Plaintiff-Appellant [Plaintiff] filed a claim for Social Security Disability Insurance benefits on her medical condition of major depressive disorder. After a hearing, the administrative law judge [ALJ] denied Plaintiff’s claim for benefits because the ALJ determined that Plaintiff was not disabled within the meaning of the Social Security Act, 42 U.S.C. §§401–434.
Plaintiff having exhausted the administrative appeals process, challenged the final administrative decision of the Social Security Administration [SSA] in the United States District Court for the Southern District of New York. The district court affirmed SSA's decision.
In her appeal Plaintiff contended that SSA’s
determination that she was not disabled during the period covered by her claim
was not based on substantial evidence. The
Explaining the under 42 U.S.C. §405(g), "federal courts are permitted to engage in only “limited review of final SSA disability benefit decisions”, on an appeal from the denial of disability benefits, the Second Circuit "will focus on the administrative ruling rather than the district court’s opinion ... because the same standard of review applies to the agency’s decision, both in the district court and before a court of appeals”. Citing Estrella v. Berryhill, 925 F.3d 90, the Circuit Court said will then conduct a "plenary review of the administrative record to determine if there is substantial evidence, considering the record as a whole, to support the Commissioner’s decision and if the correct legal standards have been applied.”
In determining whether there is evidentiary sufficiency under this standard, a court is “required to examine ... contradictory evidence and evidence from which conflicting inferences can be drawn.” Noting that in the event the evidence "is susceptible to more than one rational interpretation, the Commissioner’s conclusion must be upheld.” However, this presupposes that the ALJ has not disregarded or misconstrued relevant evidence and has not applied incorrect legal standards.
Here, said the court Plaintiff argued that the ALJ "committed a categorical error" by denying her application for benefits without a medical opinion to support that decision in that the record. The Circuit Court that noted that the only substantive medical opinions was that of one physician, who opined that Plaintiff met the criteria of Listed Impairment 12.04 and did not have the capacity to perform even low stress work on a consistent basis.*
As the record contained on one medical opinion which had concluding that Plaintiff was not disabled, Plaintiff contended that the ALJ’s decision was not supported by substantial evidence. The Circuit Court agreed, stating that "In the absence of a medical opinion contradicting sole physician's opinion "substantive medical opinion" that Plaintiff meets the listed criteria, we must carefully scrutinize the rest of the record evidence to determine whether it supports the ALJ’s decision to partially discount [the physician's] opinion and conclude that Plaintiff did not meet those criteria.
Noting that the Second Circuit has held that “the absence of an express rationale does not prevent [it] from upholding the ALJ’s determination regarding [an] appellant’s claimed listed impairment[] [where] portions of the ALJ’s decision and the evidence before [her] indicate that [her] conclusion was supported by substantial evidence,” in this instance the other portions of the ALJ’s decision and the record evidence here "do not provide substantial support for the ALJ’s conclusion that Plaintiff could adapt to changes in her environment or demands not already part of her daily life".
The Circuit Court's decision also included the observation that "the ALJ herself found that Plaintiff had not “engage[d] in substantial gainful activity” after losing her part-time retail job ... implicitly recognizing that her venture into self-employment was insubstantial." To the extent that the ALJ’s cited evidence might suggest that Plaintiff was not disabled during some of 2018, the Circuit Court said this "certainly does not support a finding that [Plaintiff] was not seriously impaired well within her coverage period.
Holding that the ALJ’s determination that Plaintiff did not meet the 12.04 listing criteria is not supported by substantial evidence, the court concluded that the ALJ erred in finding that Plaintiff failed to establish that she was disabled under the Social Security Act and entitled to benefits at step three of the sequential analysis.
Circuit Court, stating it was "Reluctant, however, to determine that Plaintiff was in fact disabled, given that the absence of additional medical evidence stems from her failure to appear for a consultative examination" due to miscommunication, concluded that the better course is to remand the case to the agency for further proceedings, including a fuller consideration of the existing evidence and the results of a consultative examination.
Accordingly, the Circuit Court vacated the judgment of the district court and the case to the district court "with instructions to remand the case to the Commissioner for further proceedings not inconsistent with this opinion".
* In addition, two state agency psychologists also examined the record at the initial and reconsideration levels of the administrative process. Both opined that there was insufficient evidence to adjudicate Plaintiff’s claim.
Click HERE to access the Second Circuit Court of Appeals' decision posted on the Internet.