E.M. v. Kijakazi
| Docket Number | Case No. 20-cv-02272-JCS |
| Decision Date | 18 March 2022 |
| Parties | E.M., Plaintiff, v. Kilolo KIJAKAZI, Defendant. |
| Court | U.S. District Court — Northern District of California |
Kate G. Walsham, Lauren Melynn Johnson, Bay Area Legal Aid, Oakland, CA, for Plaintiff.
Tina Laxmi Naicker, Office of General Counsel Social Security Administration, Sara Winslow, United States Attorney's Office, San Francisco, CA, for Defendant.
ORDER GRANTING IN PART AND DENYING IN PART PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT AND GRANTING IN PART AND DENYING IN PART DEFENDANT'S CROSS-MOTION FOR SUMMARY JUDGMENT
Re: Dkt. Nos. 32, 42
Plaintiff E.M.1 received Supplemental Security Income ("SSI") based on disability as a child pursuant to Title XVI of the Social Security Act ("the Act"). Pursuant to Section 1614(a)(3)(H) of the Act, after E.M. turned eighteen years-old, the Social Security Administration ("SSA") redetermined E.M.’s eligibility for disability benefits under the rules for determining disability in adults, Titles II and XVI of the Act.
On January 9, 2015, the SSA found that E.M. was no longer disabled. The determination was upheld upon reconsideration after a disability hearing by a state agency disability hearing officer. E.M. then requested a hearing before an administrative law judge ("ALJ"), which the ALJ held on January 22, 2019. On April 5, 2019, the ALJ concluded that E.M. was no longer disabled as defined by the Act, and on February 11, 2020, the Appeals Council denied review of E.M.’s appeal of the ALJ's decision, making it the final decision of the Defendant Commissioner of the Social Security Administration ("Commissioner").
After the Appeals Council denied review, E.M. sought review in this Court pursuant to 42 U.S.C. § 405(g). Presently before the Court are the parties’ cross-motions for summary judgment. For the reasons stated below, the Court GRANTS IN PART AND DENIES IN PART E.M.’s motion for summary judgment, GRANTS IN PART AND DENIES IN PART the Commissioner's cross-motion for summary judgment, and REMANDS for additional proceedings pursuant to the Court's order.2
Section 1614(a)(3)(H) of the Act provides that individuals who are eligible for SSI benefits as children must have their disability redetermined under the rules for disability used for adults after they turn eighteen. 42 U.S.C. § 1382c(a)(3)(H)(iii). When the SSA redetermines child disability after a claimant turns eighteen, the agency applies the standards for adult applicants, without deference to the prior disability finding and award of child's SSI. See 20 C.F.R. § 416.987(a) - (b) ; Social Security Ruling 11-2p § IV(E)(2); accord Pollard v. Berryhill , 688 F. Appx 422 (9th Cir. 2017). In other words, the SSA reviews the claimant as if he were a newly applying adult without deference to prior determinations. See Sabala v. Saul , No. 1:19-CV-03683-DDD, 2020 WL 6946562, at *3 (D. Colo. Nov. 25, 2020) (citing 20 C.F.R. § 416.987(b) ).
Section 1614(a)(3)(H) states that the medical improvement review standard, section 1614(a)(4), which is utilized in adult cases, does not apply to disability redeterminations at age eighteen.3 Accordingly, on redetermination of a child disability, an ALJ is not required to "compar[e] the current severity of the impairment with the severity of that impairment when claimant was last found to be disabled." 20 C.F.R. § 404.1594(b)(7).
Disability insurance benefits are available under the Act when an eligible claimant 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) ; see also 42 U.S.C. § 423(a)(1). A claimant is only found disabled if their physical or mental impairments are of such severity that they are not only unable to do their previous work but also "cannot, considering [their] age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy." 42 U.S.C. § 423(d)(2)(A).
The Commissioner has established a sequential, five-part evaluation process to determine whether a claimant is disabled under the Act. See Tackett v. Apfel , 180 F.3d 1094, 1098 (9th Cir. 1999) (citing 20 C.F.R. § 404.1520 ). The claimant bears the burden of proof at steps one through four, but the burden shifts to the Commissioner at step five. Id. "If a claimant is found to be ‘disabled’ or ‘not disabled’ at any step in the sequence, there is no need to consider subsequent steps." Id.
At step one, the ALJ typically considers whether the claimant is presently engaged in "substantial gainful activity." 20 C.F.R. § 404.1520(a)(4)(i).4 However, step one of the five-step sequential evaluation process is not used for redetermining disability at age eighteen. See 20 C.F.R. § 416.987(b).
