United States District Court, D. Massachusetts
MEMORANDUM AND ORDER REGARDING PLAINTIFF'S MOTION TO REVERSE THE DECISION OF THE COMMISSIONER AND DEFENDANT'S MOTION TO AFFIRM THE DECISION OF THE COMMISSIONER (Dkt. Nos. 19 & 21)
KATHERINE A. ROBERTSON, Magistrate Judge.
This is an action for judicial review of a final decision by the Defendant, the Acting Commissioner of the Social Security Administration ("Commissioner"), regarding a minor's entitlement to Supplement Security Income ("SSI") pursuant to 42 U.S.C. § 1383(c)(3) (referencing 42 U.S.C. § 405(g)). On behalf of the minor ("P.W."), Marilyn McCoy ("Plaintiff") asserts that the Commissioner's decision that P.W. was no longer disabled as of June 1, 2011 - memorialized in a June 20, 2013 decision by an administrative law judge ("ALJ") - is in error and not supported by substantial evidence. Plaintiff has moved to reverse the decision of the Commissioner (Dkt. No. 21) and requests that P.W.'s benefits be reinstated and that he receive retroactive payments (Dkt. No. 1 at 6). The Commissioner has moved for an order affirming her decision on the grounds that it is supported by substantial evidence and not erroneous. (Dkt. No. 19).
The parties have consented to this court's jurisdiction. See 28 U.S.C. § 636(c); Fed.R.Civ.P. 73. For the following reasons, the court will deny Plaintiff's motion to reverse and allow the Commissioner's motion to affirm.
II. Procedural Background
In October 2001, P.W. was found disabled due to a respiratory impairment that met 11, the SSA conducted a continuing disability review in P.W.'s case ( id. at 74, 70-71, 27-28). After review of various medical records, the SSA found that P.W.'s "condition ha[d] medically improved, " and that new medical evidence demonstrated that his "health ha[d] improved and he no longer me[t] the disability requirements" ( id. at 74). P.W. was therefore deemed "no longer disabled" as of June 1, 2011 ( id. ). After a hearing on reconsideration, that determination was upheld in a December 23, 2011 decision by a disability hearing officer ( id. at 23, 77, 90-100). Plaintiff timely requested review of the hearing officer's decision and a hearing before an administrative law judge ( id. at 103-148, 23). A hearing before the ALJ was held initially on February 14, 2013, continued, and then resumed on May 9, 2013 ( id. at 40-69). The ALJ issued her decision on June 20, 2013, finding that Plaintiff was no longer disabled as of June 1, 2011 ( id. at 20-39). Plaintiff sought review of the ALJ's decision by the Appeals Council and submitted new medical evidence in support of her appeal ( id. at 6-19). On August 25, 2014, the Appeals Council denied Plaintiff's request for review ( id. at 1-5). Thus, the ALJ's decision became the final decision of the Commissioner. This appeal followed.
III. Standard of Review
This court may affirm, modify or reverse a decision of the Commissioner upon review of the pleadings and the record. 42 U.S.C. § 405(g). This review is limited, however, "to determining whether the ALJ used the proper legal standards and found facts upon the proper quantum of evidence." Ward v. Comm'r of Soc. Sec., 211 F.3d 652, 655 (1st Cir. 2000) (citing Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999)). Under 42 U.S.C. § 405(g), this Court must accept the factual findings of the Commissioner as conclusive "if supported by substantial evidence." 42 U.S.C. § 405(g). Substantial evidence exists "if a reasonable mind, reviewing the evidence in the record as a whole, could accept it as adequate to support [the Commissioner's] conclusion." Rodriguez v. Sec'y of Health and Human Servs., 647 F.2d 218, 222 (1st Cir. 1981). In applying the substantial evidence standard, the court must be mindful that it is the province of the ALJ, and not the courts, to determine issues of credibility, resolve conflicts in the evidence, and draw conclusions from such evidence. Irlanda Ortiz v. Sec'y of Health & Human Servs., 955 F.2d 765, 769 (1st Cir. 1991). So long as the substantial evidence standard is met, the ALJ's factual findings are conclusive even if the record "arguably could support a different conclusion." Id. at 770. The ALJ's findings of fact, however, "are not conclusive when derived by ignoring evidence, misapplying the law, or judging matters entrusted to experts." Nguyen, 172 F.3d at 35. Thus, if the ALJ made a legal or factual error, the court may reverse or remand such a decision to consider new material evidence or to apply the correct legal standard. See Manso-Pizarro v. Sec'y of Health & Human Servs., 76 F.3d 15, 16 (1st Cir. 1996); 42 U.S.C. § 405(g).
