Curtin v. Barnhart
Filing
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DECISION and ORDERED, that Plaintiffs Motion for judgment on the pleadings (Dkt. No. 9) is DENIED; and it is further ORDERED, that Defendants Motion for judgment on the pleadings (Dkt. No. 16) is GRANTED; and it is further ORDERED, that Administrative Law Judge Stephans November 2007 decision (Dkt. No. 1 at 40) is AFFIRMED. Signed by Senior Judge Lawrence E. Kahn on September 27, 2012. (sas)
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF NEW YORK
PAMELA CURTIN on behalf of
Brian C. Sheil,
Plaintiff,
-against-
3:10-CV-1401 (LEK/DRH)
JO ANNE B. BARNHART,
COMMISSIONER OF SOCIAL
SECURITY,
Defendant.
DECISION and ORDER
I.
INTRODUCTION
Presently before the Court are two Motions for judgment on the pleadings, filed by Pamela
Curtin (“Plaintiff”) on behalf of Brian C. Sheil on July 18, 2011 and by Defendant Jo Anne B.
Barnhart, Commissioner of Social Security on November 29, 2011. Dkt. Nos. 9 (“Plaintiff’s Brief”),
16 (“Defendant’s Brief”). Plaintiff is appealing the unfavorable decision made by Administrative
Law Judge (“ALJ”) Carl E. Stephan, denying her application for Supplemental Security Income
(“SSI”). Dkt. No. 1 (“Complaint”) at 51. For the reasons stated below, ALJ Stephan’s decision is
affirmed.
II.
BACKGROUND
This action began with an administrative hearing on September 13, 2000, after Pamela Curtin,
mother and trustee of Claimant Brian Sheil (“Claimant”), was initially denied SSI for her son. Id. at
13. Plaintiff had created a special needs trust (“Trust”) in 1998 worth approximately $500,000, left
from Plaintiff’s deceased father, which dispersed approximately $4,000 per month. Def.’s Br. at 3.1
Plaintiff used this money to pay for Claimant’s transportation and stay at a residential medical
treatment facility (“Berkeley Oaks”) at McLean Hospital from March 20, 1996 until September 5,
2000. Id. Pursuant to a hearing, Administrative Law Judge (“ALJ”) Robert Wright issued a favorable
decision for Plaintiff, and Claimant was granted SSI. Id. However, on May 2, 2001, the Appeals
Council, on its own motion, reviewed and subsequently vacated the decision. Id. at 18. The Council
rendered a new decision unfavorable to Plaintiff. Id.
Plaintiff then appealed to United States District Court for the Northern District of New York.
Id. at 37. On September 10, 2004, the District Court vacated the Appeals Council’s decision and
remanded for another hearing on the grounds that the record lacked substantial evidence to determine
in what capacity Claimant was residing at Berkeley Oaks. Id. On December 28, 2005, ALJ Carl E.
Stephan issued a decision in Plaintiff’s favor. Id. at 26 The Appeals Council again vacated and
remanded the decision, instructing ALJ Stephan to investigate the case further. Id. at 51. Based on
new evidence, ALJ Stephan issued a second decision unfavorable to Plaintiff on November 19, 2007.
Id. Plaintiff now appeals to the Court.
III.
STANDARD OF REVIEW
A court reviewing a denial of disability benefits may not determine de novo whether
an individual is eligible for SSI. See 42 U.S.C. §§ 405(g), 1383(c)(3). Rather, the Commissioner’s
determination will only be reversed if the correct legal standards were not applied, or it was
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All page numbers refer to the printed numbers at the bottom of each page rather than the
electronically inserted numbers at the top of each page.
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not supported by substantial evidence. Johnson v. Bowen, 817 F.2d 983, 986 (2d Cir. 1987); see Grey
v. Heckler, 721 F.2d 41, 46 (2d Cir. 1983); Marcus v. Califano, 615 F.2d 23, 27 (2d Cir. 1979).
Substantial evidence is “more than a mere scintilla” and “means such relevant evidence
as a reasonable mind might accept as adequate to support a conclusion.” Richardson v. Perales,
402 U.S. 389, 401 (1971). In deciding whether the Commissioner’s decision is supported by
substantial evidence, the Court defers to the Commissioner’s resolution of conflicting evidence.
Clark v. Commissioner of Social Security, 143 F.3d 115, 118 (2d Cir. 1998). If substantial
evidence in the record supports the Commissioner’s factual findings, they are conclusive and
must be upheld. Perez v. Chater, 77 F.3d 41, 46 (2d Cir. 1996) (citing 42 U.S.C. § 405(g)).
If supported by substantial evidence, the Commissioner’s finding must be sustained
“even where substantial evidence may support the plaintiff’s position and despite that the
court’s independent analysis of the evidence may differ from the [Commissioner’s].” Rosado
v. Sullivan, 805 F. Supp. 147, 153 (S.D.N.Y. 1992). In other words, the Court must afford
the Commissioner’s determination considerable deference, and may not substitute “its own
judgment for that of the [Commissioner], even if it might justifiably have reached a different
result upon a de novo review.” Valente v. Sec’y of Health & Human Servs., 733 F.2d 1037,
1041 (2d Cir. 1984).
