United States District Court, Middle District of Pennsylvania
REPORT AND RECOMMENDATION
THOMAS M. BLEWITT United States Magistrate Judge
I. PROCEDURAL HISTORY.
In this case, we are called upon to decide whether the ALJ properly evaluated Plaintiff Justin Ogin’s alleged impairment of intellectual disability under § 12.05C of the listing of impairments. See 20 C.F.R. Pt. 404, Subpt. P, Appx. 1. Having found several inconsistencies in the ALJ’s treatment of Plaintiff’s alleged impairment of intellectual disability under the medical listings, we recommend that this case be remanded for further proceedings consistent with this report.
On June 30, 2010, Plaintiff protectively filed Title II and Title XVI applications for a period of DIB, and SSI. (TR 124-33, 149). In both applications Plaintiff alleged that he was unable to work as of October 1, 2007, in large part, to an intellectual disability. (TR 124, 131).
Plaintiff‘s DIB and SSI applications were initially denied by the Agency on January 6, 2011. (TR 101-08). Thereafter, Plaintiff filed a written request for a hearing. (TR 109-10). On November 8, 2011, a hearing was held before Administrative Law Judge (“ALJ”) Sridhar Boini in Wilkes-Barre, Pennsylvania. (TR 11-53). Plaintiff, and his wife, Jennifer Ogin, both appeared and testified at the hearing. (Id.). An impartial vocational expert (“VE”), Patricia L. Chilleri, also appeared and testified. (Id.). On January 19, 2012, the ALJ issued a decision denying Plaintiff’s applications for benefits and found that Plaintiff was not under a disability within the meaning of the Act from October 1, 2007, the alleged disability onset date, through the date of the ALJ’s decision. (TR 85-97).
The Plaintiff sought review of the ALJ’s decision by the Appeals Council. On March 18, 2013, the Appeals Council denied Plaintiff’s request for review. (TR 1-6).
On May 17, 2013, Plaintiff, through counsel, filed a Complaint appealing the final decision denying his applications for Social Security Disability Insurance Benefits (“DIB”) and for Supplemental Security Income (“SSI”), under Titles II and XVI of the Social Security Act (“the Act”), 42 U.S.C. §§401-433, 1381-1383f. (Doc. 1). This Court has jurisdiction over this case pursuant to 42 U.S.C. §405(g) and 42 U.S.C. § 1383(c)(3).
On August 22, 2013, the Commissioner filed an Answer together with a copy of the administrative record. (Docs. 7, 8). On October 4, 2013, Plaintiff filed his brief. (Doc. 9). After being granted an extension of time, the Commissioner filed her brief on December 6, 2013. (Doc. 12). On December 20, 2013, Plaintiff filed a reply. (Doc. 13). This appeal is now ripe for disposition.
II. STANDARD OF REVIEW.
Resolution of the instant social security appeal involves an informed consideration of the respective roles of two adjudicators-the ALJ and this court. When reviewing the denial of disability benefits, we must determine whether the denial is supported by substantial evidence. Brown v. Bowen, 845 F.2d 1211, 1213 (3d Cir. 1988); Johnson v. Comm. of Soc. Sec, 529 F.3d 198, 200 (3d Cir. 2008). Substantial evidence “does not mean a large or considerable amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Pierce v. Underwood, 487 U.S. 552 (1988); Hartranft v. Apfel, 181 F.3d 358, 360. (3d Cir. 1999); Johnson, 529 F.3d at 200. It is less than a preponderance of the evidence but more than a mere scintilla. Richardson v. Perales, 402 U.S. 389, 401 (1971).
A single piece of evidence is not substantial evidence if the ALJ ignores countervailing evidence or fails to resolve a conflict created by the evidence. Mason v. Shalala, 994 F.2d 1058, 1064 (3d Cir. 1993). In an adequately developed factual record, however, substantial evidence may be "something less than the weight of the evidence, and the possibility of drawing two inconsistent conclusions from the evidence does not prevent [the decision] from being supported by substantial evidence." Consolo v. Federal Maritime Comm'n, 383 U.S. 607, 620 (1966). Furthermore, in determining if the ALJ's decision is supported by substantial evidence the court may not parse the record but rather must scrutinize the record as a whole. Smith v. Califano, 637 F.2d 968, 970 (3d Cir. 1981).
