MEDIA

September 10, 2004

Disability Insurance and Other Benefits

Published in: New York Law Journal | volume 231
Written by: Peter R. Schlam and Harvey M. Stone

In the U.S. District Court for the Eastern District of New York, in the five cases discussed below, Eastern District judges reversed decisions by the commissioner of Social Security denying disability insurance and other benefits. Judge David G. Trager awarded benefits to a claimant suffering from disabling depression. Judge Arthur D. Spatt remanded a case involving a claim for widow’s benefits where the marriage ended with the wage-earner’s death after only two months. Judge Jack B. Weinstein held that claimant’s depression arising from his desire to be a woman had made him disabled before his insured status ended. Judge Frederic Block and Judge Raymond J. Dearie each remanded cases because the administrative law judge had not adequately developed the record.

Disability Benefits: Depression

In Golubchick v. Barnard, 03 CV 3362 (Aug. 9), Judge Trager reversed a decision by the commissioner denying disability insurance benefits, rejected the commissioner’s request for a remand to the administrative law judge to determine plaintiff’s eligibility for benefits as of Feb. 3, 1997 (the date he was hospitalized for depression), and awarded benefits to plaintiff from that date forward.

In 1996 plaintiff filed an application for disability benefits based on his clinical depression with alcohol and drug addiction, osteoarthritis, spinal stenosis with peripheral neuropathy, and seizures. The case had a long and tortuous history of administrative review, including two remands to the administrative law judge by the Appeals Council before, on the third round, the administrative law judge denied plaintiff’s claim yet again and the Appeals Council declined further review.

Plaintiff, born in 1947, served as a weather observer in the Air Force. He then worked for years, by telephone, as a customer service representative, then briefly worked at a computer as a night-shift manager. In July 1995 he suffered a "breakdown" after neck surgery. He claimed that numbness in his hands prevented him from operating a computer keyboard. Citing a variety of emotional and physical disorders, he also claimed that he could not handle a job. In late 1995 he allegedly stopped drinking and attended an outpatient detox program at a VA hospital. After his breakdown and hospitalization in February 1997, he lived alone without working. In October 1997 he was approved for placement in a supported housing program because he was homeless and considered mentally ill.

In finding plaintiff not to be "disabled," the administrative law judge concluded that plaintiff’s impairments did not meet certain listed criteria and that he could perform "the full range of light work.’

As Judge Trager saw it, however, the administrative law judge did not properly analyze the overwhelming evidence of disability. For example, the administrative law judge: (1) failed to acknowledge or discuss the assessment of a medical expert who testified at one of the hearings about plaintiff’s impaired mental and physical capacity; (2) failed to consider other evidence suggesting that plaintiff’s mental impairment was severe; (3) failed to make a finding as to the weight he gave to the testimony of plaintiff’s treating psychiatrist, whose opinions were uncontradicted and thus controlling; (4) failed to identify any specific limitations resulting from plaintiff’s mental impairments; (5) failed to explain his consideration of plaintiff’s subjective complaints, as required by the regulations; and (6) relied on two medical reports which do not provide substantial support for his findings.

Contrary to the commissioner’s position, there was no need for another remand as to plaintiff’s condition starting with his hospitalization in February 1997. The report and notes of his treating psychiatrist showed that, as of that time, plaintiff met listed requirements. None of the other reports contradicted that assessment.

Here, Judge Trager stated, "remand with instructions to obtain additional psychological evidence" as to that period would be "useless." Slip op. 15. As Judge Trager also observed:

Despite having two attempts to review the same evidence, the administrative law judge was still unable to draft a decision that complied with applicable laws. … In the meanwhile, eight years have passed. Slip op. 17.

While awarding benefits as of Feb. 3, 1997, the court remanded the case for further hearings regarding any disability from Aug.10, 1995, until Feb. 3, 1997.

Widow’s Benefits

In Randazzo v. Barnhart, 03 CV 2844 (EDNY, Aug. 26, 2004), Judge Spatt vacated the commissioner’s decision denying benefits to a deceased wage earner’s widow and remanded the case for a new hearing to determine whether (a) the wage earner, despite his early death, had been "expected" to live for nine months from the date of marriage; and (b) if so, whether his death was "accidental.’

Mrs. Randazzo brought this case as a pro se plaintiff. The administrative record showed that she and her husband had intended to marry in late June 1972. A few weeks before the planned wedding Mr. Randazzo was diagnosed with lung cancer. His doctor told him he had about a year to live. The marriage went forward on July 27, 1972. On Sept. 18, 1972, Mr. Randazzo fell down a flight of stairs, sustaining bruises and breaking his left femur. He was hospitalized for six days before dying on Sept. 24, 1972.

Mrs. Randazzo claimed that "because of the cancer, he was not able to overcome the injuries sustained in his fall." The death certificate stated: "Immediate cause [of death] was carcinoma lung due to or as a consequence of fractured left femur.’

