Cage v. Comm'r of Soc. Sec.

• Decision Date: 17 August 2012
• Docket Number: Docket No. 09–4530–cv.
• Citation: 692 F.3d 118,183 Soc.Sec.Rep.Serv. 43
• Parties: Josephine L. CAGE, Plaintiff–Appellant, v. COMMISSIONER OF SOCIAL SECURITY, Defendant–Appellee.
• Court: U.S. Court of Appeals — Second Circuit

692 F.3d 118

183 Soc.Sec.Rep.Serv. 43

Josephine L. CAGE, Plaintiff–Appellant,

v.COMMISSIONER OF SOCIAL SECURITY, Defendant–Appellee.

Docket No. 09–4530–cv.

United States Court of Appeals, Second Circuit.

Argued: Oct. 24, 2011.

Decided: Aug. 17, 2012.

Timothy W. Hoover (Peter C. Obersheimer, on the brief), Phillips Lytle LLP, Buffalo, NY, for Plaintiff–Appellant.

Michelle L. Christ, Special Assistant U.S. Attorney (Stephen P. Conte, Regional Chief Counsel, Region II, Office of the General Counsel Social Security Administration, on the brief) for William J. Hochul, Jr., U.S. Attorney for the Western District of New York, for Defendant–Appellee.

Before: NEWMAN, JOHN M. WALKER, JR., and KATZMANN, Circuit Judges.

JOHN M. WALKER, JR., Circuit Judge:

Plaintiff-appellant Josephine L. Cage appeals from a judgment of the United States District Court for the Western District of New York (Michael A. Telesca, Judge ) upholding a decision by an Administrative Law Judge (“ALJ”) of the Social Security Administration (the “SSA”) denying Cage's application for Supplemental Security Income (“SSI”) benefits. Although the ALJ determined that Cage met certain requirements for being “disabled” under the Social Security Act (the “Act”), 42 U.S.C. § 301 et seq., he found Cage ineligible for SSI on the ground that drug addiction or alcoholism (“DAA”) was a contributing factor material to that determination.

On appeal, Cage argues that (1) the ALJ improperly imposed upon her the burden of proving that she would be disabled in the absence of DAA, and (2) the record did not support the ALJ's finding that she would not be disabled absent DAA, in particular because the ALJ lacked a predictive medical or psychological opinion to that effect. She therefore asks that the district court's decision upholding the ALJ's ruling be vacated, and that the case be remanded to the district court with instructions to vacate the ALJ's decision and calculate retroactive SSI benefits.

We hold that the ALJ did not err in denying Cage benefits, because SSI applicants bear the burden of proving that they would be disabled in the absence of DAA, and substantial evidence supported the ALJ's finding that Cage would not be disabled absent DAA.

BACKGROUND

I. Factual Background

Josephine Cage, who was born in 1960, has an extensive medical history. Over the course of these proceedings, she has offered evidence of numerous health conditions, including bipolar disorder, depression, suicidal ideation, dizziness, blackouts, memory loss and chest pain. Cage has received periodic primary and emergency medical care for her health problems since at least 2001, and with greater frequency beginning in December 2003, when she was admitted to the hospital for a variety of ailments. She has not worked since November 2003. Her employment history to that point included work as a retail cashier, hotel maid and home healthcare aide.

Cage also has a long history of drug and alcohol abuse, including alcohol abuse on the day she was admitted to the hospital in December 2003. Her ongoing medical care has included treatment for both DAA and her other conditions. At least one of Cage's healthcare providers has opined that Cage's substance abuse “made worse” her non-DAA impairments, and Cage has acknowledged that her drinking was “not helpful” to her mental health. There is medical evidence that Cage has attempted suicide only when under the influence—although she testified that she has felt suicidal even while sober—and that on the two occasions she reported hearing voices she had used crack cocaine. Cage also once explained to a doctor that she felt depressed because she had spent her money on cocaine.

Cage applied for SSI benefits on May 12, 2004, claiming that her various health impairments rendered her unable to work. After her application was initially denied, Cage proceeded in May 2007 to an ALJ hearing in Rochester, New York, at which she was represented by counsel.

In a decision dated August 7, 2007, the ALJ issued his findings and conclusions. Based on the medical records and Cage's testimony at the hearing, the ALJ found that Cage suffered from the following severe impairments: polysubstance dependence disorder, personality disorder, schizoaffective disorder and syncope. In view of those impairments, he determined that Cage met the regulatory requirements for affective disorder, personality disorder and substance addiction disorder, see20 C.F.R. pt. 404, subpt. P, app. 1, §§ 12.04, 12.08, 12.09 (2007). However, the ALJ further determined that in the absence of her drug and alcohol abuse, Cage would not meet the requirements for those disorders. He also concluded, based on the testimony of a vocational expert, that Cage would be able to work absent DAA. He therefore found her not disabled within the meaning of the Act. The record did not contain any consultive opinion predicting Cage's health and functionality in the absence of DAA; rather, in making his findings, the ALJ relied on the record as a whole.

