N.Y. Court Clarifies Administrative Standard of Review in Disability Determinations

On October 20, Judge Therese Dancks expounded upon the legal standard of review necessary for an Administrative Law Judge (ALJ) to follow when determining whether a plaintiff has a mental disability qualifying for benefits under the Social Security Act. In summation, the judge ruled that an ALJ is not allowed to exclude any relevant evidence, even if the relevant evidence is only discovered following due diligence of the examining board.

The clarified standard arose out of a controversy involving a plaintiff, Virginia R., who sought review in a federal magistrate court after an ALJ denied her application for federal disability benefits, ruling that Virginia failed to provide evidence of the existence of a disability via mental impairment. The court, while not confirming whether or not the plaintiff maintained a mental disability, held that the ALJ failed to follow the evidentiary review process mandated under federal law when making a determination as to whether a disability exists. Specifically, the judge stated that the ALJ failed to examine letters from the plaintiff’s previous physician prior to adjudging that no mental health impairment subsisted. 

The court elucidated that the law required an ALJ to consider “all medical opinions received regarding the claimant” and “appropriately explain the weight afforded to opinion and medical evidence.” As such, Judge Dancks continued, “an ALJ’s failure to acknowledge relevant evidence … is plain error,” making the disability determination subject to appellate review, and where appropriate, remanding for reconsideration as to the outcome with the proper evidence present in the factual record. Relevant evidence, the court defined, means all evidence that, if properly considered and weighed, created “at least a reasonable likelihood that a different result could be reached” by the ALJ. This relevant evidence, concluded the court, must be located and examined, even if, in certain circumstances, it required the ALJ to gather the evidence on the judge’s own fruition. “This duty to develop the record has its roots in the (ALJ’s) regulatory obligation to ascertain a claimant’s complete medical history before making a disability determination.” 

The case is now remanded back to the ALJ with the requirement that the administrative judge “seek further records from (the plaintiff’s physician) and a medical source statement detailing (their) opinion as to (the) (p)laintiff’s mental impairments.”

The plaintiff is represented by Segar and Sciortino, LLC