Paredes v. Commissioner of Social Security
1:16-cv-00810
| S.D.N.Y. | May 19, 2017Background
- Plaintiff David Paredes (b. 1975) applied for DIB and SSI alleging disability from February 23, 2013; ALJ denied benefits on September 9, 2015 and Appeals Council denied review.
- Medical history: bipolar/schizoaffective disorder with multiple psychiatric hospitalizations (medication-responsive when compliant); degenerative lumbar disc disease; IgA nephropathy → chronic kidney disease (CKD), diagnosed Stage IV by biopsy; fistula created for future dialysis/ transplant evaluation.
- Treatment records show variable labs (BUN ~27; creatinine rising to ~3.4; eGFR readings <20 on at least two occasions) but no treating physicians’ formal medical-source opinions or functional assessments in the record.
- Two ALJ hearings: plaintiff pro se; non‑examining medical expert (Dr. Gussoff) testified that claimant could perform sedentary work; vocational expert identified sedentary jobs.
- ALJ found severe impairments (bipolar/schizoaffective disorder, CKD Stage IV, lumbar degenerative disease), assigned an RFC for sedentary work with simple tasks and limited social contact, relied heavily on Dr. Gussoff, and denied benefits at step five.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| ALJ duty to develop the record re: CKD/nephrology evidence | ALJ failed to obtain treating physicians’ opinions or a consultative nephrology/internal medicine exam despite gaps and claimant being on transplant list | ALJ relied on extensive treatment records and a well-supported non‑examining ME (Dr. Gussoff); no obvious gaps requiring remand | Court: ALJ failed to develop the record; remand required to obtain treating opinions or consultative exam given seriousness of CKD and absence of treating‑source opinions |
| Weight given to non‑examining ME vs. treating/examining sources | ALJ gave "great weight" to non‑examining Dr. Gussoff whose opinion lacked detail and overlooked record elements; gave too little weight to some examining sources | Commissioner argues ME’s opinion and treatment records suffice to assess RFC | Court: ME’s opinion was not sufficiently detailed or tied to controlling listing criteria; ALJ erred in overrelying on it without treating opinions or a consultative exam |
| Step‑three listing determination for genitourinary and spine listings | ALJ made conclusory finding that listings 1.04, 6.05, 6.06, 6.09 not met without analyzing listing elements or addressing eGFR/creatinine evidence | Defendant contends medical records and ME testimony do not show listing‑level severity | Court: ALJ failed to provide adequate reasoning or consider required laboratory metrics (e.g., creatinine, eGFR); substantial‑evidence review impaired; remand required for proper listing analysis |
| HALLEX advisement about right to representation | Paredes argues ALJ did not follow HALLEX in advising pro se claimant about representation | Commissioner notes HALLEX is internal guidance and ALJ did inform claimant he could adjourn to obtain counsel | Court: No reversible error on HALLEX point; ALJ’s advisement sufficient here |
Key Cases Cited
- Jasinski v. Barnhart, 341 F.3d 182 (2d Cir. 2003) (describes five‑step sequential evaluation for disability claims)
- Arone v. Bowen, 882 F.2d 34 (2d Cir. 1989) (DIB insured‑status/date‑last‑insured principle)
- Snell v. Apfel, 177 F.3d 128 (2d Cir. 1999) (ALJ must provide an adequate "roadmap" and reasoned analysis for review)
- Burgess v. Astrue, 537 F.3d 117 (2d Cir. 2008) (substantial evidence standard; treatment of treating‑physician opinions)
- Rosa v. Callahan, 168 F.3d 72 (2d Cir. 1999) (substantial evidence review and RFC determination principles)
- Peed v. Sullivan, 778 F. Supp. 1241 (E.D.N.Y. 1991) (ALJ must obtain treating physician's opinion where necessary to determine disability)