United States District Court, D. Massachusetts
TIMOTHY S. HILLMAN, District Judge.
Christopher Pelosi ("Pelosi") has brought this action pursuant to section 205(g) of the Social Security Act, 42 U.S.C. §405(g)("Act") seeking judicial review of a final decision made by the Commissioner of the Social Security Administration ("Commissioner") finding that he ceased being disabled under the Act as of March 1, 2008. This Order addresses Pelosi's Motion To Reverse The Decision Of The Commissioner of Social Security (Docket No. 16), and Defendant's Motion To Affirm The Commissioner's Decision (Docket No. 20).
Pelosi filed for disability insurance benefits ("DIB") on April 11, 2002 ( Tr., at pp. 73-76). In a determination dated December 30, 2002, the Social Security Administration ("SSA") found Pelosi disabled as of April 1, 2002 (Id., at p. 15). Pelosi was determined to have the following medically determinable impairment: hepatitis C with liver damage. (Id., at p. 17). By notice dated March 16, 2008, the agency informed Pelosi that it had determined that his medical condition had improved and that as of March 1, 2008, he was no longer disabled (Id., at pp. 28-30). Pelosi's request for reconsideration was denied on July 31, 2009, after a hearing before a State agency Disability Hearing Officer (Id., at pp. 31-49). Thereafter, Pelosi requested a hearing before an administrative law judge ("ALJ"). The ALJ issued an unfavorable decision on December 22, 2010, finding that Pelosi's disability ceased as of March 1, 2008 (Id., at pp. 12-25). The ALJ's decision became final on July 6, 2012, when the Appeals Council denied his request for review (Id., at pp. 5-9).
Standard for Entitlement to Continued Disability Insurance Benefits
Entitlement To Benefits
To qualify for disability insurance benefits, a claimant must demonstrate that s/he is disabled within the meaning of the Act. The term "disability" as the defined in the Act is the "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 twelve months." 42 U.S.C. §1382c(a)(3)(A). The impairment(s) must be severe enough to prevent the claimant from performing not only his or her past work, but also any substantial gainful work existing in the national economy. 42 U.S.C. §423(d)(2)(A); 20 C.F.R 404.1560(c)(1). In making such determination, the ALJ must assess the claimant's RFC in combination with the "vocational factors, [including the claimant's] age, education, and work experience." 20 CFR § 404.1560(c)(1). Findings of fact made by the ALJ "are conclusive when supported by substantial evidence, 42 U.S.C. § 405(g), but are not conclusive when derived by ignoring evidence, misapplying the law, or judging matters entrusted to experts." Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999).
Essentially, under the Act, benefits may be discontinued only if there is substantial evidence to support a finding: (1) that there is medical improvement related to the individual's ability to work, and (2) that the individual is now able to engage in substantial gainful activity. See 20 C.F.R. § 404.1594(a). "Medical improvement" is defined "as any decrease in the medical severity of [an] impairment(s), which was present at the time of the most recent favorable medical decision that [the claimant was] disabled or continued to be disabled. A determination that there has been a decrease in medical severity must be based on changes (improvement) in the symptoms, signs and/or laboratory findings associated with [the claimant's] impairment." Id. § 404.1594(b)(1); see also Rice v. Chater, 86 F.3d 1, 2 (1st Cir. 1996). "To find medical improvement, the Commissioner must compare the prior and current medical evidence to determine whether there have been any such changes in the signs, symptoms and laboratory findings associated with the claimant's impairment." Rice, 86 F.3d at 2; see also 20 C.F.R. § 404.1594(c)(1). "Once medical improvement has been shown, a claimant's failure to meet a prior listing suffices to show that medical improvement is related to ability to work, a separate issue which is not even considered until medical improvement has been established." Rice, 86 F.3d at 2 n. 2 (emphasis in original); see also 20 C.F.R. § 404.1594(c)(2) & (3)(i). "Failure to seek treatment is not evidence of medical improvement. The regulations require actual physical improvement in a claimant's impairment, not simply an improved prognosis." Santiago v. Barnhart, 386 F.Supp.2d 20, 22 (D.P.R. 2005)(internal citation omitted).
Determination By The ALJ
In order to determine whether the claimant is suffering from a continued disability, the ALJ utilizes the following eight step sequential analysis:
(1) [Is the claimant] engaging in substantial gainful activity? If [yes] (and any applicable trial work period has been completed), we will find disability to have ended.
(2) If [no], [does the claimant] have an impairment or combination of impairments which meets or equals the severity of an impairment listed in appendix 1...? If [yes], [the claimant's] disability will be found to continue.
(3) If [the claimant does not have such an impairment or combination of impairments], has there been medical improvement...? If there has been medical improvement as shown by a decrease in medical severity, see step (4). If there has been no decrease in medical severity, there has been no medical improvement. (See step (5).
(4) If there has been medical improvement, [it must be] determine[d] whether it is related to [the claimant's] ability to do work...; i.e., whether or not there has been an increase in the residual functional capacity based on the impairment(s) that was present at the time of the most recent favorable medical determination. If medical improvement is not related to [the claimant's] ability to do work, ...