Nieves v. Comm'r of Soc. Sec.

• Decision Date: 31 March 2021
• Docket Number: CIVIL NO. 19-1346 (GLS)
• Parties: MURIELITA NIEVES, Plaintiff, v. COMMISSIONER OF SOCIAL SECURITY, Defendant.
• Court: U.S. District Court — District of Puerto Rico

MURIELITA NIEVES, Plaintiff, v. COMMISSIONER OF SOCIAL SECURITY, Defendant.

CIVIL NO. 19-1346 (GLS)

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO

March 31, 2021

OPINION AND ORDER

Murielita Nieves seeks judicial review of the denial of her application for disability insurance benefits by the Commissioner of the Social Security Administration ("Commissioner"). Docket No. 3. On April 6, 2020, Plaintiff filed a motion requesting the Court to reverse the Commissioner's final decision denying disability benefits because the decision was not based on substantial evidence, as required by 42 U.S.C. § 405(g). Docket No. 22. The Commissioner submitted a motion in opposition to Plaintiff's request (Docket No. 23), and both parties had the opportunity to present their arguments before the Court during a hearing held on March 8, 2021 Docket No. 34.

The parties consented to the entry of judgment by a United States Magistrate Judge under the provisions of 28 U.S.C. §636(c). Docket Nos. 5 and 7. After careful review of the administrative record, the briefs on file and the arguments raised by the parties during the hearing, the case is REMANDED for further administrative proceedings consistent with the Court's opinion.

I. PROCEDURAL BACKGROUND

Plaintiff, who worked as a packager in the manufacturing industry, filed an application for disability insurance benefits on November 12, 2013, and claims that her disability began on June 15, 2012 (Tr¹. 405-408). Plaintiff's application was denied on March 20, 2014 and, upon reconsideration, on August 8, 2014 (Tr. 254, 276). As a result, on October 17, 2014 Plaintiff requested a hearing before an Administrative Law Judge ("ALJ") (Tr. 293-294). The hearing was held on February 16, 2017 before ALJ Livia Morales and Plaintiff, represented by counsel, was able to present her testimony (Tr. 90-113). A second hearing was held on August 24, 2017. In this hearing, the ALJ heard the testimony of both Plaintiff and Vocational Expert, Dr. Marieva Puig (Tr. 77-89).

On November 16, 2017, the ALJ issued a decision finding that Plaintiff was not disabled, as defined in the Social Security Act, at any time from the onset date of June 15, 2012 through December 31, 2015, the last date insured (Tr. 52-76). On December 13, 2017, Plaintiff asked the Appeals Council to review the final decision issued by the ALJ (Tr. 402-404). The Appeals Council denied this request on February 15, 2019 (Tr. 1-8), making the Commissioner's decision the final decision for review by this Court.

II. LEGAL FRAMEWORK

A. STANDARD OF REVIEW

Pursuant to 42 U.S.C. § 405(g), the court is empowered to affirm, modify, reverse or remand the decision of the Commissioner, based upon the pleadings and transcript of the record. 42 U.S.C. § 405(g). In reviewing a Social Security decision, the Court's function is limited to deciding whether the ALJ's decision is supported by substantial evidence from the record and based on a correct legal standard. See Id; Seavey v. Barnhart, 276 F. 3d 1 (1^st Cir. 2001); Manso-Pizarro v. Secretary of Health & Human Services, 76 F. 3d 15, 16 (1^st Cir. 1996); Ortiz v. Secretary of Health & Human Servs., 955 F.2d 765, 769 (1^st Cir. 1991). The Commissioner's findings of fact are conclusive when supported by substantial evidence, but not when obtained by ignoring evidence, misapplying the law, or judging matters entrusted to experts. See Nguyen v. Chater, 172 F. 3d 31, 35 (1^st Cir. 1999). "Substantial evidence" is more than a "mere scintilla"; it is such relevant evidence that a reasonable mind might accept as adequate to support a conclusion. See Purdy v. Berryhill, 887 F. 3d 7, 13 (1^st Cir. 2018). As recently explained by the United States Supreme, under the substantial evidence standard, "a court looks to an existing administrative record andasks whether it contains 'sufficient evidence' to support the agency's factual determinations" and "the threshold for such evidentiary sufficiency is not high". Biestek v. Berryhill, ___ U.S. ___, 139 S. Ct. 1148, 1154 (2019).

If the Court finds that the Commissioner's decision is supported by substantial evidence, it must be upheld, even if there is also substantial evidence in support of Plaintiff's position. 20 C.F.R. § 404.1546(c). The Commissioner's findings must be upheld by the court if a reasonable mind, reviewing the evidence in the record, could accept them as adequate to support his conclusion. See Rodríguez v. Secretary of Health and Human Services, 647 F. 2d 218, 222 (1^st Cir. 1981). If the ALJ's decision is supported by substantial evidence, it must be upheld, even if the record could arguably justify a different conclusion. See Rodríguez Pagán v. Secretary of Health and Human Services, 819 F. 2d 1, 3 (1^st Cir. 1987). Therefore, reversal of an ALJ's decision by a Court is warranted only if the ALJ made a legal error in deciding the claim, or if the record contains no "evidence rationally adequate...to justify the conclusion" of the ALJ. Manso-Pizarro, 76 F.3d at 16.

