Henningsen v. Commissioner of the Social Security Administration
Docket: No. 13-CV-4392 (SJF)
Court: District Court, E.D. New York; June 8, 2015; Federal District Court
Richard Henningsen, the plaintiff, initiated a legal action under 42 U.S.C. 405(g) to challenge the denial of his disability benefits application by the Commissioner of the Social Security Administration. Henningsen filed for benefits on November 29, 2010, claiming disability due to injuries sustained in a car accident on November 4, 1997, and alleging his disability began on January 31, 2000. The SSA denied his application on March 2, 2011, prompting a hearing before Administrative Law Judge (ALJ) Seymour Rayner on November 1, 2011.
The ALJ determined in a decision dated January 11, 2012, that Henningsen was not disabled from the alleged onset date through the date he was last insured, December 31, 2002. Key findings included that Henningsen had severe impairments affecting his ability to stand, walk, lift, and carry, but these did not meet or equal the severity of listed impairments. The ALJ found he had the residual functional capacity for sedentary work, could not perform past relevant work, was 42 years old at the last insured date, had at least a high school education, and that jobs existed in significant numbers that he could perform.
The Appeals Council denied a subsequent request for review on July 2, 2013, making the ALJ's decision final. The court is now addressing the defendant's motion to remand for further proceedings, which is denied, and plaintiff's motion for judgment and remand solely for the calculation of benefits, which is granted.
Plaintiff underwent chiropractic treatment from 1997 to 2000 with Joseph Mills, D.C., and saw Steven Pinsky, M.D. for low back pain in 1999. He received epidural steroid injections at Mercy Medical Center during the same year. Roman Urbanczyck, M.D. served as his primary care physician for over ten years. In February 2000, the plaintiff had an L5-S1 lumbar discectomy but continued to experience lumbar, cervical, and thoracic pain. Since 2003, he has been treated by Lauren Stimler-Levy, M.D., and is prescribed Fiorcet for headaches, Oxycodone for pain, and Tylenol.
The plaintiff reported significant limitations due to pain, including difficulty sitting, standing, or walking for extended periods. He could walk for only ten to twenty minutes unmedicated and up to forty-five minutes with medication, followed by required rest periods. He experienced muscle spasms and frequently needed to lie down throughout the day. Despite ongoing treatment, including physical therapy and medication, his condition worsened over eleven years post-surgery.
The plaintiff testified about his limited daily activities, stating he occasionally used a cane and wore a back brace. He maintained some ability to perform personal care and light cooking but did not engage in household chores like laundry or cleaning. He could lift 40-50 pounds but not repetitively and could manage stairs twice daily. His limitations began in 2000, following a rear-end car accident on November 5, 1997, after which he was deemed totally disabled by Dr. Eric Roth from January 14, 1998, onwards.
Plaintiff underwent physical therapy at Valley PT from November 6, 1997, to January 26, 2000, with consultations from Dr. Pavani Tipirneni and Dr. Emil Stracar during this period. A cervical sonogram on November 8, 1997, returned normal results, while an EMG study on December 9, 1997, indicated left C5-6 radiculopathy. Spinal range of motion testing on December 26, 1997, revealed a ten percent whole person impairment. An MRI of the cervical spine on January 3, 1998, identified central disc herniations at C4-5 and C5-6, and a lumbar MRI on January 12, 1998, showed a right paracentral disc herniation at L-5/S-1, affecting the right S-1 nerve root, along with an annular disc bulge at T-12/L-1. A lumbar sonogram on March 1, 1998, indicated muscular edema. Diagnosed with lumbar disc disorder with myelopathy, the plaintiff received an epidural steroid injection on August 11, 1999, with additional injections on September 8 and October 13, 1999.
