Opinion ID: 769742
Heading Depth: 2
Heading Rank: 1

Heading: Eligibility for SSD Benefits

Text: 18 An applicant must be insured for disability insurance benefits to be eligible for SSD benefits. 42 U.S.C. § 423(a)(1)(A), (c)(1); 20 C.F.R. §§ 404.101(a), 404.110 to 404.130, 404.130 to 404.133; Arnone v. Bowen, 882 F.2d 34, 37 (2d Cir. 1989). This translates into two requirements: the applicant must have 1) adequate social security earnings to be fully insured, 20 C.F.R. § 404.110 through § 404.115; and 2) disability insured status in the quarter he became disabled or in a later quarter in which he was disabled, C.F.R. § 404.131(a). 19 A district court may set aside the Commissioner's determination that a claimant is not disabled only if the factual findings are not supported by substantial evidence or if the decision is based on legal error. 42 U.S.C. § 405(g); Bubnis v. Apfel, 150 F.3d 177, 181 (2d Cir. 1998). Substantial evidence means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Richardson v. Perales, 402 U.S. 389, 401 (1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)). The ALJ has an obligation to develop the record in light of the non-adversarial nature of the benefits proceedings, regardless of whether the claimant is represented by counsel. See Schaal v. Apfel, 134 F.3d 496, 505 (2d Cir. 1998); Echevarria v. Secretary of Health & Human Servs., 685 F.2d 751, 755 (2d Cir. 1982). On appeal, we conduct a plenary review of the administrative record to determine if there is substantial evidence, considering the record as a whole, to support the Commissioner's decision and if the correct legal standards have been applied. See Schaal, 134 F.3d at 500-01. 20 The ALJ's decision must be guided by the relevant legal standards. To receive federal disability benefits, an applicant must be disabled within the meaning of the Social Security Act. See 42 U.S.C. § 423(a), (d). To show disabled status a claimant must establish inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment . . . which has lasted or can be expected to last for a continuous period of not less than 12 months. Id. § 423(d)(1)(A). The impairment must be of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy. Id. § 423(d)(2)(A). 21 Agency rules promulgated under the Act outline a five-step analysis to determine disability. See 20 C.F.R. §§ 404.1520, 416.920. We tracked this methodology in DeChirico v. Callahan, 134 F.3d 1177, 1179-80 (2d Cir. 1998), as follows: 22
23 2. If not, the Commissioner considers whether the claimant has a severe impairment which limits his or her mental or physical ability to do basic work activities. 24 3. If the claimant has a severe impairment, the Commissioner must ask whether, based solely on medical evidence, claimant has an impairment listed in Appendix 1 of the regulations. If the claimant has one of these enumerated impairments, the Commissioner will automatically consider him disabled, without considering vocational factors such as age, education, and work experience. 25 4. If the impairment is not listed in the regulations, the Commissioner then asks whether, despite the claimant's severe impairment, he or she has residual functional capacity to perform his or her past work. 26 5. If the claimant is unable to perform his or her past work, the Commissioner then determines whether there is other work which the claimant could perform. The Commissioner bears the burden of proof on this last step, while the claimant has the burden on the first four steps. 27 Thus, to create an irrebuttable presumption of disability under the regulations, the claimant must either have a listed impairment, 20 C.F.R. §§ 404.1520(d), 416.920(d), or one that is equal to a listed impairment, id. §§ 404.1520(d), 416.920(d) (If you have an impairment(s) which . . . is listed in appendix 1 or is equal to a listed impairment(s), we will find you disabled without considering your age, education, and work experience.). 28 Accordingly, plaintiff maintained that his condition as of March 31, 1985 met or equaled the criteria for vertebrogenic disorders as defined by Listing 1.05(C), 20 C.F.R. § 404, Sbpt. P, App. 1, Pt. A, 1.05(C), which describes these impairments as disorders persisting for at least 3 months despite prescribed therapy and expected to last 12 months, with 29 1. Pain, muscle spasm, and significant limitation of motion in the spine; and 30 2. Appropriate radicular distribution of significant motor loss with muscle weakness and sensory and reflex loss. 31 In performing the five-step analysis to determine whether Shaw was disabled the ALJ did not refer to the Listing that enumerates severe impairments, yet expressly found that claimant did not meet or equal the medical criteria of a listed impairment and therefore failed to establish disability on March 31, 1985. Concluding that Shaw did not have a disability per se under step three of the analysis, the ALJ proceeded to step four, and found him capable of performing his past relevant work as a machinist, described as light work, and other light work. 32 Claimant contended on appeal that the ALJ erred in concluding that his impairment did not equal a listed impairment, and this occurred because the ALJ discounted his functional limitations and failed to follow the treating physician rule that required him to give controlling or at least greater weight to the opinion of Dr. Cassvan. See 20 C.F.R. § 416.927(d)(2).