A. Childhood Disability Standard Under 20 C.F.R. § 416.924 and Medical Improvement Review Standard Under 20 C.F.R. § 416.994a(b)
An individual under the age of eighteen is considered disabled and entitled to SSI if he or she "has a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and 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 12 months." 42 U.S.C. § 1382c(a)(3)(C)(i). Such a determination is made pursuant to a three-step analysis set forth in 20 C.F.R. §§ 416.924(b)-(d). See, e.g., Belivau v. Apfel, 154 F.Supp.2d 89, 93 (D. Mass. 2001); Nelson ex rel. S.N. v. Astrue, No. CIV. A 09-10729-JGD, 2010 WL 3081690, at *10 (D. Mass. Aug. 6, 2010). P.W. was found disabled pursuant to this standard in October 2001. Because that decision is the most recent favorable determination in this case, it is referred to as the comparison point decision ("CPD") (A.R. at 27, 93). See Social Security Program Operations Manual System ("POMS") § DI 28010.105, Comparison Point Decision (referencing 20 C.F.R. § 416.994a(c)(1) ("The most recent favorable decision is the latest final determination or decision involving a consideration of the medical evidence and whether you were disabled or continued to be disabled")); Social Security Ruling, SSR 05-03p, 70 FR 21833-01, 2005 WL 952065 (Apr. 27, 2005). In 2011, the CPD was subject to a continuing disability review ("CDR").
When conducting a CDR, the Commissioner applies a three-step sequential evaluation process known as the "medical improvement review standard" or "MIRS" set forth in 20 C.F.R. § 416.994a(b). See SSR 05-03P, 2005 WL 952065, at *1. At the first step, the Commissioner determines whether the impairment(s) the child had at the time of the CPD has medically improved. 20 C.F.R. § 416.994a(b)(1). "Medical improvement is any decrease in the medical severity of [the child's] impairment(s) which was present at the time of the most recent favorable decision that [the child was found] disabled or continued to be disabled." 20 C.F.R. § 416.994a(c). Such a determination must be based on changes, i.e., improvement, in the symptoms, signs, or laboratory findings associated with such impairment(s). Id.; see 20 C.F.R. § 416.928 (defining "symptoms, signs, and laboratory findings"). While a decrease in severity may be of any quantity or degree, minor changes are disregarded. 20 C.F.R. § 416.994a(c). If no medical improvement has occurred, the child's disability continues; if there has been medical improvement, the Commissioner proceeds to step two. 20 C.F.R. §§ 416.994a(b)(1)-(2).
At step two, the Commissioner determines whether the CPD impairment(s) still meets, medically equals, or functionally equals "the severity of the listed impairment that it met or equaled at the time of the CPD." 20 C.F.R. § 416.994a(b)(2). "As long as [the Commissioner] determine[s] that the CPD impairment(s) currently meets or medically or functionally equals the listing [ ] considered before, [the Commissioner] does not have to make the same finding [ ] made at the CPD." SSR 05-03P, 2005 WL 952065, at *1. If the CPD impairment(s) still meets, medically equals, or functionally equals the listing considered at the CPD, the child remains disabled. See id.; 20 C.F.R. § 416.994a(b)(2). If not, the Commissioner must proceed to the third and final step.
At step three, the Commissioner determines whether the child is currently disabled, considering all impairments, including any not present or not considered at the CPD. 20 C.F.R. § 416.994a(b)(3); SSR 05-03P, 2005 WL 952065, at *1. The child's current impairment(s) must first be deemed severe. 20 C.F.R. § 416.994a(b)(3)(i); SSR 05-03P, 2005 WL 952065, at *1; see 20 C.F.R. § 416.924(c) ("If you do not have a medically determinable impairment, or your impairment(s) is a slight abnormality or a combination of slight abnormalities that causes no more than minimal functional limitations, we will find that you do not have a severe impairment(s) and are, therefore, not disabled."). If not severe, the child's disability has ended. 20 C.F.R. § 416.994a(b)(3)(i). If the current impairment(s) is severe, the Commissioner considers whether it meets or medically equals any impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. 20 C.F.R. § 416.994a(b)(3)(ii); SSR 05-03P, 2005 WL 952065, at *1; see also 20 C.F.R. §§ 416.925, 416.926. If it does, the child's disability continues. 20 C.F.R. § 416.994a(b)(3)(ii). If not, the Commissioner considers whether ...