Cole v. Barnhart

Citations: 436 F. Supp. 2d 1239; 2006 U.S. Dist. LEXIS 45873; 2006 WL 1867654Docket: Civil Action 05-G-1303-NW

Court: District Court, N.D. Alabama; June 28, 2006; Federal District Court

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Sherry Cole, on behalf of her son E.S.C., filed a civil action against Jo Anne B. Barnhart, the Commissioner of Social Security, seeking judicial review of a denial of Supplemental Security Income (SSI) benefits under section 205(g) of the Social Security Act. After exhausting administrative remedies, the case was ripe for review. The court's role is to determine whether the Commissioner's decision is supported by substantial evidence and adheres to proper legal standards, as established in Bloodsworth v. Heckler.

To qualify for SSI benefits, a child must have a medically determinable physical or mental impairment leading to marked and severe functional limitations expected to last at least 12 months. The process for determining a child's disability involves three steps: assessing if the child is engaged in substantial gainful activity, if there is a severe impairment, and if the impairment meets or equals a listed impairment.

In this case, ALJ Randall Stout found that E.C. had not engaged in gainful activity since the alleged onset date and suffered from severe impairments, including asthma, allergies, and tight heel cords. However, he concluded that E.C. did not meet or equal any listed impairments, resulting in a determination of non-disability and denial of benefits. E.C. was two years old at the time of the hearing, with a claimed disability onset of April 25, 2002. The Social Security Administration denied benefits initially and upon reconsideration.

On August 26, 2004, ALJ Randall Stout denied E.C.'s benefits after an administrative hearing. The Appeals Council upheld this decision on April 22, 2005, making it the final decision of the Commissioner. The court found that the ALJ erred legally by not recognizing E.C.'s asthma as meeting Listing 103.03B, as his conclusion lacked substantial evidence. Medical records showed E.C. used multiple prescription medications and required frequent emergency interventions, with seven hospital admissions documented between May 19, 2003, and April 5, 2004. The criteria for Listing 103.03B were met, as E.C. had frequent asthma attacks despite treatment.

Moreover, even if E.C. did not meet the listing, he could still qualify for benefits if he had severe impairments causing functional limitations. Evidence from treating physicians indicated he met this standard. The ALJ improperly substituted his judgment for that of medical professionals in evaluating E.C.'s limitations and made unfounded claims regarding E.C.'s diagnoses of cerebral palsy and mental retardation without supporting evidence. Dr. Mallette, a treating physician, had documented E.C.'s conditions accurately, and other professionals corroborated these findings. The ALJ dismissed the assessments of occupational therapist Shirley Smith, alleging bias in her report, despite its comprehensive basis in E.C.'s long-term therapy, indicating marked limitations in developmental domains. The ALJ's assertions of incorrect diagnoses were unsubstantiated and contradicted by existing medical evidence.

The Record indicates significant developmental delays quantified through testing results and therapy narratives. The ALJ's opinion lacks substantial evidence and contradicts the Record, as he improperly substituted his judgment for that of health professionals, in violation of precedents established in Rohan v. Chater. Occupational therapists are recognized as medical sources under 20 C.F.R. 416.924(a), and their opinions, especially those of treating physicians, must generally be given considerable weight unless adequately refuted. The ALJ failed to provide good cause for disregarding the treating sources' opinions, which must be accepted as true if not properly challenged. Dr. Mallette's assessment of marked limitations in the health domain and the occupational therapist's evaluations in three developmental domains remain uncontested. Under 20 C.F.R. 416.926a(a), marked functional limitations in two domains suffice to establish disability, and E.C. demonstrates marked limitations across four domains, meeting the standard for disability benefits. The court orders the reversal of the Commissioner's decision and remands the case with instructions to award the claimed benefits. Furthermore, it stipulates that the Commissioner may withhold up to 25% of the awarded benefits for attorney fees and grants the plaintiff's attorney an extension to file for such fees. The legal standards for Disability Insurance Benefits and Supplemental Security Income claims are noted to be generally consistent, with specific references to applicable statutes and regulations.