Court: District Court, W.D. New York; June 29, 2015; Federal District Court
Martha Conlin, representing N.T.C.B., filed for supplemental security income under 42 U.S.C. §§ 405(g) and 1383(c)(3), challenging the denial of her application by Carolyn W. Colvin, Acting Commissioner of Social Security. Conlin contends that the decision made by Administrative Law Judge (ALJ) David S. Pang was unsupported by substantial evidence and based on incorrect legal standards. The Court reviewed competing motions for judgment on the pleadings and concluded that the Commissioner's decision was indeed supported by substantial evidence and adhered to legal requirements. Consequently, the Court granted the Commissioner's motion and denied Conlin's, resulting in the dismissal of her complaint with prejudice.
The procedural history reveals that Conlin filed her application on August 16, 2011, claiming disability onset as of February 1, 2011, due to Attention Deficit Hyperactivity Disorder (ADHD), a learning disorder, and Oppositional Defiance Disorder (ODD). After the application was denied, a hearing was held on December 27, 2012, where Conlin, represented by counsel, testified. On February 22, 2013, ALJ Pang determined that N.T.C.B. was not disabled as per the Social Security Act. The Appeals Council upheld this decision on June 9, 2014, finalizing the Commissioner's decision, which Conlin subsequently appealed in this civil action filed on July 1, 2014.
N.T.C.B., a five-year-old, was evaluated by Dr. Naomi Yachelevich on September 24, 2010, due to behavioral issues and developmental delays. At that time, he had a diagnosis of ADHD and a history of global developmental delay, though he was in a regular classroom. Dr. Yachelevich noted he was cooperative and communicative. A follow-up visit on June 30, 2011, addressed inattention and aggression, leading to prescriptions for Adderall and Guanfacine, and an Individualized Educational Plan (IEP) that included therapeutic support. Dr. Yachelevich recommended a referral to a child development specialist due to uncertainty regarding the underlying causes of N.T.C.B.'s issues.
On August 5, 2011, Dr. M. Raqib Raja confirmed the ADHD diagnosis and also identified Oppositional Defiant Disorder (ODD). Reports from Ms. Conlin indicated behavioral challenges at home but noted N.T.C.B. was happy and social. Dr. Raja found him verbal and easy to engage, with average cognitive skills but poor insight and impulsive judgment. He suggested further evaluation for potential learning disorders.
On September 28, 2011, state agency mental health expert Dr. J. Randall assessed N.T.C.B. using the six domains of functioning outlined in 20 C.F.R. 416.926(a). Dr. Randall identified a marked limitation in "Acquiring and Using Information," while noting academic interventions in place. Limitations were less than marked in "Attending and Completing Tasks" and "Interacting and Relating with Others." N.T.C.B. was described as having good social engagement and no issues with physical activities. No limitations were found in "Caring For Yourself" and "Health and Physical Well-Being." Dr. Randall concluded that although N.T.C.B. had severe mental impairments, his limitations did not meet or medically equal any listings in the relevant regulations.
On December 2, 2011, school psychologist Emily Darrow Meisch evaluated N.T.C.B., including parental interviews, record reviews, classroom observations, and cognitive testing. N.T.C.B. was cooperative and engaged during testing but needed reminders to work independently. Although performing within the average range on standardized academic tests, N.T.C.B. displayed below-average results on curriculum-based measures, with Ms. Meisch uncertain whether this was due to ADHD, motivation issues, a learning disability, or speech/language problems. She recommended that the special education committee consider more intensive academic interventions to improve N.T.C.B.'s focus and independent work, suggesting additional time for tasks in low-distraction settings.
Teacher Ms. Granbois provided progress reports over three periods in the 2010-2011 school year, noting N.T.C.B.'s initial social improvements followed by regression in behavior when frustrated. N.T.C.B. struggled with attention and classroom tasks but showed some progress in not disrupting others. By the fourth period, Ms. Granbois observed that N.T.C.B. was a caring friend and was making good efforts, though still facing learning challenges. A letter from Ms. Granbois to Dr. Bjorseth on March 11, 2011, detailed N.T.C.B.'s difficulties with the kindergarten curriculum and social interactions, noting a variable attitude toward school and frequent transitions requiring multiple prompts.
On July 22, 2011, licensed clinical social worker Kim Bautista assessed N.T.C.B., identifying significant ADHD symptoms, including hyperactivity and impulsivity. N.T.C.B.'s mother expressed concerns about behavioral issues, which improved with medication. Bautista's examination indicated N.T.C.B. was cooperative with appropriate affect and focused thought, but reported ongoing impulse control problems. The assessment concluded that N.T.C.B.'s emotional and behavioral challenges were partly triggered by ADHD symptoms.
