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Ortiz v. Colvin

United States District Court, D. Massachusetts

March 15, 2017

EDWIN ORTIZ, Plaintiff
CAROLYN W. COLVIN, Acting Commissioner of Social Security Administration, Defendant


          KATHERINE A. ROBERTSON, United States Magistrate Judge

         I. Introduction

         Before the court is an action for judicial review of a final decision by the Acting Commissioner of the Social Security Administration ("Commissioner") regarding an individual's entitlement to Supplemental Security Income ("SSI") pursuant to 42 U.S.C. § 1381(c)(3). Plaintiff Edwin Ortiz ("Plaintiff") asserts that the Commissioner's decision denying him such benefits -- memorialized in a July 28, 2014 decision of an administrative law judge ("ALJ") -- is not supported by substantial evidence. Plaintiff has filed a motion to reverse or remand (Dkt. No. 15) and the Commissioner, in turn, has moved to affirm (Dkt. No. 20).

         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 ALLOW the Commissioner's motion to affirm and DENY Plaintiff's motion to reverse or remand.

         II. Factual Background

         Plaintiff was born in Puerto Rico and, at the time of the ALJ hearing, was 49 years old and had lived in the United States for approximately thirty years (Administrative Record ("A.R.") at 42, 62). Although he is unable to read or write in either English or Spanish, he speaks and understands both languages (id. at 44-46, 73). He worked as a welder for about five years (id. at 43-44). Because asthma and wrist surgery prevented him from performing his job, he stopped working as a welder in January 2008 when he was 43 years old (id. at 19, 46-48). In his application for SSI, Plaintiff alleged that he was disabled due to liver disease, specifically hepatitis C, pain in his back and right hand, asthma, and depression (id. at 90, 112, 860).

         III. Procedural Background

         Plaintiff applied for SSI on May 7, 2012 alleging an onset of disability on January 25, 2008 (id. at 90, 291). The application was denied initially and upon reconsideration (id. at 105-12, 116-18). Following a hearing on May 21, 2014, the ALJ issued his decision on July 28, 2014 finding Plaintiff was not disabled (id. at 12, 19, 29). The Appeals Council denied review (id. at 1-5). This appeal followed.

         IV. Discussion

         A. Legal Standards

         1. Standard of Review

         The District Court may enter a judgment affirming, modifying, or reversing the final decision of the Commissioner, with or without remanding for a rehearing. See 42 U.S.C. § 1383(c)(3). Judicial review "is limited 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). The court reviews questions of law de novo, but must defer to the ALJ's findings of fact if they are supported by substantial evidence. See id. (citing Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999)). Substantial evidence exists "'if a reasonable mind, reviewing the evidence in the record as a whole, could accept it as adequate to support [the] conclusion.'" Irlanda Ortiz v. Sec'y of Health & Human Servs., 955 F.2d 765, 769 (1st Cir. 1991) (quoting Rodriguez v. Sec'y of Health & Human Servs., 647 F.2d 218, 222 (1st Cir. 1981)). "Complainants face a difficult battle in challenging the Commissioner's determination because, under the substantial evidence standard, the [c]ourt must uphold the Commissioner's determination, 'even if the record arguably could justify a different conclusion, so long as it is supported by substantial evidence.'" Amaral v. Comm'r of Soc. Sec., 797 F. Supp. 2d 154, 159 (D. Mass. 2010) (quoting Rodriguez Pagan v. Sec'y of Health & Human Servs., 819 F.2d 1, 3 (1st Cir. 1987)). 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. See Irlanda Ortiz, 955 F.2d at 769. That said, the Commissioner may not ignore evidence, misapply the law, or judge matters entrusted to experts. See Nguyen, 172 F.3d at 35.

         2. Standard for Entitlement to Social Security Disability Insurance Benefits and Supplemental Security Income.

         In order to qualify for SSI, a claimant must demonstrate that he was disabled within the meaning of the Social Security Act (the "Act") and that he had financial need. See 42 U.S.C. § 1381a. "Plaintiff's need, for purposes of SSI, . . . [is] not challenged. The only question is whether the ALJ had substantial evidence with which to conclude that Plaintiff did not suffer from a disability." Bitsacos v. Barnhart, 353 F. Supp. 2d 161, 165-66 (D. Mass. 2005).

         The Act defines disability, in part, as 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 12 months." 42 U.S.C. § 423(d)(1)(A). An individual is considered disabled under the Act

only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work.

42 U.S.C. §1382c(a)(3)(B). See generally Bowen v. Yuckert, 482 U.S. 137, 146–49 (1987).

         The Commissioner evaluates a claimant's impairment under a five-step sequential evaluation process set forth in regulations promulgated under the Act. See 20 C.F.R. § 416.920(a). The hearing officer must determine: (1) whether the claimant is engaged in substantial gainful activity; (2) whether the claimant suffers from a severe impairment; (3) whether the impairment meets or equals a listed impairment contained in Appendix 1 to the regulations; (4) whether the impairment prevents the claimant from performing previous relevant work; and (5) whether the impairment prevents the claimant from doing any work considering the claimant's age, education, and work experience. See id; see also Goodermote v. Sec'y of Health & Human Servs., 690 F.2d 5, 6-7 (1st Cir. 1982) (describing the five-step process). If the hearing officer determines at any step of the evaluation that the claimant is or is not disabled, the analysis does not continue to the next step. See 20 C.F.R. § 416.920.

         Before proceeding to steps four and five, the Commissioner must make an assessment of the claimant's RFC, which the Commissioner uses at step four to determine whether the claimant can do past relevant work and at step five to determine if the claimant can do other work. See id. "The RFC is an administrative assessment of the extent to which an individual's medically determinable impairment(s), including any related symptoms, such as pain, may cause physical or mental limitations or restrictions that may affect his or her capacity to do work-related physical and mental activities." Social Security Regulation ("SSR") 96-8p, 1996 WL 374187, at *2 (July 2, 1996). Put another way, "[a]n individual's RFC is defined as 'the most you can still do despite your limitations.'" Dias v. Colvin, 52 F. Supp. 3d 270, 278 (D. Mass. 2014) (quoting 20 C.F.R. § 416.945(a)(1)).

         The claimant has the burden of proof through step four of the analysis. At step five, the Commissioner has the burden of showing the existence of jobs in the national economy that the claimant can perform notwithstanding impairment(s). See Goodermote, 690 F.2d at 7.

         B. Medical Records

         1. Physical condition.

         Plaintiff presented the ALJ and the court with medical records that spanned the period from January 2007 through July 2014. Northgate Medical P.C. ("Northgate") provided Plaintiff's primary care. New England Orthopedic Surgeons ("NEOS"), Pioneer Spine and Sports Physicians, P.C. ("Pioneer"), and the Arthritis Treatment Center treated Plaintiff's right wrist. An infectious disease physician at Baystate Medical Center ("BMC") treated Plaintiff's liver condition. Plaintiff also received treatment at the Mercy Medical Center ("Mercy").

         2. Mental condition.

         Plaintiff received mental health treatment from the Center for Psychological and Family Services ("CPFS") and Behavioral Health Network Crisis Services ("BHN"). Margarita Hernandez, Ph.D. examined Plaintiff on January 26, 2013 at the request of the Massachusetts Rehabilitation Commission's Disability Determination Services (A.R. at 644). Dr. Hernandez diagnosed Plaintiff with depressive disorder not otherwise specified ("NOS") and learning disorder NOS and assigned a Global Assessment of Functioning ("GAF") score of 70 (id. at 648).[1] Testing of reading and mathematics revealed that Plaintiff's "level of intellectual functioning ...

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