United States District Court, M.D. Pennsylvania
Matthew W. Brann United States District Judge
above-captioned action is one seeking review of a decision of
the Acting Commissioner of Social Security
(“Commissioner”), denying Plaintiff John Jay
Kopinetz's (“Kopinetz”) application for
Social Security Disability Insurance Benefits
(“DIB”) and Supplemental Security Income
(“SSI”) under Title II and Title XVI,
respectively. For the reasons set forth below, the Court will
affirm the Commissioner's denial of DIB, but vacate and
remand the Commissioner's denial of SSI.
insurance benefits are paid to an individual if that
individual is disabled and “insured, ” that is,
the individual has worked long enough and paid social
security taxes. The last date that a claimant meets the
requirements of being insured is commonly referred to as the
“date last insured.” It is undisputed that
Kopinetz met the insured status requirements of the Social
Security Act through March 31, 2010. (Tr. 17). In order to
establish entitlement to disability insurance benefits,
Kopinetz was required to establish that he suffered from a
disability on or before that date. 42 U.S.C. §
423(a)(1)(A), (c)(1)(B); 20 C.F.R. § 404.131(a); see
Matullo v. Bowen, 926 F.2d 240, 244 (3d Cir. 1990).
a federal income supplement program funded by general tax
revenues (not social security taxes). It is designed to help
aged, blind or other disabled individuals who have little or
no income. Insured status is irrelevant in determining a
claimant's eligibility for supplemental security income
applied protectively for DIB on May 24, 2013 and SSI on June
30, 2013, alleging disability beginning May 12, 2009. (Tr.
14, 124-134). His claims were initially denied on August 27,
2013 (Tr. 98, 99). Kopinetz requested a hearing before the
Administrative Law Judge (“ALJ”) Office of
Disability and Adjudication and Review of the Social Security
Administration, and one was held on August 6, 2014. (Tr. 33,
109-111). At the hearing, Kopinetz was represented by
counsel, and a vocational expert testified. (Tr. 33-67). On
September 22, 2014, the ALJ issued a decision denying
Kopinetz's application. (Tr. 11-32). Kopinetz filed a
request for review with the Appeals Council, which was
denied. (Tr. 1-10). Thus, the ALJ's decision stood as the
final decision of the Commissioner.
filed a complaint in this Court on June 6, 2016. (Doc. 1).
The Commissioner filed an answer on August 8, 2016. (Doc. 8).
After supporting and opposing briefs were submitted (Docs. 10
and 11), the appeal became ripe for disposition.
was born on November 26, 1965, has at least a high school
education, and is able to communicate in English. (Tr. 27).
In the past, Kopinetz worked as a pastry chef and bakery
manager. (Tr. 26). Kopinetz has not engaged in substantial
gainful activity since the alleged onset date of disability,
May 12, 2009. (Tr. 17).
has the following severe impairments: osteoarthritis,
degenerative disc disease, obesity, narcotic addiction/abuse
and, as of June 2014, anxiety and major depressive disorder.
Standard of Review
considering a social security appeal, the Court has plenary
review of all legal issues decided by the Commissioner.
See Poulos v. Comm'r of Soc. Sec., 474 F.3d 88,
91 (3d Cir. 2007); Johnson v. Comm'r of Soc.
Sec., 529 F.3d 198, 200 (3d Cir. 2008). However, our
review of the Commissioner's findings of fact pursuant to
42 U.S.C. § 405(g) is to determine whether those
findings are supported by “substantial evidence.”
Id. The factual findings of the Commissioner,
“if supported by substantial evidence, shall be
conclusive . . . .” 42 U.S.C. § 405(g).
“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.” Johnson, 529 F.3d at
200 (3d Cir. 2008) (quoting Hartranft v. Apfel, 181
F.3d 358, 360 (3d Cir. 1999)) (internal quotations and
citations omitted). Substantial evidence has been described
as more than a mere scintilla of evidence but less than a
preponderance. Brown v. Bowen, 845 F.2d 1211, 1213
(3d Cir. 1988). “It means such relevant evidence as a
reasonable mind might accept as adequate to support a
conclusion.” Plummer v. Apfel, 186 F.3d 422,
427 (3d Cir. 1999) (citing Ventura v. Shalala, 55
F.3d 900, 901 (3d Cir. 1995)) (quoting Richardson
v. Perales, 402 U.S. 389, 401 (1971) (internal
citations omitted)). The United States Court of Appeals for
the Third Circuit has stated,
[O]ur decisions make clear that determination of the
existence vel non of substantial evidence is not
merely a quantitative exercise. A single piece of evidence
will not satisfy the substantiality test if the
[Commissioner] ignores, or fails to resolve, a conflict
created by countervailing evidence. Nor is evidence
substantial if it is overwhelmed by other evidence -
particularly certain types of evidence (e.g., that offered by
treating physicians) - or if it really constitutes not
evidence but mere conclusion.
Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000)
(citing Kent v. Schweiker, 710 F.2d 110, 114 (3d
Cir. 1983); Gilliland v. Heckler, 786 F.2d 178, 183
(3d Cir. 1986)). Therefore, a court reviewing the decision of
the Commissioner must scrutinize the record as a whole.
Id. (citing Smith v. Califano, 637
F.2d 968, 970 (3d Cir. 1981)).
Sequential Evaluation Process
plaintiff must establish that there is some “medically
determinable basis for an impairment that prevents him from
engaging in any substantial gainful activity for a statutory
twelve-month period.” Fargnoli v. Massanari,
247 F.3d 34, 38-39 (3d Cir. 2001) (quoting Plummer,
186 F.3d at 427) (internal quotations omitted). “A
claimant is considered unable to engage in any substantial
gainful activity ‘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 . . . .'” Fargnoli, 247 F.3d at 39
(quoting 42 U.S.C. § 423(d)(2)(A)). The
Commissioner follows a five-step inquiry pursuant to 20
C.F.R. § 404.1520 to determine whether the claimant is
disabled. In Plummer, the Third Circuit set out the
In step one, the Commissioner must determine whether the
claimant is currently engaging in substantial gainful
activity. 20 C.F.R. § [404.]1520(a). If a claimant is
found to be engaged in substantial activity, the disability
claim will be denied. Bowen v. Yuckert, 482 U.S.
137, 140 (1987) . . . . In step two, the Commissioner must
determine whether the claimant is suffering from a severe
impairment. 20 C.F.R. § 404.1520(c). If the claimant
fails to show that her impairments are “severe, ”
she is ineligible for disability benefits.
In step three, the Commissioner compares the medical evidence
of the claimant's impairment to a list of impairments
presumed severe enough to preclude any gainful work. 20
C.F.R. § 404.1520(d). If a claimant does not suffer from
a listed impairment or its equivalent, the analysis proceeds
to steps four and five. Step four requires the ALJ to
consider whether the claimant retains the residual functional
capacityto perform her past relevant work. 20 C.F.R. §
404.1520(d). The claimant bears ...