In June 2008, the SSA Appeals Council denied Cage's request for review, making the ALJ's ruling the final decision of the Commissioner of Social Security (the “Commissioner”) on Cage's May 2004 application.

On August 25, 2008, Cage reapplied for SSI benefits. In December 2009, the same ALJ who had denied her first application found Cage disabled and entitled to benefits as of the date of her reapplication. In particular, the ALJ concluded that DAA was not a contributing factor material to the second determination of disability because there was no evidence of DAA since the August 25, 2008 onset date of Cage's reapplication.

II. Procedural Background

Having received benefits upon her second application, Cage in this suit seeks retroactive benefits, for the period between her 2004 and 2008 applications, to which she believes she is entitled by virtue of her first application.

In August 2008, around the time she reapplied for benefits, Cage challenged the ALJ's decision on her initial application in the district court. She contended that the ALJ had applied the wrong legal standards and that his decision was not supported by substantial evidence. The district court disagreed and granted the Commissioner's motion for judgment on the pleadings pursuant to 42 U.S.C. § 405(g) and Fed.R.Civ.P. 12(c). See Cage v. Astrue, No. 08–CV–6364T, 2009 WL 3245643 (W.D.N.Y. Oct. 5, 2009). Relevant to this appeal, the district court held that (1) “[t]here is substantial evidence in the record that supports the ALJ's determination that [Cage's] substance abuse was a key factor contributing to her disability”; (2) Cage “has the burden of proving that absent her drug and alcohol abuse, she would still be disabled”; and (3) Cage “failed to satisfy [that] burden.” Id., 2009 WL 3245643, at *4.

Cage appealed the district court's ruling to this Court. At our request, the parties briefed two issues in particular: (1) whether Cage “had the burden of proof before the [ALJ] with respect to whether her [DAA] was a contributing factor material to the determination of disability”; and (2) whether “the [ALJ] erred by finding that [Cage's DAA] was a contributing factor where there was no medical opinion specifically addressing that issue.” See Order Appointing Counsel, Cage v. Comm'r of Soc. Sec., No. 09–4530–cv (2d Cir. Apr. 23, 2010).

DISCUSSION

I. Standard of Review

When reviewing an appeal from a denial of SSI benefits, “our focus is not so much on the district court's ruling as it is on the administrative ruling.” Rivera v. Sullivan, 923 F.2d 964, 967 (2d Cir.1991) (internal quotation marks omitted). But we do not substitute our judgment for the agency's, see Veino v. Barnhart, 312 F.3d 578, 586 (2d Cir.2002), or “determine de novo whether [the claimant] is disabled,” Schaal v. Apfel, 134 F.3d 496, 501 (2d Cir.1998) (internal quotation marks omitted). Instead, “this Court is limited to determining whether the SSA's conclusions were supported by substantial evidence in the record and were based on a correct legal standard.” Lamay v. Comm'r of Soc. Sec., 562 F.3d 503, 507 (2d Cir.2009); see also Moran v. Astrue, 569 F.3d 108, 112 (2d Cir.2009) ( “[W]e conduct a plenary review of the administrative record to determine if there is substantial evidence, considering the record as a whole, to support the Commissioner's decision....”). “Substantial evidence is ‘more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.’ ” Halloran v. Barnhart, 362 F.3d 28, 31 (2d Cir.2004) (per curiam) (quoting Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971)). In our review, we defer to the Commissioner's resolution of conflicting evidence. Clark v. Comm'r of Soc. Sec., 143 F.3d 115, 118 (2d Cir.1998).

II. The Burden of Proof on DAA Materiality

Cage first argues that the ALJ erred by requiring that she prove that she still would be disabled in the absence of her drug and alcohol abuse. She contends that the burden was on the Commissioner to prove that she would not be disabled absent DAA.

An SSI applicant qualifies as “disabled” under the Act if she is 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). This determination is reached through a five-step process:

First, the Commissioner considers whether the claimant is currently engaged in substantial gainful activity. Where the claimant is not, the Commissioner next considers whether the claimant has a “severe impairment” that significantly limits her physical or mental ability to do basic work activities. If the claimant suffers such an impairment, the third inquiry is whether, based solely on medical evidence, the claimant has an impairment that is listed [in the so-called ...