Aldea v. Astrue

Citations: 828 F. Supp. 2d 396; 2011 U.S. Dist. LEXIS 135475; 2011 WL 5882190Docket: Civil Action No. 10-30202-KPN

Court: District Court, D. Massachusetts; November 22, 2011; Federal District Court

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Gerald Aldea, the Plaintiff, seeks judicial review of a final decision by the Commissioner of the Social Security Administration regarding his claims for Supplemental Security Income (SSI) and Child’s Insurance Disability Benefits (CIDB). Aldea argues that the Commissioner improperly considered evidence outside the administrative record and claims that the May 6, 2010 decision by the administrative law judge (ALJ) denying his benefits is erroneous. He filed a motion to remand the case, while the Commissioner moved to affirm the decision. The court has jurisdiction under 28 U.S.C. 636(c) and Fed. R. Civ. P. 73.

The court grants Aldea's motion to remand and denies the Commissioner’s motion to affirm. The standard of review requires that the Commissioner’s decision be based on substantial evidence, defined as evidence that a reasonable mind would accept as adequate to support a conclusion. While the court recognizes the Commissioner’s authority to resolve conflicts in evidence and determine credibility, it will not uphold a denial of benefits if there is an error of law in evaluating a claim.

Aldea filed for CIDB and SSI benefits on October 17, 2007, citing disability due to back, arm, and leg pain. His claims were denied initially and upon reconsideration, leading to an ALJ hearing on February 22, 2010. At the hearing, Aldea, then 23, testified about his inability to work since a work-related accident in December 2006, which caused severe back issues. He reported that he requires assistance with daily activities and can only stand comfortably for about 25 minutes. A federal reviewing official initially determined on October 23, 2008, that Aldea was not disabled, citing credibility issues regarding his claims about the persistence and functional limitations of his symptoms, especially given evidence of substantial gainful activity post-disability onset. The ALJ's May 6, 2010 decision echoed these conclusions.

The ALJ determined that Plaintiff was not disabled despite his claim of inability to work since 2006. The ALJ found evidence of Plaintiff's employment as a painter in 2007 and self-employment in 2008, contradicting his testimony. Although the ALJ acknowledged a continuous 12-month period without substantial gainful activity, he concluded that Plaintiff's severe back pain did not substantiate his claims of disability due to inconsistencies with medical records and his work history. The Commissioner’s Decision Review Board selected the ALJ’s decision for review, but the review was not completed within 90 days, rendering the ALJ’s decision final on August 6, 2010. 

The eligibility for Child Insurance Disability Benefits (CIDB) requires that the individual is a child of an insured person with a disability beginning before age 22, while Supplemental Security Income (SSI) requires a demonstration of disability and financial need. 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. The definition of disability also considers whether the impairment prevents the individual from performing any other work available in the national economy. The Commissioner employs a five-step analysis to assess disability, which includes evaluating current employment status, severity of impairments, equivalence to specific listed impairments, ability to perform past work, and ability to engage in other work in the economy.

The ALJ determined that, despite Plaintiff's claim of being unable to work since December 5, 2006, he engaged in substantial gainful activity from January 2007 to December 2008, with earnings of $13,184.00 in 2007 and $32,002.59 in 2008. The ALJ acknowledged Plaintiff's severe impairment of back pain but concluded it did not meet the criteria for listed impairments. Plaintiff was found to have the residual functional capacity to perform simple, unskilled light work, with certain limitations, including illiteracy in English and restrictions on using leg or foot controls and climbing heights.

Plaintiff argued that the ALJ improperly relied on evidence outside the record to support his findings regarding substantial gainful activity and credibility. The Commissioner contended that any error was harmless, citing overall support for the ALJ's conclusions. However, the court found Plaintiff's argument more compelling, noting that the earnings records used by the ALJ were undermined by Plaintiff's testimony and medical records indicating he was receiving treatment in Puerto Rico and Massachusetts during the alleged working period in Alaska. The court emphasized that the ALJ failed to adequately consider contradictory evidence and improperly relied on unrecorded evidence, leading to the decision to remand the case for further review.

The court remanded the case because the administrative law judge (ALJ) failed to consider crucial evidence and improperly relied on evidence not present in the record. The ALJ deemed the Plaintiff not credible, citing his ability to perform a rigorous level of work during part of the relevant period and discounted a medical report from the Plaintiff's primary care physician, Dr. Martin Hernandez-Bem, based on the Plaintiff's testimony about exertional activities. While the Commissioner highlighted other supporting evidence, the court concluded that the ALJ's reliance on extraneous information undermined the credibility determination. Therefore, a remand for a new hearing is warranted. The court allowed the Plaintiff's motion for a new hearing and denied the Commissioner's motion to affirm. It also clarified that a federal reviewing official is responsible for evaluating disability claims, with the authority to consider new evidence, but noted that this office had been eliminated in 2011.