United States District Court, M.D. Georgia, Athens Division
STEPHEN HYLES, Magistrate Judge.
Gabriel Evan Andrews, referred to herein as "Plaintiff, " filed an application for disability insurance benefits under the Social Security Act on August 6, 2010. He alleged that he became disabled to work on April 8, 2010 as a result of injuries to his back and neck suffered in an automobile accident. His application was denied initially on February 1, 2011, and denied on reconsideration on March 29, 2011. On May 18, 2011 he filed his written request for a hearing before an administrative law judge (ALJ) as provided for in 20 C.F.R. 404.929 et seq. The hearing before the ALJ was conducted on April 18, 2012. Plaintiff appeared with his attorney and testified at the hearing. Testimony was also taken from a vocational expert (VE). On September 18, 2012 the ALJ issued her "partially favorable" decision finding Plaintiff to have been disabled from work from the alleged onset date of April 8, 2010 through April 30, 2011 but to have the residual functional capacity (RFC) to engage in light work as defined in 20 C.F.R. 404.1567(b) with additional restrictions commencing May 1, 2011. (Tr. 20-44.) The Appeals Council (AC) denied review on December 17, 2013. (Tr. 17-19, 4-9). Having exhausted the administrative remedies available to him under the Act, Plaintiff filed this action on March 20, 2014 seeking judicial review of the decision by the Commissioner of Social Security to deny him disability insurance benefits after April 30, 2011.
The court's review of the Commissioner's decision is limited to a determination of whether it is supported by substantial evidence and whether the correct legal standards were applied. Walker v. Bowen, 826 F.2d 996, 1000 (11th Cir. 1987) (per curiam). "Substantial evidence is something more than a mere scintilla, but less than a preponderance. If the Commissioner's decision is supported by substantial evidence, this court must affirm, even if the proof preponderates against it." Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005) (internal quotation marks omitted). The court's role in reviewing claims brought under the Social Security Act is a narrow one. The court may neither decide facts, re-weigh evidence, nor substitute its judgment for that of the Commissioner. Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). It must, however, decide if the Commissioner applied the proper standards in reaching a decision. Harrell v. Harris, 610 F.2d 355, 359 (5th Cir. 1980) (per curiam). The court must scrutinize the entire record to determine the reasonableness of the Commissioner's factual findings. Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983). However, even if the evidence preponderates against the Commissioner's decision, it must be affirmed if substantial evidence supports it. Id.
The Plaintiff bears the initial burden of proving that he/she is unable to perform his/her previous work. Jones v. Bowen, 810 F.2d 1001 (11th Cir. 1986). The Plaintiff's burden is a heavy one and is so stringent that it has been described as bordering on the unrealistic. Oldham v. Schweiker, 660 F.2d 1078, 1083 (5th Cir. 1981). A Plaintiff seeking Social Security disability benefits must demonstrate that he/she suffers from an impairment that prevents him/her from engaging in any substantial gainful activity for a twelve-month period. 42 U.S.C. § 423(d)(1). In addition to meeting the requirements of these statutes, in order to be eligible for disability payments, a Plaintiff must meet the requirements of the Commissioner's regulations promulgated pursuant to the authority given in the Social Security Act. 20 C.F.R. § 404.1 et seq.
Under the Regulations, the Commissioner uses a five-step procedure to determine if a Plaintiff is disabled. Phillips v. Barnhart, 357 F.3d 1232, 1237 (11th Cir. 2004); 20 C.F.R. § 404.1520(a)(4). First, the Commissioner determines whether the Plaintiff is working. Id. If not, the Commissioner determines whether the Plaintiff has an impairment which prevents the performance of basic work activities. Id. Second, the Commissioner determines the severity of the Plaintiff's impairment or combination of impairments. Id. Third, the Commissioner determines whether the Plaintiff's severe impairment(s) meets or equals an impairment listed in Appendix 1 of Part 404 of the Regulations (the "Listing"). Id. Fourth, the Commissioner determines whether the Plaintiff's residual functional capacity can meet the physical and mental demands of past work. Id. Fifth and finally, the Commissioner determines whether the Plaintiff's residual functional capacity, age, education, and past work experience prevent the performance of any other work. In arriving at a decision, the Commissioner must consider the combined effects of all of the alleged impairments, without regard to whether each, if considered separately, would be disabling. Id. The Commissioner's failure to apply correct legal standards to the evidence is grounds for reversal. Id.
Where the Plaintiff is found disabled at any point in the above analysis, the Commissioner must also determine if the disability continues through the date of the decision. To do this, the Commissioner has established an eight step sequential evaluation process for Title II (DIB) claims and a seven step sequential evaluation process for Title XVI (Supplemental Security Income or SSD claims, the difference being that performing substantial gainful activity is not relevant to determine whether disability continues under Title XVI. 20 CFR § 416.994(b)(5). Benefits may be terminated only if a claimant has experienced medical improvement to the point of having a residual functional capacity sufficient to permit work at jobs available in the national economy.
Medical improvement is defined as "any decrease in the medical severity of an impairment which was present at the time of the most recent favorable decision that the claimant is disabled or continued to be disabled." 20 CFR § 404.1594(b)(1). A determination that there has been such a decrease in medical severity must be based on changes in the claimant's symptoms, clinical signs, or laboratory findings or medical source opinions. Chumbley v. Shalala, No. 92-12-VAL (RLH), 1994 WL 774030, at *2 (M.D. Ga. Nov. 22, 1994). When determining if medical improvement has occurred, there is no presumption of continuing disability based upon the previous finding of disability. Cutlip v. Sec'y of Health and Human Servs., 25 F.3d 284 (6th Cir.1994), 20 C.F.R § 416.994(b)(1)(vi). See also Barbara Samuels, Social Security Disability Claims Practice & Procedure § 30.2 (2d ed. 2007) ("Note that the medical improvement standard does not include any presumption of continuing disability by reason of a prior finding of disability.")
For a reviewing court, the inquiry is first "whether the [Commissioner's] finding of improvement to the point of no disability is supported by substantial evidence." Simpson v. Schweiker, 691 F.2d 966, 969 (11th Cir. 1983). If so, the factual findings are deemed conclusive. The reviewing court is not permitted to reweigh the evidence or replace the judgment of the Commissioner with its own. Bloodworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983). Next, the court must decide whether the Commissioner applied the correct law. Conclusions of law made by the Commissioner are not presumed valid. Cornelius v. Sullivan, 936 F.2d 1143, 1145 (11th Cir. 1991).
The multi-step evaluation process used to determine whether disability benefits should be terminated is as follows:
(1) Whether the claimant is engaging in substantial gainful activity;
(2) If not gainfully employed, whether the claimant has an impairment or combination of impairments which meets or equals a listing;
(3) If impairments do not meet a listing, whether there has been medical improvement;
(4) If there has been improvement, whether the improvement is related to the ...