IV.
DISCUSSION
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A United States citizen is eligible for SSI if that citizen is disabled and does not have more
income or resources than is permitted. 20 C.F.R. § 416.202. At issue is whether Plaintiff’s Trust
disbursements used to pay for Claimant’s stay at Berkeley Oaks constituted income that would bar
him from SSI eligibility.
For the purposes of SSI, “income” is defined as “anything you receive in cash or in kind that
you can use to meet your needs for food and shelter.” 20 C.F.R. § 416.1102. “Some things you
receive are not income because you cannot use them as food or shelter, or use them to obtain food or
shelter.” 20 C.F.R. § 416.1103. Among the listed items that are not considered income are, in
relevant part, medical care and services that include “[r]oom and board you receive during a medical
confinement.” 20 C.F.R. § 416.1103(a)(2). In making his determination, ALJ Stephan reviewed the
Social Security Administration (“SSA”) procedure for determining what constitutes medical
confinement:
Consider the individual’s stay to be for a medical confinement when the individual
is an inpatient in an institution, or that part of an institution which is licensed or
otherwise approved by a Federal, State, or local government to provide medical
services and the individual is in the institution for the primary purpose of receiving
medical services.
(SSA POMS SI 00520.400.)
The two leading cases on distinguishing a group home setting from a medical facility are
Lapin v. Mathews, 422 F. Supp. 1089 (D.D.C. 1976) and Slavin v. Sec’y of Dept.of Health, Ed.
& Welfare, 486 F. Supp. 204 (S.D.N.Y. 1980). Both Lapin and Slavin require courts to ascertain
whether a disabled person was residing at a treatment facility in a medical confinement capacity
or an assisted living capacity for the purpose of determining SSI eligibility. Lapin v. Mathews,
422 F. Supp at 1091. While a medical facility may provide some incidental, assisted living
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services, the disabled person’s main purpose at the facility must be medical in order to exempt
a claimant’s expenses from income calculations. Slavin v. Sec’y of Dept.of Health, Ed. &
Welfare, 486 F. Supp. 204, 207. Among the factors considered to make this determination are
whether there are full time physicians on staff at the facility, whether the residents are billed
separately for medical treatment and room and board costs, and what level of medical training is
required for supervisory employees. Lapin v. Mathews, 422 F. Supp at 1091-92.
Determining the capacity of Claimant’s stay at Berkeley Oaks has been a challenge because it
no longer exists under the same name and is presently a different facility than it was when Claimant
was a resident. Dkt. No. 1-7 (“ALJ Decision”) at 6. However, in diligently investigating the capacity
of Claimant’s residence, ALJ Stephan was able to acquire a detailed evaluation of the approximate
value of daily medical and residential services Claimant received from Mary Gormley, a former
employee who worked in a management capacity while Sheil was a resident. Id. Ms. Gormley stated
that of Claimant’s daily facility charge of $110, approximately $47.87 was allocated to medical
treatment and monitoring costs, and $63.13 was allocated to food, clothing, and shelter costs. Id.
This assessment supports ALJ Stephan’s finding that the majority of the trust money being
used to pay for Claimant’s stay at Berkeley Oaks was going towards food, shelter, and clothing and
consequently should be regarded as countable income for the purposes of SSI eligibility. This finding
is also supported by the Lapin and Slavin factors. There was not a full time physician on staff, and
medical treatment bills including doctor visits, medication, and psychiatrist visits were paid for
separately by insurance and not as part of the $110 per day charge. Id. at 6-7. The percentage of the
daily charge that was allocated to Claimant’s “medical treatment” primarily paid for non-psychiatric
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counseling and monitoring. Id. These details severely weaken the contention that Claimant’s stay
could be regarded as medical confinement.
Further, a form SSA 8045, which verifies that a facility is in fact a medical treatment facility
within the meaning of the relevant social security rules, was never filed for Berkeley Oaks. Id. at 6.
While the absence of this filing is not dispositive, it further counsels against a finding that Berkeley
Oaks was a medical treatment facility.
Accordingly, the Court finds that the Commissioner’s decision was supported by substantial
evidence and should be upheld.
V.
CONCLUSION
Accordingly, it is hereby:
ORDERED, that Plaintiff’s Motion for judgment on the pleadings (Dkt. No. 9) is DENIED;
and it is further
ORDERED, that Defendant’s Motion for judgment on the pleadings (Dkt. No. 16) is
GRANTED; and it is further
ORDERED, that Administrative Law Judge Stephan’s November 2007 decision (Dkt. No. 1
at 40) is AFFIRMED; and it is further
ORDERED, that the Clerk shall serve a copy of this Order on all parties.
IT IS SO ORDERED.
DATED:
September 27, 2012
Albany, New York
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