The administrative law judge found that Mr. Randazzo died from lung cancer rather than an accident, and that claimant did not satisfy the nine-month marriage requirement to be eligible for widow’s benefits.

As Judge Spatt noted, the nine-month requirement, 42 USC § 416(c)(5), is intended to preclude widow’s benefits where a relationship was entered into to secure benefit rights. Even if the marriage lasted less than nine months, the requirement is satisfied where the widow can show that, at the time of the marriage, the wage earner reasonably expected to live for nine months, and that his death was caused by "accidental" bodily injury. 42 USC § 416(k). When a preexisting disease exists, the commissioner must decide which factor —- the disease or the accident–was the primary cause of death. The regulations relating to Social Security and disability benefits are found within the Program Operations Manual System (POMS), GN 00305.105(A)(3)(d) states: "A preexisting disease … does not, necessarily, preclude a finding that the accidental injury was the proximate cause of death." Slip op. 11-12.

Here, Judge Spatt observed, "the crucial inquiry" is whether Mr. Randazzo was reasonably expected to live for nine months from the date of marriage–a question not addressed by the commissioner. Moreover, the POMS states that the death will be deemed accidental "[i]f the worker had an active, progressive disease which, in and of itself, could have caused death more than 9 months after the date of the marriage, and an accident aggravated it so that death resulted before nine months of marriage elapsed." POMS GN 00305.105(A)(3)(d).

In Judge Spatt’s view the commissioner also erred by relying disproportionately on the death certificate, which is not controlling, and by failing to follow the procedure set forth in the POMS to review all relevant documents, particularly the medical files. The administrative record contained none of the medical files addressing the 1972 diagnosis of cancer. These materials, Judge Spatt observed, would be instrumental in determining Mr. Randazzo’s life expectancy at the time of marriage. Were that issue to be resolved in plaintiff’s favor, "under the POMS the fact that Mr. Randazzo’s death was a ‘consequence’ of his accident mandates a finding that Mrs. Randazzo is eligible for widow’s benefits." Slip op. 14.

Finally, Judge Spatt reminded the Commissioner of her duty to notify the claimant of options for free legal services in connection with the hearing on remand.

Depression/Gender Identity

In Manago v. Barnhart, 03 CV 2977 (EDNY, June 18, 2004), Judge Weinstein, reversing the administrative law judge’s denial of disability insurance benefits, found that claimant’s depression secondary to gender identity disorder had rendered him disabled since some point before June 30, 1990, when his insured status ended. Though the parties cited no prior decision awarding disability benefits on this ground, Judge Weinstein noted that legal protections for transsexuals have recently been expanding.

On an earlier remand from Judge Weinstein, the administrative law judge found that claimant had not been disabled between December 1986 and June 30, 1990, the date of last insurance coverage.

Contrary to the administrative law judge’s opinion, Judge Weinstein stated, "the absence of contemporaneous medical records does not preclude a finding that claimant was disabled prior to the expiration of insured status." Slip op. 15. Claimant’s confusion as to gender identity began in early childhood. In December 1986, his levels of depression and anxiety related to this disorder caused him to stop working. He began staying home all day, and dressed up in women’s clothing when alone. By 1990, he dressed that way full-time. His work history and his wife’s testimony supported his claims as to the date of onset. Claimant finally began receiving medical treatment in 1994. The reports of his treating physicians support a finding of total disability beginning in the late 1980’s. An expert on gender identity disorders found that claimant had a "psychiatric collapse" in 1986.

Judge Weinstein pointed to inconsistencies in the record as to the onset date, but the record was "uncontradicted" in saying that the disability started before June 1990. The court awarded benefits from March 14, 1990, the latest possible onset date, and remanded the case solely to calculate benefits starting at that time.

Failure to Develop Record

In two other cases the court granted claimants’ motions to remand to the administrative law judge for further development of the record.

In Pacheco v. Barnhart, 03 CV 3235 (EDNY, June 14, 2004), a mother applied for SSI benefits for her minor son, alleging disability because of asthma and attention deficit disorder. The administrative law judge found no disability. Judge Block held that the administrative law judge did not adequately weigh the evidence, explain her determination, or develop the record.

In Batista v. Barnhart, 02 CV 3779 (EDNY, June 18, 2004), the administrative law judge found claimant physically disabled as of August 1993, but later terminated benefits after a hearing on the ground that she had improved enough to engage in gainful activity. Judge Dearie found that the administrative law judge had not obtained a treating physician’s report and failed in other ways to develop the record. In remanding the case, Judge Dearie noted that the administrative law judge should also consider claimant’s "new evidence" submitted directly to the court.

Peter R. Schlam and Harvey M. Stone are partners at Schlam Stone & Dolan.

[This article is reprinted with permission from the September 10, 2004, issue of the New York Law Journal. Copyright © 2007 ALM Properties, Inc. All rights reserved. Further duplication without permission is prohibited.]