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Lefebvre v. Saul

United States District Court, D. Massachusetts

October 17, 2019

ANDREW SAUL, [1] Commissioner of the Social Security Administration



         Henry Lefebvre (“plaintiff” or “claimant”) appeals from a final decision by the Commissioner of Social Security (“the Commissioner”) upholding an administrative law judge's (“ALJ”) decision. The ALJ determined that plaintiff qualified for supplemental security income (“SSI”) beginning on December 19, 2017, but did not qualify prior to that date. He denied disability insurance benefits (“DIB”) entirely because plaintiff did not have disability insured status on the date his disability began.

         I. Background[2]

         In February 2009, plaintiff filed for SSI and DIB, but his claims were denied on April 17, 2009 at the initial determination phase. Plaintiff did not seek reconsideration of the denial.

         In April 2012, plaintiff filed new SSI and DIB applications, in which he alleged that he had been disabled since April 2003 after a large spring fell on his hand and broke his right wrist. These applications were denied in an initial determination and again on reconsideration. Plaintiff then obtained a hearing before an ALJ, who denied the claims on December 10, 2013. The Appeals Council declined plaintiff's request for review, and plaintiff appealed to the United States District Court. R. 552.[3] At the Commissioner's request, the Court remanded the case for further proceedings. Lefebvre v. Colvin, No. 15-CV-11610-GAO, ECF No. 23 (D. Mass. Feb. 16, 2016); see also R. 555. On remand, the ALJ held a hearing on October 24, 2017, at which plaintiff and Vocational Expert (“VE”)[4] Marissa Howell testified.

         The ALJ issued his written decision on December 28, 2017 (“2017 ALJ decision”). As an initial matter, he declined to reopen plaintiff's SSI and DIB claims that had been denied on April 17, 2009, and therefore only focused on the period beginning with April 17, 2009. He found plaintiff was not disabled from that date until December 19, 2017, when he presumptively became disabled and eligible for SSI due to the combination of his age and limitations. However, the ALJ denied the claim for DIB because plaintiff no longer had disability insured status on that date.[5] See 20 C.F.R. § 404.131. Plaintiff now appeals the ALJ's SSI decision.

         A. Applicable Statutes and Regulations

         To receive SSI or DIB benefits, a claimant must be unable “to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment 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), 1382c(a)(3)(A).[6] The impairment or impairments must be “of such severity that [a claimant] 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.” Id. §§ 423(d)(2)(A), 1382c(a)(3)(B); see also 20 C.F.R. §§ 404.1505(a), 416.905(a).

         The ALJ analyzes whether a claimant is disabled by using an established five-step sequential evaluation process. See 20 C.F.R. §§ 404.1520(a)(4)(i)-(v), 416.920(a)(4)(i)-(v). Under this framework, the ALJ first determines whether the claimant is currently engaging in substantial gainful work activity. If not, then at Step 2, the ALJ decides whether the claimant has a “severe” medical impairment or impairments. A severe impairment “significantly limits [the claimant's] physical or mental ability to do basic work activities.” Id. §§ 404.1520(c), 416.920(c). If the claimant has a severe impairment or impairments, the ALJ considers, third, whether the impairment or impairments meets or equals an entry in the Listing of Impairments, 20 C.F.R. Part 404, Subpt. P, App. 1, and meets the duration requirement. If so, the claimant is considered disabled. If not, the ALJ must next determine the claimant's residual functional capacity (“RFC”), which is “the most [a claimant] can still do despite [his] limitations.” 20 C.F.R. §§ 404.1545(a)(1), 416.945(a)(1). The ALJ then moves to Step 4 and determines whether the claimant's RFC allows him to perform his past relevant work. If the claimant has the RFC to perform his past relevant work, he is not disabled. If the claimant does not, “the Commissioner then has the burden, at Step 5, of coming forward with evidence of specific jobs in the national economy that the applicant can still perform.” Seavey v. Barnhart, 276 F.3d 1, 5 (1st Cir. 2001); see also 20 C.F.R. §§ 404.1560(c)(2), 416.960(c)(2). The ALJ consults a VE and/or the Medical-Vocational Grid Rules (“Grid Rules”)[7] at Step 5 to determine whether the claimant can do other work in light of his RFC, age, education, and work experience.

         B. The 2017 ALJ Decision

         At the first step of the sequential evaluation process, the ALJ determined that since April 17, 2009, plaintiff “has not engaged in substantial gainful activity.” R. 448. At Step 2, he found that plaintiff has the following severe impairments: status post right wrist fusion, borderline intellectual function, and alcohol abuse. The ALJ explained at Step 3 that plaintiff “has not had an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments” in 20 C.F.R. Part 404, Subpt. P, App. 1. R. 449. He assessed plaintiff's RFC:

After careful consideration of the entire record, I find that since April 17, 2009, the claimant has the residual functional capacity to perform light work as defined in 20 CFR 416.967(b) except the claimant is able to lift and carry 10 pounds occasionally and less than 10 pounds frequently, stand and walk for 6 hours and sit for 6 hours out of an 8 hour workday, can occasionally push and pull with the right dominant upper extremity, can frequently climb ramps and stairs, stoop, kneel, crouch, occasionally balance and never climb ropes, scaffolds and ladders and crawl, can occasionally finger and handle with the right dominant upper extremity, must avoid hazards such as moving machinery, unprotected heights, slipper[y] and uneven surfaces and is limited to simple, routine, repetitive tasks.

R. 450.

         At the fourth step, the ALJ determined that plaintiff is unable to perform his past work as a truck mechanic. Finally, he explained that, prior to December 19, 2017, considering plaintiff's age, education, work experience, and RFC, there were jobs that existed in significant numbers in the national economy that plaintiff could have performed. R. 455. He concluded, however, that as of December 19, 2017, plaintiff's age category changed from “closely approaching advanced age” to “advanced age.” R. 454. As plaintiff was within “a few days to a few months” of attaining the “advanced age” category at the time of the ALJ's decision, the ALJ explained that use of the next age category was supported by “the significant adverse impact of all factors on the claimant's ability to adjust to other work.” R. 454; see also 20 C.F.R. § 416.963(b) (age categories need not be applied mechanically). He concluded that the Grid Rules support a presumption that plaintiff was disabled as of December 19, 2017, see R. 456, and was therefore entitled to SSI beginning on that date. However, because plaintiff's onset date was December 19, 2017, when plaintiff did not have disability insured status, he was not entitled to DIB.

         C. The Appeal

         Plaintiff did not file exceptions to the ALJ's decision, and the Social Security Administration's Appeals Council did not assume jurisdiction within 60 days. The ALJ's decision thus became the final decision of the ...

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