On February 9, 2000, Dr. Tipirneni noted the plaintiff's complaints of lower back pain radiating to the right leg and observed an antalgic gait. Physical examination revealed normal muscle strength and sensation but positive straight leg raising on the right side. Dr. Tipirneni diagnosed lumbar sprain, L-5/S-1 disc herniation, and lumbar radiculopathy, and recommended ongoing physical therapy. On February 14, 2000, neurosurgeon Dr. Jack Stern performed a microlumbar discectomy, successfully removing a substantial disc herniation at L-5/S-1. Post-surgery, the plaintiff reported significant improvement in leg pain. Dr. Stern's August 25, 2000, letter documented treatment following a November 5, 1997, motor vehicle accident, noting persistent neck and back pain despite conservative therapy. A January 1998 MRI showed severe degenerative disc disease at L5-S1, and EMGs confirmed C-6 radiculopathy. After unsuccessful conservative treatment, the plaintiff opted for surgery, leading to significant relief from radicular pain. Dr. Stern's last consultation with the plaintiff was on April 18, 2000. Between January and May 2000, the plaintiff attended physical therapy at Valley PT fifty-six times.
On March 17, 2000, during a visit to Dr. Tipirneni at Valley PT, the plaintiff reported pain and stiffness in the lower back, mild neck pain, headaches, and intermittent right calf pain, exhibiting an antalgic gait. Physical examination indicated tenderness and spasms in the lumbar spine, with painful motion restrictions in both cervical and lumbar areas, though straight leg raising was negative bilaterally. Dr. Tipirneni diagnosed lumbar radiculopathy and post-micro discectomy status for L-5/S-1, authorizing chiropractic treatment.
On April 17, 2000, the plaintiff returned with lower back pain radiating to the right buttock and headaches. Physical examination showed moderate improvement, with normal muscle strength and sensation, but persistent lumbar spine tenderness and spasms. Dr. Tipirneni diagnosed post-micro discectomy status and approved continued physical therapy.
During a June 2, 2000 visit, the plaintiff reported worsening pain and stiffness over three weeks, with a similar physical examination revealing antalgic gait and significant lumbar spine issues. Dr. Tipirneni diagnosed lumbar subluxations, myofascitis, headaches, and post-surgical status, recommending light administrative duties and ongoing physical therapy.
At an August 28, 2000 appointment, the plaintiff presented with similar symptoms, and the examination indicated lumbar tenderness and spasms. Dr. Tipirneni diagnosed lumbar subluxations, myofascitis, radiculopathy, and referred the plaintiff to a pain clinic while continuing physical therapy.
On November 6, 2000, the plaintiff reported stiffness, pain radiating to the right leg, and noted a nerve block procedure. Examination findings were consistent with previous visits, leading to a diagnosis of sacroiliac sprain and post-surgical back pain, with a recommendation for continued physical therapy.
The final visit on January 3, 2001, involved complaints of increased pain and stiffness, with an antalgic gait noted again. The examination revealed persistent lumbar issues, and Dr. Tipirneni reaffirmed the post-discectomy diagnosis while recommending ongoing physical therapy.
In early 2001, the plaintiff underwent multiple physical therapy sessions at Valley PT, with treatments on specific dates in January, February, March, and continuing into April, May, and June. During a March 24, 2001 visit to Dr. Tipirneni, the plaintiff reported lower back pain and stiffness, noting moderate improvement from therapy. Examination revealed tenderness and restricted motion in the lumbar spine, but normal muscle strength and sensation. Dr. Tipirneni diagnosed lumbar myofascitis and a history of discectomy at L-5/S-1.
Subsequent visits showed persistent lower back pain, antalgic gait, and occasional radiation of pain into the buttocks, with diagnoses including lumbar subluxations and radiculopathy. A May 15, 2002 letter indicated the plaintiff had "permanent partial disability" and was unable to work as a chiropractor. The plaintiff continued physical therapy throughout the year, with visits documented into December 2001 and January 2002. By December 17, 2001, the plaintiff exhibited symptoms including low back pain, leg cramping, and right leg numbness, while still demonstrating moderate improvement from therapy. Dr. Tipirneni's assessments consistently noted painful restrictions in lumbar motion and varying degrees of improvement with physical therapy.