At step two, the ALJ considers whether the claimant has "a severe medically determinable physical or mental impairment" or combination of such impairments that meets the regulations’ twelve-month durational requirement. 20 C.F.R. §§ 404.1509, 404.1520(a)(4)(ii). An impairment or combination of impairments is severe if it "significantly limits [the claimant's] physical or mental ability to do basic work activities." 20 C.F.R. § 404.1520(c). If the claimant does not have a severe impairment, disability benefits are denied. 20 C.F.R. § 404.1520(a)(4)(ii). If the ALJ determines that one or more impairments are severe, the ALJ proceeds to the next step. See id.
At step three, the ALJ compares the medical severity of the claimant's impairments to a list of impairments that the Commissioner has determined are disabling ("Listings"). See 20 C.F.R. § 404.1520(a)(4)(iii) ; see also 20 C.F.R. Pt. 404, Subpt. P, App. 1. If one or a combination of the claimant's impairments meets or equals the severity of a listed impairment, the claimant is disabled.
20 C.F.R. § 404.1520(a)(4)(iii). Otherwise, the analysis continues. See id.
At step four, the ALJ must assess the claimant's residual functional capacity ("RFC") and past relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). The RFC is "the most [a claimant] can still do despite [that claimant's] limitations ... based on all the relevant evidence in [that claimant's] case record." 20 C.F.R. § 404.1545(a)(1). The ALJ then determines whether, given the claimant's RFC, the claimant would be able to perform their past relevant work. 20 C.F.R. § 404.1520(a)(4). Past relevant work is "work that [a claimant] has done within the past fifteen years, that was substantial gainful activity, and that lasted long enough for [the claimant] to learn how to do it." 20 C.F.R. § 404.1560(b)(1). If the claimant is able to perform their past relevant work, then the ALJ finds that they are not disabled. If the claimant is unable to perform their past relevant work, then the ALJ proceeds to step five.
At step five, the Commissioner has the burden to "identify specific jobs existing in substantial numbers in the national economy that the claimant can perform despite [the claimant's] identified limitations." Meanel v. Apfel , 172 F.3d 1111, 1114 (9th Cir. 1999) (quoting Johnson v. Shalala , 60 F.3d 1428, 1432 (9th Cir. 1995) ). If the Commissioner meets this burden, the claimant is not disabled. See 20 C.F.R. § 404.1520(f). Conversely, the claimant is disabled and entitled to benefits if there are not a significant number of jobs available in the national economy that the claimant can perform. Id.
The SSA has supplemented the five-step general disability evaluation process with regulations governing the evaluation of mental impairments at steps two and three of the five-step process. See generally 20 C.F.R. § 404.1520a. First, the Commissioner must determine whether the claimant has a medically determinable mental impairment. 20 C.F.R. § 404.1520a(b)(1). Next, the Commissioner must assess the degree of functional limitation resulting from the claimant's mental impairment with respect to the following functional areas: 1) understand, remember, or apply information; 2) interact with others; 3) concentrate, persist, or maintain pace; and 4) adapt or manage oneself. 20 C.F.R. §§ 404.1520a(b)(2), (c)(3). Finally, the Commissioner must determine the severity of the claimant's mental impairment and whether that severity meets or equals the severity of a mental impairment listed in Appendix 1. 20 C.F.R. § 404.1520a(d). If the Commissioner determines that the severity of the claimant's mental impairment meets or equals the severity of a listed mental impairment, the claimant is disabled. See 20 C.F.R. § 404.1520(a)(4)(iii). Otherwise, the evaluation proceeds to step four of the general disability inquiry. See 20 C.F.R. § 404.1520a(d)(3).
Appendix 1 provides impairment-specific "Paragraph A" criteria for determining the presence of various listed mental impairments, but all listed mental impairments share certain "Paragraph B" severity criteria in common (and some have alternative "Paragraph C" severity criteria). See generally 20 C.F.R. § 404, Subpt. P, App. 1 at 12.00. Any medically determinable mental impairment—i.e., one that satisfies the Paragraph A criteria of one or more listed mental impairments—is sufficiently severe to render a claimant disabled if it also satisfies the general Paragraph B criteria, which requires that a claimant's mental disorder "result in ‘extreme’ limitation of one, or ‘marked’ limitation of two, of the four areas of mental functioning." Id. at 12.00(A)(2)(b). A claimant has a "marked" limitation if the claimant's "functioning in this area independently, appropriately, effectively, and on a sustained basis is seriously limited." 20 C.F.R. § Pt. 404, Subpt. P, App. 1, 12.00(F)(2)(d). A...
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