Hart v. Commissioner Social Security Administration
1:22-cv-00620
| D. Or. | Jul 31, 2023Background
- Plaintiff applied for Disability Insurance Benefits; alleged onset Feb 4, 2015; date last insured (DLI) was March 31, 2017.
- In late March 2017 she was hospitalized with sepsis, acute respiratory failure, shock, and acute kidney injury; complications led to a below‑knee amputation (BKA) on April 14, 2017.
- Initial ALJ denied benefits; District Court (Judge Hernández) reversed and remanded in 2021 for inadequate step‑two/onset analysis under the applicable SSR.
- On remand an impartial medical expert (Dr. Dhiman) testified that the March 31, 2017 hospitalization and its complications were severe, that the events could linger up to a year, and that the vascular problems during that hospitalization led to the BKA.
- The ALJ again denied benefits, finding the BKA did not meet/list a listing as of the DLI and characterizing the condition as acute (not traumatic or non‑traumatic under SSR 18‑01p).
- The district court reversed the Commissioner, concluding the hospitalization on March 31, 2017 was a traumatic event causing the BKA, that the ME’s testimony linked the DLI to a disabling condition lasting 12 months, and remanded for immediate calculation of benefits.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the ALJ properly applied SSR 18‑01p in determining onset/type of impairment (traumatic vs non‑traumatic) for the BKA | ALLEY: hospitalization on March 31, 2017 was a traumatic event that led to the BKA and thus establishes onset within insured period | ALJ/Comm’r: conditions were acute and treatable before amputation; BKA did not arise from a traumatic event or a non‑traumatic progressive/static impairment | Court: ALJ erred; record and ME testimony show March 31, 2017 hospitalization was a traumatic event leading to BKA and onset within DLI |
| Whether the medical‑expert testimony and record support a finding that the impairment met/listed criteria and satisfied the 12‑month durational requirement as of the DLI | Plaintiff: ME linked March 31 complications and subsequent BKA; the amputation is evidence that effects lasted beyond 12 months | Comm’r: ME said some conditions were expected to improve; prior to amputation claimant did not meet a listing | Court: ME’s testimony, read as a whole, shows the complications did not respond to treatment, led to the BKA, and produced disabling effects meeting the listing and durational requirement |
| Whether further remand for administrative fact‑finding is required or immediate benefits are warranted | Plaintiff: record is fully developed and supports immediate award of benefits | Comm’r: (implicit) further proceedings may be appropriate to resolve factual issues | Court: record fully developed; immediate award of benefits ordered |
Key Cases Cited
- Hammock v. Bowen, 879 F.2d 498 (9th Cir. 1989) (standard of judicial review of Social Security determinations)
- Bray v. Comm’r of Soc. Sec. Admin., 554 F.3d 1219 (9th Cir. 2009) (definition of substantial evidence)
- Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 1190 (9th Cir. 2004) (courts may not substitute their judgment for the ALJ when the ALJ’s interpretation is rational)
- Orn v. Astrue, 495 F.3d 625 (9th Cir. 2007) (reviewing court must consider the entire record)
- Lichter v. Bowen, 814 F.2d 430 (7th Cir. 1987) (traumatic origin of impairment may inform onset determination)
- Dominguez v. Colvin, 808 F.3d 403 (9th Cir. 2015) (award of benefits appropriate when record is fully developed and the claimant is disabled as a matter of law)