Claim Approved Nine Years and Three Hearings Later

March 1, 2008

Author: Catherine M. Callery (Kate)| Louise M. Tarantino

What would a Disability Law News be without a recounting of one of Buffalo Bruce Caulfield’s victories? Bruce, a paralegal at Neighborhood Legal Services, has triumphed yet again in a case that he estimates took only 85 hours and 35 minutes, spread out over the last nine years!

Bruce’s client had been approved for benefits as a child in 1994 following an ALJ hearing. Bruce began representing her in 1998, when her benefits were discontinued pursuant to a Continuing Disability Review (CDR) reconsideration, which was upheld by an Administrative Law Judge (ALJ) in 1999. In 2002, the Appeals Council remanded the claim, which by then had morphed into an adult psychiatric claim as well as a childhood CDR based on borderline intellectual functioning, learning disabilities and depression, including suicidal gestures as a child. Both claims were denied by a different ALJ in 2003, but remanded again by the Appeals Council in 2005.  In 2006, that same ALJ approved the claim, but with an onset date of January 2006.

Needless to say, Bruce returned to the Appeals Council, pointing out, among other things, that the ALJ had rejected the opinion of the treating psychiatrist as to disability in 2003, yet relied upon the opinion of the same doctor for finding disability in 2006. The ALJ had also rejected treatment notes and records from the treating sources, claiming that they were an amalgam of different hand writing styles, and therefore could not represent the opinion of the psychiatrist, the only person, according to the ALJ, whose opinion should be accorded weight. Bruce produced a letter from the treatment center explaining its treatment team approach and indicating that the psychiatrist read all the assessment and other clinical documents compiled by the members of the team, thus giving them validation.  Bruce also relied on Social Security Ruling (SSR) 06-03p, which requires adjudicators to take the opinions of members of such treatment teams into consideration.

The Appeals Council agreed, and remanded the claim to a different ALJ.  Ironically, it was assigned to the very ALJ who had granted benefits in the first place in 1994.  He was persuaded by Bruce and the evidence that Bruce developed that the claimant had remained disabled as a child, since her condition was functionally equivalent to a listed impairment in that she had marked limitations in two domains.  He also agreed that she continued to be disabled as an adult, in light of her diminished mental residual functional capacity.  He found the claimant disabled from June 1997 to January 2006, and continuing.

Kudos to Bruce for his perseverance, and, always, for his uncanny ability to uncover just the right evidence to win his cases.