United States District Court, E.D. California
MIRANDA P. HOFFMAN, Plaintiff,
CAROLYN W. COLVIN,  Acting Commissioner of Social Security, Defendant.
AMENDED ORDER 
EDMUND F. BRENNAN, Magistrate Judge.
Plaintiff seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner") denying her application for Disability Insurance Benefits ("DIB") under Title II of the Social Security Act (the "Act"). As discussed below, plaintiff challenges an ALJ decision that, although she became disabled beginning on December 1, 1994, her disability ended on April 1, 1998, and that she was not entitled to benefits. Presently before the court is plaintiff's motion for summary judgment. ECF No. 14.
The procedural posture of this case is unusual and complicated. The issues involve a May 28, 1997 application which resulted in a final decision of the Commissioner that plaintiff was disabled and entitled to Supplemental Security Income ("SSI") under Title XVI of the Act as of May 1, 1997, a Continuing Disability Review which resulted in a final decision that plaintiff continued to be disabled as of November 15, 2002, and an ALJ decision on a subsequent Title II application (filed on October 8, 2004) that, notwithstanding the Commissioner's final decision in November 2002, plaintiff's disability ended on April 1, 1998. The crux of the issue presented here is on what evidence and according to what standards and authority did the ALJ set aside the earlier final decision of the Commissioner?
Plaintiff argues on this motion that the ALJ (i.e., the Commissioner) was collaterally estopped from finding that Plaintiff was no longer disabled as of any time on or prior to the November 15, 2002 decision. Therefore, plaintiff seeks an order from the court reversing the most recent "final" decision of the Commissioner and ordering the payment of benefits or, in the alternative, remanding the case for further administrative proceedings. For the reasons discussed below, the court grants plaintiff's motion, reverses the ALJ's decision that plaintiff's disability ended on April 1, 1998, and remands the matter for further consideration consistent with this order.
On May 28, 1997, plaintiff filed an application for both DIB and SSI. Administrative Record ("AR") 297, 344. Thereafter, the Commissioner granted plaintiff's application for Title XVI benefits, finding that plaintiff had been disabled as of May 1, 1997. AR 298, 344. However, the Commissioner also determined that plaintiff was not eligible for Title II benefits because there was insufficient evidence to demonstrate that she was disabled prior to September 30, 1995, the date that she last met the insured status requirement for Title II benefits. AR 298-99.
Significantly, the Commissioner later conducted a Continuing Disability Review to determine whether plaintiff continued to be disabled. AR 298. Pursuant to that review, the Commissioner found on November 15, 2002 that plaintiff continued to be disabled as of that date. Id. There were no further reviews of that decision and it became a final and binding decision of the Commissioner. 20 C.F.R. §§ 404.905 and 416.1405. Thereafter, plaintiff continued receiving Title XVI disability benefits until February 2007, at which time her eligibility terminated, not because of a finding that she was no longer disabled, but rather because her financial resources then exceeded the eligibility limits for SSI. Id.
SSI is a needs-based program, and one of last resort. As such, it requires all applicants as well as current beneficiaries to seek and apply for any other benefits for which they might be eligible, including Title II benefits under the Social Security Act. 20 C.F.R. § 416.210. The failure to do so results in either the denial or termination of SSI benefits. Id. § 416.210(e). Thus, on October 8, 2004, (and prior to the termination of her SSI benefits), plaintiff again applied for DIB under Title II. AR 54-58, 298. That application, and the subsequent decision by an ALJ to effectively reconsider the Commissioner's continuing disability finding of November 15, 2002, present the issue raised herein. Id.
The application was initially denied on January 20, 2005, and upon reconsideration on March 10, 2005. AR 17-22, 25-27. On January 16, 2007, a hearing on the application was held before administrative law judge ("ALJ") Guy E. Fletcher. AR 263-81. Plaintiff was represented by counsel at the hearing, at which plaintiff and a vocational expert ("VE") testified. Id.
On February 20, 2007, the ALJ issued a decision finding that plaintiff was not disabled under sections 216(I) and 223(d) of the Act through September 30, 1995, the date last insured. AR 16. The ALJ made the following specific findings:
1. The claimant last met the insured status requirements of the Social Security Act on September 30, 1995.
2. The claimant did not engage in substantial gainful activity during the period from her alleged onset date of April 10, 1990 through her last date insured on September 30, 1995 (20 CFR 404.1520(b) and 404.1571 et seq. ).
3. Through the date last insured, the claimant had the following medically determinable impairments: polysubstance dependence and an affective disorder (20 CFR 404.1520(c)).
4. Through the date last insured, excluding the effects of substance abuse, the claimant did not have an impairment or combination of impairments that significantly limited her ability to perform basic work-related activities for 12 consecutive months; therefore, the claimant did not have a severe impairment or combination of impairments aside from substance abuse (20 CFR 404.1521).
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5. The claimant was not under a disability, as defined in the Social Security Act, at any time from April 10, 1990, the alleged onset date, through September 30, 1995, the date last insured (20 CFR 404.1520(c)).
The Appeals Council denied plaintiff's request for review of the ALJ's decision. AR 4-7. Plaintiff then filed a civil action. On January 28, 2008, the United States District Court for the District of Maine granted the Commissioner's request for voluntary remand of the claim for a new ALJ hearing to obtain expert medical testimony. AR 316-18.
A supplemental hearing was held before ALJ Peter Belli on October 20, 2008. AR 396-446. Plaintiff had a non-attorney representative at the hearing, at which plaintiff, a vocational expert (hereafter "VE"), and a medical consultant, James E. Shoemaker, M.D., testified. Id. On February 6, 2009, ALJ Belli issued a decision finding first that plaintiff met the Listing of Impairments and therefore was presumptively disabled under Title II of the Act through March 31, 1998,  but secondly that as of April 1, 1998, plaintiff had improved and regained the residual functional capacity ("RFC") to perform unskilled work. AR 297-314. After posing a ...