III. DISABILITY EVALUATION PROCESS.
At the outset, it is the responsibility of the ALJ in the first instance to determine whether a Plaintiff has met the statutory prerequisites for entitlement to benefits. To receive disability benefits, Plaintiff must demonstrate an 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); see also 42 U.S.C. § 1382c(a)(3)(A). In order to be eligible to receive DIB under Title II of the Act, a Plaintiff must also show that he or she contributed to the insurance program, and became disabled prior to the date on which he or she was last insured. 42 U.S.C. § 423(a); 20 C.F.R. §404.131. SSI under Title XVI of the Act, however, is a need-based program, and therefore insured status is irrelevant in determining an individual’s eligibility.
[a]n individual shall be determined to be under a disability only if his physical or mental impairment or 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, 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 be hired if he applied for work. For purposes of the preceding sentence (with respect to any individual), “work which exists in the national economy” means work which exists in significant numbers either in the region where such individual lives or in several regions of the country.
42 U.S.C. § 423(d)(2)(A); see also 42 U.S.C. § 1382c(a)(3)(B).
In determining whether an individual is “disabled” as defined by the Act, the ALJ must proceed through a five-step evaluation. See 20 C.F.R. §§ 404.1520, 416.920; see also Plummer v. Apfel, 186 F.3d 422, 428 (3d Cir. 1999). If the Commissioner finds that a Plaintiff is disabled or not disabled at any point in the sequence, review does not proceed any further. See 20 C.F.R. §§ 404.1520, 416.920. The Commissioner must sequentially determine: (1) whether Plaintiff is engaged in substantial gainful activity; (2) whether Plaintiff has a severe impairment; (3) whether Plaintiff’s impairment meets or equals a listed impairment; (4) whether Plaintiff’s impairment prevents him from doing past relevant work; and (5) whether Plaintiff’s impairment prevents him from doing any other work. Id.
Before moving on to step four in this process, the ALJ must also determine Plaintiff’s residual functional capacity (“RFC”). 20 C.F.R. §§ 404.1520(e), 416.920(e). RFC is defined as “that which an individual is still able to do despite the limitations caused by his or her impairment(s).” Burnett v. Comm. of SSA, 220 F.3d 112, 121 (3d Cir. 2000) (citations omitted); see also 20 C.F.R. §§ 404.1545, 416.945; SSR 96-8p. In making this assessment, the ALJ considers all of Plaintiff’s impairments, including any medically determinable non-severe impairments. 20 C.F.R. §§ 404.1545(a)(2), 416.945(a)(2).
This disability determination involves shifting burdens of proof. The initial burden rests with Plaintiff to demonstrate that she is unable to engage in past relevant work. If Plaintiff satisfies this burden, then the Commissioner must show that jobs exist in the national economy that a person with the claimant's abilities, age, education, and work experience can perform.
Mason, 994 F.2d at 1064.
The ALJ’s disability determination must also meet certain basic procedural and substantive requirements. Most significant among these legal benchmarks is a requirement that the ALJ adequately explain the legal and factual basis for this disability determination. Thus, in order to facilitate review of the decision under the substantial evidence standard, the ALJ's decision must be accompanied by "a clear and satisfactory explication of the basis on which it rests." Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981). Conflicts in the evidence must be resolved and the ALJ must indicate which evidence was accepted, which evidence was rejected, and the reasons for rejecting certain evidence. Id. at 706-707. In addition, “[t]he ALJ must indicate in his decision which evidence he has rejected and which he is relying on as the basis for his finding.” Schaudeck v. Com. of Soc. Sec., 181 F.3d 429, 433 (3d Cir. 1999).
Here, the ALJ found that Plaintiff met the insured status requirements of the Social Security Act through December 31, 2008. (TR 87). Then, the ALJ proceeded through each step of the sequential evaluation process and concluded that Plaintiff was not disabled within the meaning of the Act from October 1, 2007, his alleged disability ...