|President Roosevelt signing the Social Security Act. |
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Each of these cases if for disability benefits under Title II of the Social Security Act and supplemental income benefits under Title XVI. Procedurally, the Commissioner of Social Security (named defendant Michael Astrue) makes a determination of benefits. If rejected, the claimant can request reconsideration. If denied again, the claimant can request a hearing before an Administrative Law Judge (ALJ). If denied again, the claimant can appeal to the Appeals Council. If denied there, the claimant can file suit in federal district court under 42 U.S.C. § 405(g). That is where each of the underlying cases occurred.
The federal judge reviews each case to determine if the ALJ's decision is supported by substantial evidence and made with the correct application of the law. In particular, compliance with the procedure in 20 C.F.R. § 404.1520(a). That procedure involves five steps:
At Step One, the Commissioner considers whether the claimant is engaged in "substantial gainful activity." If so the claimant is not disabled. At Step Two, the Commissioner considers whether the claimant has "a severe medically determinable physical or mental impairment" that has lasted, or is expected to last, at least twelve continuous months. That is, an impairment that prevents the claimant from working. At Step Three, the Commissioner considers whether the claimant’s impairment "meets or equals" one of the listed impairments that the Social Security Administration has designated as disabling.
At Step Four, the Commissioner considers whether the claimant can continue to perform work he has performed in the past. The ALJ first determines the claimant’s residual functional capacity ("RFC"). That is, "the most [the claimant] can still do despite [his] limitations," based on all relevant evidence in the record. If the RFC assessment indicates that the claimant can perform his past work, the Commissioner will find the claimant not disabled.
At Step Five, the Commissioner carries the burden of considering the claimant’s RFC, age, education, and work experience and determining whether the claimant can "make an adjustment to other work" that "exists in significant numbers in the national economy."
In Peck v. Astrue, the plaintiff was a pizza delivery man who had been hit by a car as a child suffering sever physical and mental limitations which, more recently, made it difficult to work. The dispute here concerns steps three and four above. At step three, the ALJ found that Mr. Peck was not on pain medication (he was), that he had a "moderate" concentration disability (but the ALJ did not compensate him for it). At step four, the ALJ found that Mr. Peck had "severe mental" disabilities but did not include those in the RFC. The ALJ concluded that Mr. Peck was able to do unskilled work. Judge Saundra Brown Armstrong disagreed, finding that Mr. Peck had submitted plenty of evidence to find him disabled either under step three or four to support a conclusion that he was disabled and the ALJ either disregarded it or found that he was disabled but did not compensate him for it. Judge Armstrong reversed the ALJ and remanded for a benefit determination.
O'Conner v. Astrue involved a Russian immigrant who worked as a salesperson and manager of a General Nutrition Center (GNC) store. In 2004, her haunting past of abuse at the hands of her father and husband overtook her and caused her to be depressed and unable to work out of fear of having a panic attack. At step four, the ALJ didn't believe her, stating that she appeared fine at the hearing and was able to regularly travel to Russia which questioned her claim of being physically and mentally non-functioning. He also disregarded the opinions of Ms. O'Connor's husband and treating physician as merely repeating the claimants complaints. At step five, the ALJ asked if someone with Ms. O'Connor's physical impediments could find work, to which the vocation examiner (VE) responded she could. The ALJ then added her mental impairments to which the VE responded she could not find any work. Oddly, the ALJ made his decision on the first hypothetical and not the second. Magistrate Judge Joseph C. Spero found that all three of these were errors, but that the incorrect hypothetical was reversible because the Commissioner failed to carry his burden to show work was available for Ms. O'Conner in the national economy. Judge Spero reversed and remanded the case to the ALJ for a benefit determination.
In Nguyen v. Astrue, the claimant immigrated from Vietnam who worked as a "rework technician" in the shipping and receiving department of Silicon Graphics. While there he suffered from a lack of appetite and weight lost for which he obtained surgery. After the surgery, he did not return to work and collected disabilty benefits for six years. After that, the Commissioner found that Mr. Nguyen was healthy enough to work and terminated his benefits. He did not appeal. Instead, he filed a new application three years later which is the subject of the current dispute. Mr. Ngyen, again, complains of low body weight and a variety of other problems. The ALJ, at step three, cited the claimant's frequent travel to Vietnam and rare doctor visits as evidence that he was not in as much pain as he claimed to be. Further, the ALJ noted that the treating physician's statements and Mr. Nguyen's statements were inconsistent. Judge Jeremy Fogel found that the evidence could have gone either way, deferred to the judgment of the ALJ and granted summary judgment for the Commissioner.
Zamora v. Astrue involves a Mexican immigrant who worked for twenty years before injuring a disc in his back. Step five of the analysis above is in dispute and it regards slight differences in opinions in the residual capacity Mr. Zamora has to find work in the national economy. While agreeing on nearly every other thing, the Commissioner's physicians believe Mr. Zamora could sit for six hours a day, while Mr. Zamora's physicians believe he could only sit for two hours a day. One doctor believed the claimant "could perform frequent kneeling, reaching and crawling" another, "concluded that he could kneel and reach only occassionally [sic] and never should crawl." The ALJ rejected one doctor's findings by stating he was "an advocate" for Mr. Zamora and rejected another because his findings were inconsistent with his recommendations.
Judge Jeremy Fogel saw it differently. He stated that a physician jointly paid by the state insurance commission and Mr. Zamora was not an advocate and that even if he was that was not a "clear and convincing" reason to discount his opinion. A single inconsistent statement in the other physician's work was insufficient to discount him outright. Judge Fogel reversed the ALJ, found Mr. Zamora disabled and remanded the case to the ALJ for benefit calculation.
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