On March 6, 2002, the patient visited Dr. Tipirneni, presenting with an antalgic gait and complaints of lower back pain radiating to the right buttock, along with numbness and tingling in the right thigh when lying down. Despite these symptoms, there was no reported weakness, and the patient experienced mild improvement with physical therapy. The physical examination indicated tenderness, spasms, and restricted motion in the lumbar spine, but straight leg raising tests were negative, and muscle strength and sensation in extremities were normal. Dr. Tipirneni diagnosed the patient with disc herniation at L-5/S-1 and right sciatica, recommending physical therapy once a week.
On April 10, 2002, the patient returned with similar complaints, noting moderate improvement from physical therapy. The examination findings were consistent with the previous visit, and Dr. Tipirneni updated the diagnosis to include lumbar radiculopathy and lumbar myofascitis, continuing physical therapy authorization.
The patient first consulted Dr. David Zelefsky on July 23, 2002, reporting low back pain radiating to the right buttock, leg numbness, and headaches, with symptoms aggravated by physical activity. He was taking Oxycodone for severe pain and indicated significant restrictions in lifting and bending. Examination results showed tenderness in neck and back muscles, with lumbar range of motion severely limited. Straight leg raising tests remained negative, and gait and sensation were normal.
In December 2010, Dr. Zelefsky summarized the July 2002 examination, noting that the patient had normal posture and ambulated independently. The cervical spine examination revealed muscle spasms, tenderness, and decreased range of motion, along with diminished reflexes and weakness in the right bicep and deltoid. The dorsolumbar assessment showed similar tenderness and muscle spasms, positive straight leg tests indicating radicular pain, decreased motion with pain, and diminished reflexes. A September 2002 MRI indicated a history of right hemi-laminectomy at L-5/S-1, surrounding the right S-1 nerve root, and revealed a disc protrusion at L-5/S-1. Dr. Zelefsky diagnosed the patient with cervical and lumbar radiculopathy, disc herniations at C-4/C-5, C-5/C-6, and L-5/S-1, an epidural scar, and myofascitis.
Dr. Zelefsky diagnosed the plaintiff with avulsive injuries to the anterior longitudinal and accessory spinal ligaments, accompanied by compression trauma to the intervertebral discs, leading to local hemorrhage, disc dehydration, and potential spondylosis. This condition resulted in nerve root compression and a wedge-shaped disc appearance on MRIs. He noted that abnormal weight bearing would eventually lead to pressure atrophy, diminishing the disc's thickness. The injury caused stretching and tearing of ligaments, resulting in radicular pain and muscle spasms in the affected area. Healing connective tissue would form scar tissue, which lacks elasticity and would limit the range of motion, potentially resulting in calcification and arthritic deposits.
Dr. Zelefsky observed that while the plaintiff experienced sporadic improvements, he faced episodes of pain exacerbation triggered by activities such as lifting and prolonged sitting. He concluded that the plaintiff's prognosis was poor, with minimal relief from symptoms and the expectation of recurrent pain, particularly during stress or fatigue, attributing these issues directly to a November 1997 accident.
Dr. Stimler-Levy, treating the plaintiff for cervical, thoracic, and lumbar disc disease since July 2002, indicated that the plaintiff had been unable to engage in substantial gainful activity since February 14, 2000. She outlined significant limitations on his physical capabilities, including restricted sitting and standing durations, a need to recline frequently, and limitations on lifting and repetitive actions. Her assessment indicated that the plaintiff's exertional capacity fell below the full range of sedentary work. Following the date last insured, the plaintiff continued to receive treatment from Dr. Zelefsky monthly until December 2007 and from Dr. Stimler-Levy intermittently until April 2011, during which time trigger point injections were administered for muscle pain.
