Subpart B, Appendix 1). R. 6-3 at 303-305.

On June 13, 2005, Plaintiff was informed that based upon the referral of the Office of Quality Assurance and Performance Assessment ("OQA"), and after a review of the written record, the Appeals Council of the Office of Hearings and Appeals determined the ALJ's decision was not supported by substantial evidence. R. 6-3 at 311-316. That same notification advised Plaintiff that she could send any additional evidence or request an appearance. Id. Plaintiff provided no additional evidence for consideration. R. 6-3 at 318. On August 30, 2005, the Appeals Council vacated the April 13, 2005 decision and remanded Plaintiff's case to the ALJ for further development of the evidentiary record, particularly relating to Plaintiff's mental impairment and to address Plaintiff's DIB application. R. 6-3 at 318-320.

A hearing was conducted on March 8, 2007, before Administrative Law Judge Alma S. deLéon in Pittsburgh. R. 6 at 31-47. Plaintiff did not appear at the hearing, but was represented by counsel. Testimony was heard from Dr. Rudolph Janosko, a board certified psychiatrist as an impartial medical expert, and William H. Reed, Ph.D., an impartial vocational expert. Id. On March 27, 2007, the Administrative Law Judge ("ALJ") decided that based upon her application for a period of disability and disability benefits, Plaintiff was not disabled under either Title II or Title XVI of the Social Security Act. R. 6, at 19-30.

III. Standard of Review

The Social Security Act limits this Court's review of disability claims to the final decision of the Commissioner. 42 U.S.C. §405(g). If said decision is supported by substantial evidence, it is conclusive and must be affirmed by the Court. 42 U.S.C. §405(g); Schaudeck v. Commissioner of Social Security, 181 F.3d 429, 431 (3d Cir. 1999). The Supreme Court has defined "substantial evidence" as "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 391 (1971); Hartranft v. Apfel, 181 F.3d 358, 360 (3d Cir. 1999). It means more than a mere scintilla of evidence, but less than a preponderance of the evidence. Stunkard v. Secretary of Health & Human Services, 841 F.2d 57, 59 (3d Cir. 1988).

In reviewing the record for substantial evidence, the district court does not weigh the evidence or substitute its own conclusions for those of the fact finder. Rutherford v. Barnhart, 399 F.3d 546, 552 (3d Cir. 2005). In making this determination, a district court considers and reviews only those findings upon which the ALJ based her decision, and cannot rectify errors, omissions or gaps in the medical record by supplying additional findings from its own independent analysis of portions of the record which were not mentioned or discussed by the ALJ. Fargnoli v. Massarini, 247 F.3d 34, 44 n. 7 (3d Cir. 2001)("The District Court, apparently recognizing the ALJ's failure to consider all of the relevant and probative evidence, attempted to rectify this error by relying on medical records found in its own independent analysis, and which were not mentioned by the ALJ. This runs counter to the teaching of SEC v. Chenery Corp., 318 U.S. 80 (1943), that '[t]he grounds upon which an administrative order must be judged are those upon which the record discloses that its action was based.' Id. at 87")(parallel and other citations omitted).

In determining whether a claimant is disabled within the meaning of the Social Security Act in terms of either DIB or SSI benefits, the Commissioner utilizes a five-step sequential evaluation process. 20 C.F.R. §§404.1520, 416.920. This process requires the Commissioner to consider, in sequence, whether a claimant (1) is working, (2) has a severe impairment, (3) has an impairment that meets or equals the requirements of a listed impairment, (4) can return to his or her past relevant work, and (5) if not, whether he or she can perform other work. See 42 U.S.C. §404.1520; Burnett v. Commissioner of Social Security, 220 F.3d 112, 118-19 (3d Cir. 2000) (quoting Plummer v. Apfel, 186 F.3d 422, 428 (3d Cir. 1999)).

To qualify for disability benefits under the Social Security Act, a claimant must demonstrate that there is some "medically determinable basis for an impairment that prevents him or her from engaging in any substantial gainful activity for a statutory twelve-month period." Kangas v. Bowen, 823 F.2d 775, 777 (3d Cir. 1987); 42 U.S.C. §423(d)(1). This may be done in two ways:

(1) by introducing medical evidence that the claimant is disabled per se because he or she suffers from one or more of a number of serious impairments delineated in 20 C.F.R. Reg. No. 4, Subpt. P, Appdx. 1. See Heckler v. Campbell, 461 U.S. 458 (1983); Stunkard, 841 F.2d at 59; Kangas, 823 F.2d at 777; or

(2) in the event that claimant suffers from a less severe impairment, by demonstrating that he or she is nevertheless unable to engage in "any other kind of substantial gainful work which exists in the national economy." Campbell, 461 U.S. at 461 (citing 42 U.S.C. §423(d)(2)(A)).

In order to prove disability under the second method, a claimant must first demonstrate the existence of a medically determinable disability that precludes a plaintiff from returning to his or her former job. Stunkard, 841 F.2d at 59; Kangas, 823 F.2d at 777. Once it is shown that claimant is unable to resume his or her previous employment, the burden shifts to the Commissioner to prove that, given claimant's mental or physical limitations, age, education and work experience, he or she is able to perform substantial gainful activity in jobs available in the national economy. Stunkard, 842 F.2d at 59; Kangas, 823 F.2d at 777; Doak v. Heckler, 790 F.2d 26, 28 (3d Cir. 1986); Rossi v. Califano, 602 F.2d 55, 57 (3d Cir. 1979).

Where a claimant has multiple impairments that may not individually reach the level of severity necessary to qualify for any one impairment for Listed Impairment status, the Commissioner nevertheless must consider all of the impairments in combination to determine whether, collectively, they meet or equal the severity of a Listed Impairment. Bailey v. Sullivan, 885 F.2d 52 (3d Cir. 1989) ("in determining an individual's eligibility for benefits, the Secretary shall consider the combined effect of all of the individual's impairments without regard to whether any such impairment, if considered separately, would be of such severity").

It is well established that state agency consultants are considered to be "highly qualified physicians and psychologists who are also experts in Social Security disability evaluation. Therefore, administrative law judges must consider findings of State agency medical and psychological consultants or other program physicians or psychologists as opinion evidence, except for the ultimate determination about whether [a claimant is] disabled." 20 C.F.R. ยง 404.1527 (f)(2)(I). However, the opinions of state agency ...

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