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Benjamin v. Colvin

United States District Court, D. Connecticut

November 14, 2016

PAULA BENJAMIN, Plaintiff,
v.
CAROLYN W. COLVIN, ACTING COMMISSIONER, SOCIAL SECURITY ADMINISTRATION Defendants.

          RULING ON THE PLAINTIFF'S MOTION TO REVERSE AND THE DEFENDANT'S MOTION TO AFFIRM THE DECISION OF THE COMMISSIONER

          Michael P. Shea, U.S.D.J.

         This is an administrative appeal following the denial of the plaintiff, Paula Benjamin's, application for disability insurance benefits. The appeal is brought pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3).[1] Ms. Benjamin now moves for an order reversing the decision of the Commissioner of the Social Security Administration (“Commissioner”). In the alternative, Ms. Benjamin seeks an order remanding her case for a rehearing. The Commissioner, in turn, has moved for an order affirming the decision.

         Ms. Benjamin argues, among other things, that the Administrative Law Judge (“ALJ”) erred in concluding that Ms. Benjamin's medical conditions did not meet or medically equal a listed impairment, which would have made her per se disabled, and that the ALJ did not properly apply the treating physician rule in determining Ms. Benjamin's Residual Functional Capacity (“RFC”). Although I find that the ALJ did not err in concluding that Ms. Benjamin's conditions did not medically equal a listed impairment, I agree with Ms. Benjamin that the ALJ improperly applied the treating physician rule as to opinions about concentration problems and the need for unscheduled breaks. The case is therefore REMANDED. I do not reach Ms. Benjamin's remaining arguments urging reversal or remand.

         FACTS

         On August 26, 2013, Ms. Benjamin filed an application for disability benefits for an alleged disability that commenced on March 15, 2013, and continued through the date of the ALJ's decision. (Pl's Mem., ECF No. 15-1 at 2-3; D's Mem., ECF No. 16-1 at 1.) On October 16, 2013, a disability adjudicator in the Social Security Administration denied her initial request for disability benefits and thereafter denied her request for reconsideration. (Id.) On December 17, 2014, Ms. Benjamin appeared with counsel for a hearing before Administrative Law Judge Denise Horton. (Id.) On February 20, 2015, the ALJ issued a decision denying benefits. (Id.)

         The ALJ found that Ms. Benjamin was a 56 year old woman with severe impairments of degenerative disc disease, chondromalacia of the right knee, and obesity. (ALJ Decision, ECF No. 13-3 at 45.) The ALJ determined that Ms. Benjamin did not have a listed impairment, had the RFC to perform “light work” as defined in 20 C.F.R. § 404.1567, was able to perform past relevant work, and was therefore not disabled within the meaning of the Social Security Act. (Id. at 45-56.) On October 8, 2015, the appeals council denied Ms. Benjamin's request for review of that decision, thereby making the ALJ's decision the final decision of the Commissioner. (ECF No. 15-1 at 2-3; ECF No. 16-1 at 2.) This appeal followed.

         Specific facts and portions of the ALJ's decision will be discussed below as necessary.

         STANDARD

         The Social Security Act establishes that benefits are payable to individuals who have a disability. 42 U.S.C. § 423(a)(1). “The term ‘disability' means... [an] inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment....” 42 U.S.C. § 423(d)(1). To determine whether a claimant is disabled within the meaning of the Social Security Act, the ALJ must follow a five-step evaluation process as promulgated by the Commissioner.[2] To be considered disabled, an individual's impairment must be “of such severity that he is not only unable to do his previous work but cannot... engage in any other kind of substantial gainful work which exists in the national economy.” 42 U.S.C. § 423(d)(2)(A).

         “A district court reviewing a final... decision pursuant to… 42 U.S.C. § 405(g), is performing an appellate function.” Zambrana v. Califano, 651 F.2d 842, 844 (2d Cir. 1981). “The findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive.” 42 U.S.C. § 405(g). Accordingly, a district court may not make a de novo determination of whether a plaintiff is disabled in reviewing a denial of disability benefits. Wagner v. Sec'y of Health & Human Servs., 906 F.2d 856, 860 (2d Cir. 1990). Rather, the court's function is to ascertain whether the correct legal principles were applied in reaching the decision, and whether the decision is supported by substantial evidence. Johnson v. Bowen, 817 F.2d 983, 985 (2d Cir. 1987). If the Commissioner's decision is supported by substantial evidence, that decision will be sustained, even where there may also be substantial evidence to support the plaintiff's contrary position. Schauer v. Schweiker, 675 F.2d 55, 57 (2d Cir. 1982). The Second Circuit has defined substantial evidence as “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Williams v. Bowen, 859 F.2d 255, 258 (2d Cir. 1988) (internal citation and quotation marks omitted). Substantial evidence must be “more than a mere scintilla or a touch of proof here and there in the record.” Id.

         DISCUSSION

         I. Listed Impairment

         I must first decide whether substantial evidence supported the determination that Ms. Benjamin's condition did not meet or medically equal a listed impairment, [3] which would have made her disabled per se. 20 C.F.R. § 404.1520(a)(4)(iii). “For a claimant to qualify for benefits by showing that his unlisted impairment, or combination of impairments, is ‘equivalent' to a listed impairment, he must present medical findings equal in severity to all the criteria for the one most similar listed impairment.” Sullivan v. Zebley, 493 U.S. 521, 531 (1990) (quoting 20 C.F.R. § 416.926(a); footnote omitted).

         At issue in this case is Listing 1.02A, the listed impairment of “[m]ajor dysfunction of a joint(s), ” which describes “[i]nvolvement of one major peripheral weight-bearing joint (i.e., hip, knee, or ankle), resulting in inability to ambulate effectively.” 20 C.F.R. § Pt. 404, Subpt. P, App. 1, 1.02A.[4] According to the regulations, inability to ...


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