N.T.C.B.'s mother reported on August 16, 2011, that he experienced difficulties in verbal communication, often asking questions but struggling to express desires or convey simple messages. He could count, identify colors and shapes, and define some words, but did not know his phone number or recognize capital letters. Physically, he was capable but faced challenges with sharing and taking turns. Although he could manage basic personal needs, he required assistance with dressing and hygiene. Attention span and task focus were noted as limited.
A teacher questionnaire completed on August 23, 2011, indicated that N.T.C.B. faced "very serious problems" in acquiring and using information, particularly with reading and comprehension. He was rated similarly in attending to and completing tasks, with significant difficulties across various tasks. Socially, he exhibited serious problems in interacting with others, yet showed only slight difficulties in physical mobility and self-care.
Observations by school counselor John Bittner on November 7, 2011, portrayed N.T.C.B. as engaged and responsive in class, indicating a willingness to learn without being disruptive. A review by Ms. Bautista on July 24, 2012, diagnosed N.T.C.B. with ADHD, ODD, and learning disorders in math and reading. A subsequent Medical Source Statement on September 26, 2012, detailed his frequent inattentiveness, disorganization, and distractibility, along with marked limitations in cognitive and social functioning. Ms. Bautista concluded that N.T.C.B. was markedly limited in acquiring information, completing tasks, and self-care, with moderate limitations in social interactions.
N.T.C.B., a seven-year-old second grader, was diagnosed with ADHD, ODD, and a learning disability and was receiving treatment from Dr. Raja. He was on an Individualized Education Program (IEP) and receiving speech and occupational therapy, along with assistance in mathematics. N.T.C.B. struggled with attention and focus both at home and school, where he had access to special services in both regular and separate classroom settings. He faced difficulties in reading, required extra time for tests, and worked with therapists to improve fine motor skills and speech. N.T.C.B. attended counseling sessions, which the Plaintiff found beneficial. He was prescribed Strattera, Concerta, and Claritin, but the Plaintiff felt the medications were not effectively managing his ADHD symptoms and reported no side effects. Socially, N.T.C.B. interacted reasonably with peers but would become upset during disagreements, often leading to anger directed at his sister, though he would apologize afterward. He exhibited behaviors such as throwing fits, becoming negative, and occasionally getting written up at school for his conduct, though he had never been suspended. Additionally, his excitement sometimes led to impulsive behavior in the classroom, such as blurting out answers and unclear speech.
Jurisdiction for the Court to review the Commissioner's final decision is established under 42 U.S.C. 405(g) and 1383(c)(3). The Court may affirm, modify, or reverse the Commissioner's decision based on the pleadings and record transcript, with the option to remand for a rehearing if necessary. Findings of fact by the Commissioner are to be accepted if supported by substantial evidence, defined as more than a mere scintilla and adequate for a reasonable mind to accept a conclusion. A concern arises if there's doubt about the application of correct legal principles, as it raises the risk of a claimant being deprived of a proper disability determination. Consequently, the Court's review is confined to assessing whether the Commissioner used appropriate legal standards and whether the findings were supported by substantial evidence. If the Court identifies no legal errors and finds substantial evidence for the Commissioner's determination, the decision is upheld, even if contrary evidence exists. Judgment on the pleadings may be granted under Rule 12(c) when material facts are undisputed and a merits judgment is possible based solely on the pleadings.
An individual under 18 can qualify for SSI benefits if they have a medically determinable impairment resulting in marked and severe functional limitations expected to last at least 12 months or result in death (42 U.S.C. 1382c(a)(3)(C)(i)). The ALJ applies a three-step evaluation to assess disability: (1) determining if the child is engaged in substantial gainful activity, (2) evaluating whether the child has a medically severe impairment causing more than minimal functional limitation, and (3) checking if the impairments meet or functionally equal the criteria of any listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. A child is classified as disabled if they have marked limitations in two domains or an extreme limitation in one domain (20 C.F.R. 416.926a(a), d). Limitations are defined as 'marked' if they seriously interfere with the child's ability to perform activities, and 'extreme' if they very seriously interfere (20 C.F.R. 416.926a(e)(2)(i) & (e)(3)(i)).
