United States District Court, N.D. Illinois, Eastern Division
LARRY D. KELLAMS, Plaintiff,
CAROLYN W. COLVIN, Commissioner of Social Security, Defendant.
MEMORANDUM OPINION AND ORDER
MATTHEW F. KENNELLY, District Judge.
Larry Kellams filed this suit to challenge the Social Security Administration's denial of his claim for Supplemental Security Income (SSI) benefits. Both he and the Commissioner of Social Security have moved for summary judgment. For the reasons stated below, the Court grants Kellams's motion, denies the Commissioner's motion, and remands the case for further consideration.
Kellams filed his application for SSI benefits on July 9, 2010, stating that he suffered from a history of heart attack and depression. He alleged that he had been disabled and unemployed since September 2007. Kellams ultimately amended his disability onset date to July 2010. The Social Security Administration denied Kellams's application on November 29, 2010 and on reconsideration on April 13, 2011.
Kellams filed a request for a hearing and appeared before an ALJ on June 27, 2012. The ALJ heard testimony from Kellams, his stepfather, his Alcoholics Anonymous (AA) sponsor, and a vocational expert. On July 17, 2012, the ALJ issued her decision, finding that Kellams was not disabled. On July 21, 2013, Kellams submitted records from his stay at Countryside Healthcare Center to the SSA Appeals Council. Because the records were dated from April 9, 2013 to May 31, 2013, the Appeals Council ruled that they did not affect the decision about whether Kellams was disabled on or before July 17, 2012. The Appeals Council also declined to review the ALJ's decision, making the ALJ's ruling the Commissioner's final decision. See Roddy v. Astrue, 705 F.3d 631, 636 (7th Cir. 2013).
In her decision, the ALJ applied the five-step sequential evaluation process outlined in the applicable Social Security regulations to determine whether an individual is disabled. See 20 C.F.R. § 404.1520(a). At step one, the ALJ determined that Kellams had not performed substantial gainful activity since his alleged disability onset date. R. 56. At step two, she concluded that Kellams had the following impairments qualifying as severe under 20 C.F.R. § 416.920(c): coronary artery disease with a history of myocardial infarction (commonly known as a heart attack) and stent placement in 2007; alcohol abuse, in remission; hypertension; mild obesity; major depressive order; and anxiety disorder, not otherwise specified. Id. The ALJ also found that Kellams had a "non-medically determinable" back condition, noting that although he had alleged back pain and exhibited spasm, there was insufficient diagnosis or supportive clinical findings to support a finding that the back condition limited Kellams's ability to work. R. 56-57.
At step three, the ALJ found that Kellams's impairments did not "meet[ ] or medically equal one of the listed impairments" in 20 C.F.R. § 404, Subpart P, Appendix 1. R. 57. Addressing Kellams's physical impairments, the ALJ reported that she "considered listing 4.04 for the claimant's coronary artery disease and hypertension" and found that "the medical evidence do[es] not document listing-level severity." Id.
As for Kellams's mental impairments, the ALJ concluded that they did "not meet or medically equal the criteria of listings 12.04, 12.06, and 12.09." Id. In this regard, the ALJ considered whether "paragraph B" criteria were satisfied. Each of the subsections of Part 12 of Appendix 1, including listings 12.04, 12.06, and 12.09, has a paragraph B requiring the claimant's impairments to result in at least two of the following:
1. marked restriction of activities of daily living; or
2. marked difficulties in maintaining social functioning; or
3. marked difficulties in maintaining concentration, persistence, or pace; or
4. repeated episodes of decompensation, each of extended duration.
According to SSA regulations, a "marked" limitation is one that "seriously interferes with your ability to function independently, appropriately, and effectively" and is greater in degree than a "moderate" or "mild" limitation but less in degree than an "extreme" limitation. 20 C.F.R. § 404, Subpart P, App'x 1. The SSA defines "[r]epeated episodes of decompensation, each of extended duration" as "three episodes within 1 year, or an average of every 4 months, each lasting 2 weeks." Id. The ALJ found that Kellams had a mild restriction in his daily living activities and social functioning, moderate difficulties in concentration, persistence, or pace, and found in the record "one to two" episodes of decompensation of extended duration. R. 57-58.
The ALJ next found that the evidence in Kellams's case also failed to meet the "paragraph C" criteria. Subsections 12.04, 12.06, and 12.09 each contain a paragraph C listing factors an ALJ can consider instead of the paragraph B factors. Paragraph C of subsection 12.04 requires the claimant's impairments to result in one of the following:
1. repeated episodes of decompensation, each of extended duration; or
2. a residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or
3. current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.
Paragraph C of sections 12.06 and 12.09 requires the claimant's disabilities to result in "a complete inability to function independently outside the area of one's home." In this case, the ALJ found that Kellams could "function independently outside of his home" and that ...