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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING
Regular Panel Decision
Sep 29, 2014

Hairston v. Commissioner of Social Security

Denise M. Hairston, on behalf of her minor daughter S.N., sought judicial review of a final decision by the Commissioner of the Social Security Administration, which denied S.N.'s application for Supplemental Security Income (SSI) benefits. S.N. alleged disability due to various impairments, including migraine headaches, obesity, impulse control disorder NOS, and depressive disorder NOS, leading to functional limitations. The Administrative Law Judge (ALJ) found that S.N.'s impairments were severe but did not meet or medically equal a listed impairment, and functionally equaled only a "marked" limitation in the "caring for yourself" domain, thus denying benefits. The United States Magistrate Judge Frank Maas denied the Commissioner's motion for judgment on the pleadings, concluding that the ALJ's finding regarding S.N.'s health and physical well-being domain did not withstand scrutiny and required further fact-finding regarding the frequency and intensity of her migraines. The case was remanded to the Commissioner for further proceedings, including obtaining additional school and medical records, and ensuring the claimant's understanding and waiver of the right to counsel.

Social Security BenefitsSupplemental Security Income (SSI)Child DisabilityDepressive Disorder NOSMigraine DisorderObesityFunctional ImpairmentAdministrative Law Judge (ALJ)Judicial ReviewRemand Order
References
34
Case No. ADJ7087449
Regular
Nov 02, 2012

ELVIRA VASQUEZ vs. DEL MONTE FOODS, ZURICH INSURANCE

This case involves a workers' compensation claim by Elvira Vasquez against Del Monte Foods. The defendant sought reconsideration of a prior Appeals Board decision that found applicant sustained an industrial injury and that the defendant failed to prove intoxication was the proximate cause. The defendant argued the applicant's amphetamine use was established and impaired her function, making it a substantial factor in the injury. The Appeals Board denied reconsideration, holding that a positive drug test alone is insufficient to prove intoxication or causation, citing precedent that requires further evidence of impaired function or substantial evidence of causation.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryLabor Code Section 3600(a)(4)Proximate CauseIntoxicationBurden of ProofAmphetaminesDrug TestImpaired Function
References
1
Case No. CV-23-0056
Regular Panel Decision
Dec 14, 2023

In the Matter of the Claim of Daniel Villagil

Claimant Daniel Villagil appealed two decisions from the Workers' Compensation Board. He sustained lower back and left leg injuries from a pot of boiling water in October 2019, leading his treating physician to suggest a 20% schedule loss of use (SLU) award for his left leg. The employer and carrier objected, arguing the scars weren't a basis for SLU. A Workers' Compensation Law Judge denied the award due to the physician's report lacking explanation for the percentage and failing to document permanent physical/functional impairments. The Board affirmed this, finding no credible medical evidence of permanency or functional impairment. Claimant's subsequent application for reconsideration was also denied, prompting these appeals. The Appellate Division affirmed the Board's decision, citing the lack of credible medical proof and the conclusory nature of the treating physician's report, and found no abuse of discretion in denying reconsideration.

Schedule Loss of UsePermanent ImpairmentMedical EvidenceTreating Physician ReportMaximum Medical ImprovementWorkers' Compensation BoardAppellate DivisionReconsideration ApplicationFunctional ImpairmentScars
References
7
Case No. MISSING
Regular Panel Decision

Smith v. Apfel

The plaintiff applied for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits, alleging disability since August 1993 due to bipolar disorder, attention deficit hyperactivity disorder (ADHD), and phobias. The Administrative Law Judge (ALJ) denied the claim, a decision upheld by the Appeals Council. The plaintiff subsequently brought this matter to the District Court, contending that the ALJ misapplied legal standards by failing to properly weigh his treating physician's opinion, incorrectly concluding his impairments did not meet a listed impairment, and inadequately describing his work capabilities. The court found that the ALJ failed to apply the proper legal standard to the treating physician's opinion and improperly discredited the plaintiff's subjective complaints by mischaracterizing evidence in the record. As a result, the court reversed the ALJ's decision and remanded the case, ordering reconsideration of the treating physician's opinion, the plaintiff's functional limitations, and further development of the record concerning the plaintiff's residual functional capacity.

Disability BenefitsSocial Security ActSSISSDIBipolar DisorderADHDPhobiasTreating Physician RuleALJ ErrorRemand
References
24
Case No. 2023 NY Slip Op 06426 [222 AD3d 1154]
Regular Panel Decision
Dec 14, 2023

Matter of Villagil v. Sauce Pizzeria III, LLC

Daniel Villagil, a cook, sustained lower back and left leg injuries from boiling water in 2019. His treating physician proposed a 20% schedule loss of use (SLU) award for his left leg, citing maximum medical improvement and permanent impairment. However, the employer and carrier objected, leading a Workers' Compensation Law Judge to deny the award due to the physician's report lacking explanation for the SLU calculation or documentation of functional impairments. The Workers' Compensation Board affirmed this decision, finding no credible medical evidence, which was subsequently affirmed by the Appellate Division, Third Department. The court noted the conclusory nature of the physician's report, which failed to detail test results or specific impairments to support an SLU award.

schedule loss of useSLU awardpermanent impairmentmaximum medical improvementMMImedical evidencefunctional impairmentscarringgoniometerrange of motion
References
7
Case No. MISSING
Regular Panel Decision

Guttierez v. Berryhill

Betsy Lee Guttierez applied for disability insurance benefits and Supplemental Security Income, alleging disability due to various mental health impairments. Her applications were denied by an Administrative Law Judge and the Appeals Council. Guttierez sought judicial review, arguing that the ALJ failed to properly assess her residual functional capacity (RFC) by rejecting the only medical opinion on her mental ability to work without providing adequate reasons or a function-by-function analysis. The Court agreed, finding the ALJ's RFC assessment unsupported by substantial evidence, as the ALJ, a non-medical professional, made a determination of Guttierez's mental capacity without relying on a medical opinion. Consequently, the Court granted Guttierez's motion, denied the Commissioner's motion, and remanded the case for further administrative proceedings.