In reaching the final decision, it is the Commissioner's responsibility to determine issues of credibility and to draw inferences from the evidence in the record. See Purdy v. Berryhill, 887 F. 3d 7 (1^st Cir. 2018). To this end, courts will not second guess the Commissioner's resolution of conflicting evidence. See Irlanda Ortiz v. Secretary of Health & Human Services, 955 F. 2d 765, 769 (1^st Cir. 1991). In sum, this court's role is to determine "whether the final decision is supported by substantial evidence and whether the correct legal standard was used." Seavey v. Barnhart, 276 F.3d at 9.

B. DISABILITY DETERMINATION BY THE SSA: FIVE STEP PROCESS

Plaintiff generally has the burden of proving that he has become disabled within the meaning of the Social Security Act. See Bowen v. Yuckert, 482 U.S. 137, 146 (1987); Rivera-Tufiño v. Commissioner of Social Security, 731 F.Supp.2d 210, 212-13 (D.P.R.2010). The ultimate question is whether Plaintiff is disabled within the meaning of 42 U.S.C. § 423(d). That provision defines disability 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. See 42 U.S.C. § 423. The severity of the impairment must be such that the claimant "is not only unableto do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial work which exists in the national economy." Deblois v. Secretary of Health and Human Services, 686 F.2d 76, 79 (1^st Cir.1982) (quoting 42 U.S.C. § 423(d)(2)(A)).

In determining whether a claimant is disabled, a five-step sequential evaluation must be applied. 20 C.F.R. § 404.1520; Bowen, 482 U.S. at 140-142; Goodermote v. Secretary of Health and Human Services, 690 F.2d 5, 6-7 (1^st Cir.1982). At step one, the ALJ determines whether the claimant is engaged in "substantial gainful activity" and, if so, the claimant is not disabled. 20 C.F.R. § 404.1520(b). If not engaged in substantial gainful activity, the decision-maker moves to the second step, where he must determine whether the claimant has a medically severe impairment or combination of impairment that significantly limits claimant's physical or mental ability to do basic work activities. 20 C.F.R. § 404.1520(c). If the impairment or combination of impairments is severe, the third step applies. At this point, the ALJ must determine whether the claimant's severe impairments meet the requirements of a "Listed Impairment", which the Commissioner acknowledges are so severe as to preclude substantial gainful activity. See 20 C.F.R. § 404.1520(d); 20 C.F.R. Part 404, Subpart P, App. 1. If the claimant has a listed impairment, or an impairment equivalent in severity to a listed impairment, the claimant is considered disabled.

If the claimant's impairment does not meet a listed impairment, the ALJ must determine the claimant's Residual Function Capacity ("RFC"). 20 C.F.R. § 404.1520(e). An individual's RFC is his or her ability to do physical and mental work activities on a sustained basis despite limitations from his impairments. 20 C.F.R. §§ 404.1520(e) and 404.15245(a)(1). At step four, the ALJ must determine, taking into consideration the RFC, whether the claimant can perform past relevant work. 20 C.F.R. §§ 404.1520(f) and 416.920(f). If not, then the fifth and final step applies.

At steps one through four, the claimant has the burden of proving he cannot return to his former employment because of the alleged disability. See Santiago v. Secretary of Health & Human Services, 944 F. 2d 1, 5 (1^st Cir. 1991). The Commissioner has the burden under step five to prove the existence of other jobs in the national economy that claimant can perform, in view of claimant's RFC, age, education and work experience. See Ortiz v. Secretary of Health & Human Services, 890 F. 2d 520, 524 (1^st Cir. 1989); 20 C.F.R. § 404.1520(g). If there are none, then the claimant is entitled to disability benefits. 20 C.F.R. § 404.1520(f).

To be eligible for disability benefits, the claimant must demonstrate that his disability existed prior to the expiration of his insured status, or his date last insured. See Cruz Rivera v. Secretary of Health & Human Services, 818 F. 2d 96, 97 (1^st Cir. 1986).

III. DISCUSSION

Plaintiff argues, in essence, that the ALJ erred in the weight given to the medical evidence presented regarding her mental condition and, as a result, the ALJ's mental RFC determination is unsupported by substantial evidence. Specifically, Plaintiff claims that the ALJ erred by giving "great weight" to the opinion of State Agency Consultants ("SAC") who did not examine Plaintiff nor evaluate the complete evidence in the file, and applied mental impairment evaluation criteria that are no longer applicable. Since Plaintiff's claim was...