In the case analyzed, the ALJ found that N.T.C.B. was a minor who had not engaged in substantial gainful activity since the application date. The ALJ identified severe impairments (ADHD, ODD, learning disability) but concluded that these impairments did not meet, medically equal, or functionally equal the listings. The ALJ assessed functional limitations, finding marked limitation in acquiring and using information, and less than marked limitations in the other five domains. Consequently, the ALJ determined that N.T.C.B. was not disabled. The plaintiff argues that the ALJ erred in finding less than marked limitations in attending and completing tasks and interacting and relating with others.
Plaintiff argues that the Administrative Law Judge (ALJ) failed to properly evaluate the opinion of social worker Ms. Bautista under the legal standards set forth in 20 C.F.R. 416.927, claiming insufficient weight was given to her opinion. In response, the Commissioner contends that Ms. Bautista is not classified as an acceptable medical source under 20 C.F.R. 416.913(a), and her opinions lack sufficient support and clarity in her treatment records. The weight assigned to opinions from non-acceptable medical sources depends on various factors, including the relationship with the patient, the frequency and duration of examinations, the supporting evidence, and consistency with the overall record. The ALJ evaluated Ms. Bautista’s opinion and assigned it little weight, finding it inconsistent and unsupported by her treatment records. For instance, Ms. Bautista's mental status examination indicated positive traits in the patient that contradicted her overall assessment. Additionally, academic testing showed average performance in all areas except short-term memory, and teachers noted recent improvements in the patient's struggles. The Court concludes that the ALJ did not err in giving Ms. Bautista's opinion little weight.
Ms. Granbois, a teacher, was cited by the Plaintiff as a source whose opinion the ALJ improperly disregarded due to lack of identification as the report's author. The Plaintiff argues that since the school nurse, Ms. Wilson, signed the form and Ms. Granbois identified herself as the teacher for the 2010-2011 school year, she must have completed the report. Regardless, the ALJ's decision was sufficiently supported by other expert reports, including those from Mr. Bittner, Dr. Randall, and Dr. Raja, indicating that any potential error regarding Ms. Granbois's opinion would not have affected the outcome. Teacher questionnaires are considered valid "other source" opinions under federal regulations, and the ALJ has discretion in assigning weight to these opinions. Although "other source" opinions are significant for evaluating impairment severity, the ALJ determined that substantial evidence existed to support his decision, including observations from Mr. Bittner and evaluations from school psychologist Ms. Meisch, which indicated that N.T.C.B. performed within average academic ranges and showed improvement. Additionally, Dr. Randall's assessment of N.T.C.B. revealed less than marked limitations in attention and task completion, and the ALJ gave this opinion great weight. The ALJ is permitted to rely on the opinions of State Agency experts, which can provide substantial evidence if consistent with the overall record, as demonstrated in this case. Dr. Randall's qualifications and detailed analysis further reinforced the ALJ's decision.
Medical source opinions that are deemed "conclusory, stale, and based on an incomplete medical record" may lack substantial evidence for an ALJ's findings. However, if such opinions are supported by similar findings in treatment notes and other opinions, they can be considered substantial evidence. In this case, Dr. Randall’s opinion aligned with the evidence presented. Although the ALJ did not specifically reference Dr. Randall’s opinion regarding the plaintiff's ability to attend and complete tasks, it is not mandatory for the ALJ to mention every piece of evidence. The ALJ's decision can still be valid if supported by credible evidence found elsewhere in the decision. Furthermore, while a non-medical source’s opinion can outweigh that of a medical source under certain conditions, those conditions were not satisfied in this case. Therefore, remand is not warranted, as substantial evidence, including reports from Dr. Randall and Mr. Bittner, supports the ALJ's conclusion without any legal error in evaluating the opinions.
Dr. Raja's findings were partially credited by the ALJ, who was criticized for selectively adopting the least supportive portions of medical evidence. While the ALJ does not need to reconcile every conflicting piece of medical testimony, they cannot choose only evidence that supports their conclusions. The ALJ considered Dr. Raja’s findings but assigned them little weight due to inconsistencies and reliance on Plaintiff's subjective reports. For instance, despite Plaintiff's claims about her son's behavior, Dr. Raja reported positive cognitive attributes and no signs of significant behavioral issues. The ALJ's decision was also informed by the opinions of other medical sources, including Dr. Randall, whose assessment of a less than marked limitation in interacting and relating with others was well-supported by various records, including observations from teachers and IEP notes. Consequently, the Court upheld the ALJ’s findings, stating they were backed by substantial evidence and dismissed the Plaintiff's complaint with prejudice, granting the Commissioner's motion for judgment on the pleadings.