Social Security ActDisability BenefitsSSIALJ Decision ReviewRFC AssessmentMedical EvidenceMental Health ImpairmentsBipolar DisorderAnxiety DisorderTreating Physician Rule
References
13
Case No. MISSING
Regular Panel Decision

Rosado v. Astrue

Pro se plaintiff Eli E. Rosado challenged the final decision of the Commissioner of Social Security denying him Disability Insurance and Supplemental Security Income benefits. Rosado alleged disability from April 1997 due to various physical and mental impairments; however, Administrative Law Judge Dennis G. Katz denied his initial application, a decision later upheld by the Appeals Council. The federal court reviewed whether the Commissioner's decision was supported by substantial evidence, applying the five-step sequential evaluation process for disability claims. The court concluded that while Rosado had severe impairments, they did not meet or medically equal listed impairments and he retained the residual functional capacity to perform other work in the national economy. Consequently, the Magistrate Judge granted the Commissioner's motion for judgment on the pleadings, affirming the denial of benefits.

Social Security ActDisability BenefitsSupplemental Security IncomeAdministrative Law Judge (ALJ)Residual Functional CapacityTreating Physician RuleSubstantial EvidenceMotion for Judgment on the PleadingsLumbar Spine PainHypertension
References
77
Case No. MISSING
Regular Panel Decision
Apr 29, 2010

Campbell v. Astrue

Bruce Campbell (Plaintiff) filed an action seeking review of the Commissioner of Social Security's denial of his application for Supplemental Security Income. Magistrate Judge Victor E. Bianchini issued a Report-Recommendation, which Chief Judge Norman A. Mordue adopted. The case involves a claimant's disability determination, focusing on his alleged illiteracy, residual functional capacity (RFC), mental impairments, and obesity. The court identified several deficiencies in the administrative law judge's (ALJ) decision, including an unsupported finding regarding the plaintiff's education level, a potentially flawed RFC assessment due to reliance on a non-medical opinion, and a failure to consider a reviewing psychologist's opinion on mental impairments. Consequently, the court remanded the Commissioner's decision for further proceedings to properly develop the record on the plaintiff's literacy, reconsider the RFC, and re-evaluate his mental impairments.

Social Security ActSupplemental Security IncomeDisability BenefitsResidual Functional CapacityIlliteracyMental ImpairmentsObesityVocational FactorsMedical-Vocational RulesAdministrative Law Judge
References
32
Case No. MISSING
Regular Panel Decision

Antonetti v. Barnhart

This case involves Eliabnel Antonetti's appeal of the Commissioner of Social Security's final determination that he is not disabled, seeking Supplemental Security Income benefits. The Commissioner conceded legal errors by the Administrative Law Judge (ALJ) in evaluating Antonetti's mental retardation and speech impairment, moving for a remand for a new hearing and reevaluation. Antonetti, while agreeing on the need for reversal, sought remand solely for the calculation and payment of benefits due to what he believed was substantial evidence of disability. The District Court granted the Commissioner's motion, denied Antonetti's, and remanded the case for further administrative proceedings, directing the ALJ to properly assess IQ tests, speech impairments, and their impact on work-related functional limitations using the "severity test" under Section 12.05C of the Listing of Impairments. The court also highlighted the need to develop a complete administrative record due to inaudible portions in the prior hearing transcript.

Disability BenefitsSupplemental Security IncomeSocial Security ActMental RetardationSpeech ImpairmentIQ TestsALJ ErrorRemandAdministrative RecordSeverity Test
References
16
Case No. MISSING
Regular Panel Decision

Deshotel v. Berryhill

This case reviews an Administrative Law Judge's (ALJ) decision regarding a plaintiff's Social Security disability benefits claim. The ALJ had determined that the plaintiff suffered from severe impairments, including migraine headaches, anxiety, depression, hand numbness, and fibromyalgia, and had the residual functional capacity (RFC) to perform sedentary work. However, the Court found that the ALJ erred by assessing the impact of the plaintiff's depression and anxiety on her RFC without the benefit of medical opinion evidence, thus rendering the administrative record incomplete. Despite the Commissioner's argument that the impairments were minor, the Court emphasized that the ALJ's own finding of "severe" impairments necessitated further development of the record, including obtaining medical opinions. Consequently, the Court granted the plaintiff's motion for judgment on the pleadings, denied the Commissioner's cross-motion, reversed the Commissioner's decision, and remanded the case for additional administrative proceedings to gather the necessary medical opinion evidence concerning the plaintiff's mental limitations.

Social Security ActDisability BenefitsAdministrative Law JudgeResidual Functional CapacityMedical Opinion EvidenceMental ImpairmentsDepressionAnxietyRemandSubstantial Evidence
References
12
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