Plaintiff received multiple treatments at N.Y. Rehab from March to September 2011, including trigger point injections on March 23, June 6, and July 5. An MRI of the cervical spine on September 17, 2008, showed abnormal findings, including straightening of lordosis, various herniations at C-3/C-7, and mild cord encroachment. A lumbar MRI on September 18, 2008, indicated a right posteriolateral disc herniation at L-5/S-1, along with subtle bulging at L-3/L-4 and L-4/L-5. On December 4, 2008, Dr. Zelefsky conducted nerve conduction studies and EMG testing, revealing bilateral median neuropathy consistent with carpal tunnel syndrome, right tibial motor neuropathy, and irritation of the right C-5 nerve root. A thoracic spine MRI on February 5, 2010, detected a left-sided posterior disc herniation at T-6/T-7. Dr. Roman Urbanczyzk, the plaintiff's primary care physician, indicated on February 19, 2011, that he diagnosed the plaintiff with chronic low back pain and hypercholesterolemia, noting limitations in the plaintiff's ability to sit, stand, walk, and lift.
The document also outlines the legal standards for a Rule 12(c) motion, which allows for judgment on the pleadings after the pleadings are closed, requiring the complaint to present sufficient factual matter for a plausible claim. The court must accept all well-pleaded allegations as true and can only consider the facts within the complaint or judicially noticed matters. Furthermore, it discusses the review process for decisions made by the Commissioner of Social Security, emphasizing that a court must determine if substantial evidence supports the Commissioner's decision and whether the correct legal standards were applied, without re-evaluating the claimant’s disability status.
Substantial evidence is defined as relevant evidence that a reasonable mind would find adequate to support a conclusion, surpassing mere speculation. When reviewing the Commissioner’s findings, courts must evaluate the entire record, including contradictory evidence. While the Commissioner’s factual findings are binding if supported by substantial evidence, this standard does not apply to legal conclusions or the application of legal standards. Courts have a duty to ensure correct legal standards are applied, regardless of substantial evidence support. If an incorrect legal standard is identified, the court must assess whether this error affected the case outcome; if so, the decision must be reversed. If the correct legal standard would lead to the same conclusion, the error is deemed harmless, negating the need for remand.
Upon overturning a decision, courts may remand for a new hearing or specifically for benefits calculation. Remand for calculations is justified when the record shows clear evidence of disability and applying the correct standards would yield only one conclusion. Conversely, remand for further evidence development is warranted when there are gaps in the record or improper legal standards were applied. In cases where additional proceedings would be unnecessary, remand for benefit calculation is appropriate.
Under the Social Security Act, "disability" is defined as the inability to engage in substantial gainful activity due to a medically determinable impairment expected to last at least 12 months. Benefits are available only for impairments demonstrable by clinically accepted diagnostic techniques. A determination of disability requires that an individual cannot perform previous work or any other substantial gainful work available in the national economy, considering age, education, and work experience.
The Commissioner must follow a five-step sequential analysis to assess whether an individual is disabled under Title II of the Act.
1. **Substantial Gainful Activity (SGA)**: The first step requires determining if the claimant is engaged in SGA, which includes significant physical or mental activities typically performed for pay or profit. If the claimant is involved in SGA, they are not considered disabled.
2. **Medical Severity**: If not engaged in SGA, the second step evaluates the medical severity of the claimant’s impairment. The impairment must be a severe medically determinable physical or mental condition that meets the duration requirement of at least 12 months or results in death.
3. **Listings Comparison**: The third step checks if the impairment meets or equals any listings in Appendix 1 of the regulations and meets the duration requirement. If it does, the claimant is deemed disabled.
4. **Residual Functional Capacity (RFC) Assessment**: If the impairment does not meet the listings, the Commissioner assesses the claimant's RFC based on all relevant medical evidence, including statements from medical sources and descriptions of limitations from the claimant and others.
5. **Physical and Mental Requirements of Work**: The RFC assessment considers the claimant's ability to perform physical, mental, sensory, and other work requirements, including limitations in physical demands like sitting, standing, walking, lifting, and other functions.
