United States District Court, D. Rhode Island
JENNIFER ROOT o/b/o K.R.
CAROLYN COLVIN, Acting Commissioner of the Social Security Administration
REPORT AND RECOMMENDATION
LINCOLN D. ALMOND United States Magistrate Judge
D. Almond, United States Magistrate Judge This matter is
before the Court for judicial review of a final decision of
the Commissioner of the Social Security Administration
(“Commissioner”) denying Social Security
Insurance (“SSI”) under the Social Security Act
(the “Act”), 42 U.S.C. § 405(g). Plaintiff
filed her Complaint on behalf of her sister on December 17,
2015 seeking to reverse the decision of the Commissioner. On
May 30, 2016, Plaintiff filed a Motion to Reverse the
Decision of the Commissioner. (Document No. 10). On July 27,
2016, the Commissioner filed a Motion for an Order Affirming
the Decision of the Commissioner. (Document No. 13). A Reply
Brief was filed on October 13, 2016. (Document No.
matter has been referred to me for preliminary review,
findings and recommended disposition. 28 U.S.C. §
636(b)(1)(B); LR Cv 72. Based upon my review of the record,
the parties' submissions and independent research, I find
that there is substantial evidence in this record to support
the Commissioner's decision and findings that Plaintiff
is not disabled within the meaning of the Act. Consequently,
I recommend that Plaintiff's Motion (Document No. 10) be
DENIED and that the Commissioner's Motion (Document No.
13) be GRANTED.
filed an application for SSI on behalf of her eleven year old
sister, K.R., on January 3, 2013 alleging disability since
January 1, 2010. (Tr. 109-118). The application was denied
initially and on reconsideration. Plaintiff requested an
Administrative Hearing. On April 3, 2014, a hearing was held
before Administrative Law Judge Barry H. Best (the
“ALJ”) at which time Plaintiff, represented by
counsel, appeared and testified. (Tr. 27-45). The ALJ issued
an unfavorable decision to Plaintiff on April 25, 2015. (Tr.
7-26). The Appeals Council denied Plaintiff's request for
review on October 28, 2015. (Tr. 1-4). Therefore the
ALJ's decision became final. A timely appeal was then
filed with this Court.
THE PARTIES' POSITIONS
argues that the ALJ erred in his evaluation of the medical
evidence and thus his finding that K.R.'s impairments
were not the functional equivalent of a listed impairment is
not supported by substantial evidence.
Commissioner disputes Plaintiff's claims and contends
that the ALJ's conclusions are supported by substantial
evidence and must be affirmed.
THE STANDARD OF REVIEW
Commissioner's findings of fact are conclusive if
supported by substantial evidence. 42 U.S.C. § 405(g).
Substantial evidence is more than a scintilla -
i.e., the evidence must do more than merely create a
suspicion of the existence of a fact, and must include such
relevant evidence as a reasonable person would accept as
adequate to support the conclusion. Ortiz v. Sec'y of
Health and Human Servs., 955 F.2d 765, 769
(1st Cir. 1991) (per curiam);
Rodriguez v. Sec'y of Health and Human Servs.,
647 F.2d 218, 222 (1st Cir. 1981).
the Commissioner's decision is supported by substantial
evidence, the court must affirm, even if the court would have
reached a contrary result as finder of fact. Rodriguez
Pagan v. Sec'y of Health and Human Servs., 819 F.2d
1, 3 (1st Cir. 1987); Barnes v. Sullivan,
932 F.2d 1356, 1358 (11th Cir. 1991). The court
must view the evidence as a whole, taking into account
evidence favorable as well as unfavorable to the decision.
Frustaglia v. Sec'y of Health and Human Servs.,
829 F.2d 192, 195 (1st Cir. 1987); Parker v.
Bowen, 793 F.2d 1177 (11th Cir. 1986) (court
also must consider evidence detracting from evidence on which
court must reverse the ALJ's decision on plenary review,
however, if the ALJ applies incorrect law, or if the ALJ
fails to provide the court with sufficient reasoning to
determine that he or she properly applied the law. Nguyen
v. Chater, 172 F.3d 31, 35 (1st Cir. 1999)
(per curiam); accord Cornelius v. Sullivan,
936 F.2d 1143, 1145 (11th Cir. 1991). Remand is
unnecessary where all of the essential evidence was before
the Appeals Council when it denied review, and the evidence
establishes without any doubt that the claimant was disabled.
