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Roger T. v. Berryhill

United States District Court, D. Rhode Island

February 28, 2019

NANCY A. BERRYHILL, Acting Commissioner of the Social Security Administration



         This matter is before the Court for judicial review of a final decision of the Commissioner of the Social Security Administration (“Commissioner”) denying Disability Insurance Benefits (“DIB”) under the Social Security Act (the “Act”), 42 U.S.C. § 405(g). Plaintiff filed his Complaint on February 7, 2018 seeking to reverse the Decision of the Commissioner. On July 28, 2018, Plaintiff filed a Motion to Reverse the Decision of the Commissioner. (ECF Doc. No. 13). On September 26, 2018, the Commissioner filed a Motion for an Order Affirming the Decision of the Commissioner. (ECF Doc. No. 15). A hearing was held on January 14, 2019. The Court heard argument and ordered that the Administrative Record be supplemented with additional medical evidence reviewed in connection with Plaintiff's subsequent application and award of benefits.

         This 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 to Reverse (ECF Doc. No. 13) be DENIED and that the Commissioner's Motion to Affirm (ECF Doc. No. 15) be GRANTED.


         Plaintiff filed an application for DIB on January 31, 2012 (Tr. 143-144) alleging disability since January 9, 2012. Plaintiff's date last insured is December 31, 2016. The application was denied initially on May 31, 2012 (Tr. 67-78) and on reconsideration on July 21, 2012. (Tr. 80-92). Plaintiff requested an Administrative Hearing. On May 28, 2013, a hearing was held before Administrative Law Judge Berry H. Best (the “ALJ”) at which time Plaintiff, represented by counsel, and a Vocational Expert (“VE”) appeared and testified. (Tr. 36-63). The ALJ issued an unfavorable decision to Plaintiff on June 24, 2013. (Tr. 16-35). The Appeals Council denied Plaintiff's request for review on September 2, 2014. (Tr. 1-4). Plaintiff then filed an action in this Court on December 8, 2014. (Tr. 415-417). The Commissioner assented to remand which the Court ordered on October 19, 2015. (Tr. 419-421).

         In the interim, Plaintiff filed a new application for disability and was subsequently found disabled beginning June 25, 2013. (Tr. 429). The Appeals Council issued an Order dated December 14, 2015 effectuating the Order of this Court and remanding the case for hearing by the ALJ. (Tr. 429-432). The Appeals Council concluded that the subsequent approval finding disability beginning June 25, 2013 was supported by substantial evidence and affirmed that decision. Id.

         The Appeals Council directed the ALJ to further consider the diagnosis of severe Lyme Disease and the opinion of Dr. Gloor and to rectify certain vocational issues. (Tr. 429-430). On September 13, 2016, another hearing was held before the ALJ at which time Plaintiff, Plaintiff's attorney and a VE appeared. (Tr. 367-388). On November 28, 2016, the ALJ issued a decision again denying Plaintiff's claims. (Tr. 336-356). On February 3, 2017, Plaintiff filed exceptions to the ALJ's decision. (Tr. 357-362). The Appeals Council declined to assume jurisdiction, rendering the ALJ's decision the final decision of the Commissioner. (Tr. 329-335). A timely appeal was then filed with this Court.


         Plaintiff argues that the ALJ erred in assessing the impacts of his Lyme Disease and mental impairments and the opinions of treating sources for such conditions.

         The Commissioner disputes Plaintiff's claims and contends that the ALJ's findings are supported by substantial evidence and must be affirmed.


         The 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).

         Where 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 Commissioner relied).

         The 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).

         The 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).

         Where 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.

         In 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. 1996).

         A 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 proceedings. Id.

         IV. ...

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