Each step must be thoroughly evaluated before moving to the next, ensuring a comprehensive assessment of the claimant's disability status.
A limited ability to perform specific mental activities, such as understanding, remembering, and responding appropriately in a work setting, may impact a claimant's capacity to engage in past or other work (20 C.F.R. 404.1545(c)). Under 20 C.F.R. 404.1545(e), when a claimant has severe impairments that do not meet listed impairment criteria, the Commissioner must evaluate the cumulative limiting effects of all impairments, including non-severe ones, on the claimant's residual functional capacity (RFC). The RFC reflects the most a claimant can do despite these limitations, taking into account both medical and nonmedical evidence, including pain and other symptoms that might restrict function (20 C.F.R. 404.1545(a), 404.1545(e)).
At the fourth step of the evaluation, the Commissioner compares the RFC to the demands of the claimant's past relevant work (20 C.F.R. 404.1520(a)(1)(iv) and (f)). If the claimant can still perform past work, they are not considered disabled; if not, the process moves to the fifth step, where the Commissioner assesses the claimant's ability to adjust to other work based on the RFC, age, education, and work experience (20 C.F.R. 404.1520(a)(1)(v)). The burden of proof lies with the claimant in the first four steps, while the Commissioner bears it in the final step (Talavera, 697 F.3d at 151).
Both parties agree that a remand is necessary, but they dispute the nature of the remand. The plaintiff requests a remand solely for the calculation of benefits, while the Commissioner advocates for further administrative proceedings. The Commissioner contends that the Administrative Law Judge (ALJ) erred by incorrectly identifying Dr. Tipirneni as the sole treating source during the relevant period, overlooking contributions from Doctors Stimler-Levy, Urbancyzk, and Zelefsky. The remand would allow the ALJ to properly evaluate this previously ignored evidence.
Defendant's Reply Memorandum highlights concerns regarding the administrative evaluation of the Plaintiff's credibility and the adequacy of evidence supporting the Plaintiff's residual functional capacity (RFC) for sedentary work. Under the Treating Physician Rule, a treating physician's opinion is entitled to controlling weight if well-supported by medical evidence and consistent with other substantial record evidence, as per 20 C.F.R. 404.1527(c)(2). This rule emphasizes that an ALJ must justify the weight assigned to a treating physician's opinion. If the treating physician's opinions contradict substantial evidence from other medical experts, such opinions may not receive controlling weight. The ALJ must evaluate the frequency of treatment, the evidence backing the treating physician’s opinion, its consistency with the overall record, the physician's specialization, and other pertinent factors. Genuine conflicts in medical evidence are to be resolved by the Commissioner, who ultimately determines a claimant's disability status.
The parties acknowledge that the ALJ erred in concluding that Dr. Tipirneni was the sole treating source providing opinions during the relevant period, neglecting the contributions of Dr. Stimler-Levy, Dr. Urbancyzk, and Dr. Zelefsky, who also assessed the plaintiff's abilities and limitations. The timing of these evaluations, some occurring post-insured period, is deemed irrelevant since a diagnosis can be established long after the onset of an impairment. Treating physicians’ opinions regarding the plaintiff's disability and ability to engage in sedentary work are considered binding unless substantial contrary evidence exists, even if their evaluations occurred after the last date the claimant met earnings requirements. The ALJ's failure to apply the treating physician rule warrants reversal, particularly given that the Secretary did not provide substantially contrary evidence to the treating physician's opinion of the plaintiff's disability.
Additionally, the ALJ is found to have made a legal error in assessing the plaintiff’s credibility. While the ALJ must consider the claimant’s reports of pain and limitations, they are not obligated to accept subjective complaints uncritically and have discretion in weighing credibility against other evidence. The reviewing courts defer to the agency's determinations as long as they are supported by substantial evidence. Furthermore, the Second Circuit has established that a claimant's testimony about pain can be critical in substantiating claims of disability, even in the absence of objective medical evidence.