Seavey v. Barnhart, 276 F.3d 1, 11 (1st
Cir. 2001) citing, Mowery v. Heckler, 771
F.2d 966, 973 (6th Cir. 1985).
court may remand a case to the Commissioner for a rehearing
under sentence four of 42 U.S.C. § 405(g); under
sentence six of 42 U.S.C. § 405(g); or under both
sentences. Seavey, 276 F.3d at 8. To remand under
sentence four, the court must either find that the
Commissioner's decision is not supported by substantial
evidence, or that the Commissioner incorrectly applied the
law relevant to the disability claim. Id.;
accord Brenem v. Harris, 621 F.2d 688, 690
(5th Cir. 1980) (remand appropriate where record
was insufficient to affirm, but also was insufficient for
district court to find claimant disabled).
the court cannot discern the basis for the Commissioner's
decision, a sentence-four remand may be appropriate to allow
her to explain the basis for her decision. Freeman v.
Barnhart, 274 F.3d 606, 609-610 (1st Cir.
2001). On remand under sentence four, the ALJ should review
the case on a complete record, including any new material
evidence. Diorio v. Heckler, 721 F.2d 726, 729
(11th Cir. 1983) (necessary for ALJ on remand to
consider psychiatric report tendered to Appeals Council).
After a sentence four remand, the court enters a final and
appealable judgment immediately, and thus loses jurisdiction.
Freeman, 274 F.3d at 610.
contrast, sentence six of 42 U.S.C. § 405(g) provides:
The court...may at any time order additional evidence to be
taken before the Commissioner of Social Security, but only
upon a showing that there is new evidence which is material
and that there is good cause for the failure to incorporate
such evidence into the record in a prior proceeding;
42 U.S.C. § 405(g). To remand under sentence six, the
claimant must establish: (1) that there is new,
non-cumulative evidence; (2) that the evidence is material,
relevant and probative so that there is a reasonable
possibility that it would change the administrative result;
and (3) there is good cause for failure to submit the
evidence at the administrative level. See Jackson v.
Chater, 99 F.3d 1086, 1090-1092 (11th Cir.
sentence six remand may be warranted, even in the absence of
an error by the Commissioner, if new, material evidence
becomes available to the claimant. Id. With a
sentence six remand, the parties must return to the court
after remand to file modified findings of fact. Id.
The court retains jurisdiction pending remand, and does not
enter a final judgment until after the completion of remand
CHILDHOOD DISABILITY DETERMINATION
under age eighteen is considered disabled, and is entitled to
SSI benefits, if he or she “has a medically
determinable physical or mental impairment, which results in
marked and severe functional limitations, and 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.” 42 U.S.C. § 1382c(a)(3)(c). The Social
Security regulations include a three-step test for the
purpose of adjudicating children's disability claims
under this standard. 20 C.F.R. § 416.924(b)-(d) (2004).
That test, known as the Children's Benefit Analysis,
requires the ALJ to determine: (1) whether the child is
engaged in “substantial gainful activity, ” (2)
whether the child has “a medically determinable
impairment[ ] that is severe, ” and (3) whether the
child's “impairment(s)...meet, medically equal, or
functionally equal [a] list[ed impairment].”
Id. A negative answer at any step precludes a
finding of disability. 20 C.F.R. § 416.924a. “The
claimant seeking [childhood] benefits bears the burden of
proving that his or her impairment meets or equals a listed
impairment.” Hall o/b/o Lee v. Apfel, 122
F.Supp.2d 959, 964 (N.D. Ill. 2000) (citing Maggard v.
Apfel, 167 F.3d 376, 380 (7th Cir. 1999)).