United States District Court, N.D. Alabama, Middle Division
For Nirandorn Sevarit, Plaintiff: Ralph K Strawn, Jr, HENSLEE ROBERTSON STRAWN & SULLIVAN LLC, Gadsden, AL.
For Social Security Administration, Commissioner, Defendant: Carolyn Williams Steverson, LEAD ATTORNEY, U.S. ATTORNEY'S OFFICE, Birmingham, AL; William L Hogan, SOCIAL SECURITY ADMINISTRATION-OFFICE OF GENERAL COUNSEL, Atlanta Federal Center, Atlanta, GA.
WILLIAM M. ACKER, JR., UNITED STATES DISTRICT JUDGE.
It has been over fifteen years since the undersigned has been given the responsibility for reviewing a disability denial by the Social Security Administration. When this court took senior status, it disassociated itself from Social Security appeals. For reasons that need not be stated, this court is again taking Social Security appeals, this being its first in over fifteen years. The court hopes that its rustiness will not become too apparent and that its unfamiliarity with the drastically proliferated social security regulations will not stand in the way of achieving a correct result.
Before undertaking to express its disagreement with the Commissioner, with the Administrative Law Judge (" ALJ" ), and with the Appeals Council, the court digresses to express its chagrin and displeasure with the procedure by which the case arrived in this court. As best this court can ascertain from the Record, when a person claims to be entitled to disability benefits, he files a claim with the Commissioner. If the Commissioner agrees with the claimant, he grants the claim, and the proceeding is closed. If, however, the Commissioner denies the claim, the claimant can appeal to an ALJ, who then conducts a de novo hearing, using the evidentiary materials submitted by the claimant and by the Commissioner, but with the right and sometimes the obligation to receive and consider oral testimony. If the ALJ overrules the Commissioner and grants the claim, the proceeding is closed. If, however, the ALJ's decision confirms the Commissioner's denial,
the claimant can file an appeal to the Appeals Council, which can affirm the ALJ, or reverse the ALJ and enter its own decision differing from that of the ALJ, or it can reverse the ALJ and remand the case to the ALJ with instructions.
In contradiction to the ordinary meaning of words in the King's English, the Appeals Council, after looking at the record, including the evidence received by it after the ALJ's decision pronounced as follows on page 1 of the Record:
" WE HAVE DENIED YOUR REQUEST FOR REVIEW."
If this language is meant to convey to the claimant that he has lost his appeal, it is a strange way of saying it. It sounds as if the Appeals Council is saying that it lacks jurisdiction to hear the appeal. Someone flunked Semantics 101. The Appeals Council would explain its so-called " denial of the request for review" by listing possible bases for granting a review, most, if not all, of which require an actual review of the ALJ's decision in order to reach the so-called decision " not to review." This is so illogical, so self-contradictory, and so contrary to ordinary jurisprudential and procedural principles, as to be the subject of this court's criticism and derision. Why could not the Appeals Council simply say that the ALJ's decision is " Affirmed" ? This would be what any appellate tribunal would say when rejecting an appellants' arguments. When the Appeals Council here said, " We will review your case for any of the following reasons," and then listed reasons, including that " the decision is not supported by substantial evidence," the Appeals Council was necessarily saying that it had examined the evidence and found it to be substantial enough to justify the conclusion reached by the ALJ. This is a strange and puzzling way to admit to having reviewed something without granting a review of it. This way of expressing what has gone on makes absolutely no sense.
Not being called upon in this case to straighten out this total semantic confusion, the court will simply deem the so-called denial of review to be an affirmance of the ALJ after having conducted an appropriate review. Of course, it would not hurt this court's feelings if the Commissioner should decide to amend the regulations to substitute for the strange procedure employed here a procedure and a way to explain what is happening that makes sense.
Nirandorn Sevarit (" plaintiff" ) brings this action pursuant to 42 U.S.C. § 405(g) for a judicial review of a final adverse decision that denied his application for Supplemental Security Income. Plaintiff timely pursued and exhausted the administrative remedies available to him before the Social Security Administration. Based on the Record and the briefs submitted by the parties, the court finds that the Commissioner's decision must be reversed and the case remanded to the Commissioner  for further proceedings.
II. STANDARD OF REVIEW
This court's sole function is to determine whether substantial evidence supports the Commissioner's findings of fact and whether proper legal standards were employed. Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983). To that end, this court " must scrutinize the record as a whole to determine if the decision reached is reasonable and supported
by substantial evidence." Id. (citations omitted). Substantial evidence is " such relevant evidence as a reasonable person would accept as adequate to support a conclusion." Id. This court may not decide the facts anew, reweigh the evidence, or substitute its judgment for that of the Commissioner. Id. Even if this court should find that the preponderance of evidence weighs against the Commissioner's decision, the court must affirm the decision if it is supported by substantial evidence. Id.
Unlike this deferential review standard that must be used in evaluating the Commissioner's factual findings, the Commissioner's conclusions of law are not presumptively valid. Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990). The decision must be reversed if the Commissioner failed " to apply the correct law or to provide the reviewing court with sufficient reasoning for determining that the proper legal analysis has been conducted." Cornelius v. Sullivan, 936 F.2d 1143, 1145-46 (11th Cir. 1991). This requirement that the Commissioner provide sufficient reasoning can, of course, become a question of law for the reviewing court. See Martin, 894 F.2d at 1529.
III. STATUTORY AND REGULATORY FRAMEWORK
To qualify for disability benefits, a claimant must be " disabled." Disability is defined as the " inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment 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 twelve months...." 42 U.S.C. § 423(d)(1)(A); 42 U.S.C. § 416(i). For the purposes of evaluating entitlement to disability benefits, " physical or mental impairment" is defined as " an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques." 42 U.S.C. § 423(d)(3).
Social Security regulations outline a five-step process for determining whether a claimant is disabled. 20 C.F.R. § § 404.1520(a)(4)(i)-(v), 416.920(a)(4)(i)-(v). Based on this five-step process, the Commissioner reaches a conclusion about the claimant's disability status. As stated above, the Commissioner's initial decision may be appealed to an administrative law judge, then to the Appeals Council, and then to a district court, all of which adhere to the same five-step process. First, the Commissioner must determine whether the claimant is engaging in substantial gainful activity. 20 C.F.R. § 404.1520(a)(4)(i). If the Commissioner finds that the claimant engages in substantial gainful activity, the claimant cannot claim disability, and the inquiry ends. 20 C.F.R. § 404.1520(b). Second, the Commissioner must determine whether the claimant has a medically determinable impairment or a combination of medical impairments that significantly limit the claimant's ability to perform basic work activities. 20 C.F.R. § 404.1520(a)(4)(ii). Absent such ...