In Hankerson v. Harris, the court reiterates that an Administrative Law Judge (ALJ) must first determine if a claimant has a medically determinable impairment expected to produce their alleged symptoms, such as pain. If such an impairment exists, the ALJ must evaluate the intensity and persistence of the symptoms to assess their impact on the claimant's work capacity. The evaluation process follows a two-step analysis: first, confirming the existence of an impairment, and then considering how the symptoms align with the objective medical evidence and additional evidence in the record.
If a claimant's testimony regarding the severity of symptoms is not fully supported by clinical evidence, the ALJ must consider various factors, including the claimant’s daily activities, pain characteristics, medication effects, and other treatment measures. If an ALJ finds a claimant not credible, this determination must be explicit and detailed to allow for judicial review of the legitimacy of the ALJ's reasons and the support by substantial evidence.
In this case, the ALJ acknowledged that the claimant's impairments could reasonably cause the alleged symptoms but deemed the claimant's statements about their intensity and persistence not entirely credible due to inconsistencies with the residual functional capacity (RFC) assessment. The court identified a legal error in the ALJ's approach, as the RFC assessment should follow the credibility evaluation, not precede it. The ALJ's failure to adhere to this order compromised the credibility assessment process.
Remand is deemed appropriate when an ALJ utilizes shorthand in credibility determinations, as seen in Otero v. Colvin and other cases. Courts assert that a proper assessment of a claimant's credibility must precede the evaluation of Residual Functional Capacity (RFC), adhering to SSA regulations. The ALJ failed to adequately consider all relevant factors from 20 C.F.R. 404.1529(c)(3) and did not sufficiently explain how these factors were balanced in the credibility assessment. Specific subjective complaints and medical treatments, including side effects from Oxycodone, were overlooked. The mischaracterization of the claimant's daily activities further undermined the credibility determination. This legal misapplication alone justifies remand, as indicated in multiple cited cases.
Additionally, the ALJ has a responsibility to ensure the record is comprehensive for a proper RFC determination, which reflects an individual's capabilities despite impairments. The RFC evaluation encompasses both exertional and non-exertional limitations, such as the ability to lift, carry, and perform various physical tasks. Sedentary work is defined as involving limited standing or walking and primarily sitting, with specific lifting requirements outlined by SSA guidelines.
The ALJ’s determination that the plaintiff had the residual functional capacity (RFC) to perform sedentary work is deemed unsupported by substantial evidence. The ALJ assigned considerable weight to Dr. Levy’s opinion, which limited the claimant's ability to stand and walk to two hours and to lift and carry ten pounds occasionally, but only substantial weight to the portion limiting sitting to four hours. The ALJ concluded that Dr. Levy's opinion outweighed Dr. Urbanski's, which stated that the plaintiff could not sit for six hours, stand or walk for two hours, or lift and carry ten pounds, citing that Dr. Urbanski's opinion contradicted the majority of the medical record post-March 2005, after the insured status had lapsed.
The Commissioner contends that the ALJ's conclusion was supported by substantial evidence, but the ALJ failed to adequately identify this supporting evidence regarding the plaintiff's capacity to perform sedentary work. The Commissioner highlighted Dr. Tipimeni’s June 2000 statement about the plaintiff being limited to light administrative duties, yet this statement did not address critical abilities for sedentary work, such as lifting ten pounds occasionally or sitting for six hours.
Furthermore, the ALJ's assertion that evidence up until March 2005 did not support limitations on the plaintiff's ability to sit was not backed by substantial evidence or expert medical opinion. The ALJ’s own evaluations of medical findings were inappropriate without supporting expert testimony. None of the plaintiff's treating physicians' opinions supported the ALJ's RFC assessment, and their assessments were consistent and substantiated by medical evidence. The Commissioner failed to present any medical evidence demonstrating the plaintiff's capability to fulfill a sedentary job.
Plaintiff's treating physicians determined that the plaintiff was unable to perform sedentary work due to limitations in sitting, standing, and walking. Dr. Stimler-Levy, who had treated the plaintiff since 2002, indicated that the plaintiff had been incapable of any substantial gainful activity since February 14, 2000, with no improvement in his condition. Dr. Stimler-Levy's evaluation specified that the plaintiff could sit for only 30 minutes at a time and a total of four hours in an eight-hour workday, and could stand or walk for only 30 minutes at a time and two hours total in the same period. Dr. Urbanczyzk, the plaintiff's primary care physician, also reported similar restrictions, stating the plaintiff could sit for less than six hours and stand or walk for less than two hours daily.
The Administrative Law Judge (ALJ) did not provide medical evidence to contradict these findings but concluded that the plaintiff could perform a full range of sedentary work, which the Commissioner acknowledged was unsupported by adequate evidence. The ALJ's determination was criticized for lacking a basis in medical opinion and for improperly substituting his own lay judgment for that of qualified physicians. Consequently, the court found the ALJ's conclusion regarding the plaintiff's ability to perform sedentary work was not supported by substantial evidence and deemed it necessary to reverse the ALJ’s decision.
The ALJ's finding that the plaintiff could stand, walk, and sit for about six hours in an eight-hour workday lacked substantial evidence, contradicted by two treating physicians' recommendations to avoid prolonged sitting and standing, with no examining doctor offering specific insights on the plaintiff's capabilities. An ALJ is not qualified to determine a claimant’s residual functional capacity (RFC) based solely on medical findings without a medical advisor’s assessment. The medical records diagnose the claimant's impairments but do not link them to specific functional capabilities, preventing the Commissioner from independently drawing conclusions.
Remand for calculation of benefits is warranted when the record contains persuasive evidence of disability, and additional proceedings would be futile. The defendant argues that remand is necessary due to legal errors in the ALJ's decision, while the plaintiff advocates for a remand solely for benefits calculation, asserting that the finding of the ability to perform sedentary work is unsupported. The ALJ failed to apply the treating physician rule, misjudged the plaintiff's credibility, and lacked substantial evidence for the RFC determination. The Commissioner suggests a rehearing to evaluate new evidence from treating sources and reassess credibility; however, proper application of legal standards would reinforce existing evidence that the plaintiff cannot perform full sedentary work.
Remand for benefits calculation is appropriate when existing evidence convincingly demonstrates disability, and applying correct legal standards would yield the same conclusion. The record indicates the plaintiff is totally disabled, and the evidence does not support the ability to perform sedentary work, leading to the recommendation to reverse the ALJ’s decision and remand for benefit calculation.
Reversal of the Commissioner's decision is warranted due to a lack of substantial evidence supporting the claim that the plaintiff could engage in "sedentary" work. Remanding the case for a rehearing is deemed unnecessary unless the Secretary can provide additional evidence. This aligns with precedents where remand was ordered for benefits calculation due to the Commissioner's failure to adhere to the treating physician rule or to adequately consider the plaintiff's disabling pain. Notably, the court emphasizes that the Commissioner did not meet the burden of proving the plaintiff's ability to perform sedentary work, leading to the conclusion that a remand for the calculation of benefits is appropriate. The plaintiff qualifies for SSD benefits based on the legal definition of disability and met the insured status requirements until December 31, 2002, with an alleged disability onset date of January 31, 2000, marking the relevant review period. The ALJ’s omission of Dr. Zelefsky's findings is highlighted, alongside medical evidence indicating significant physical limitations prior to the lapse of insured status. The Commissioner is required to demonstrate the claimant’s residual functional capacity at the fifth step of the evaluation process, a standard established in the Curry case. Since the plaintiff's disability onset predates the revised SSA regulations effective August 26, 2003, the Curry standard applies in this case, necessitating adherence to it in the decision-making process.
