Encarnacion Ex Rel. George v. Barnhart

191 F. Supp. 2d 463, 2002 WL 493403
District Court, S.D. New York·Decided March 29, 2002·No. 00 CIV 6597(LTS)(THK)·Published·Cited by 5 cases

Opinion

OPINION AND ORDER ON MOTION TO DISMISS AND FOR JUDGMENT ON THE PLEADINGS AND ON MOTION FOR CLASS CERTIFICATION

SWAIN, District Judge.

This lawsuit, plead in relevant part as a class action, challenges the method by which the Commissioner of Social Security (“Commissioner” or “Defendant”) determines disability in children for the purpose of awarding benefits under the Supplemental Security Income (“SSI”) program, which is administered by the federal Social Security Administration (“SSA”). On January 11, 2002, this Court issued an opinion and entered orders denying a motion for consolidation of this action with a second, individual, action in which the plaintiff sought review of the Commissioner’s denial of SSI benefits, dismissing that second action as moot in light of the Commissioner’s proffer of full relief to the plaintiff therein, and granting Plaintiffs’ motion to file a second amended complaint in this action adding two new proposed class representatives. 1

This opinion addresses Plaintiffs’ motion for class certification and Defendant’s motion to dismiss the complaint and for judgment on the pleadings to dismiss Plaintiffs’ First Claim set forth in the Second Amended Complaint, 2 both of which motions were argued in November 2001. 3 The Court has considered carefully all ar *465 guments made in connection with the pending motions. For the reasons discussed herein, Plaintiffs’ motion for class certification will be denied and Defendant’s motion for judgment on the pleadings will be granted.

BACKGROUND

The following factual recitation is taken from Plaintiffs’ Second Amended Class Action Complaint.

The Supplemental Security Income (“SSI”) program provides cash assistance to low income individuals who are aged, blind, or disabled, including disabled children. To be eligible for SSI benefits, a child must meet income and resource eligibility requirements and be under 18 and disabled. Prior to 1996, the Social Security Act (the “Act”) defined disability for children in relation to its definition of disability for adults, finding disability in a child if he or she .suffered from any medically determinable physical or mental impairment of “ ‘comparable severity’ ” to an impairment that would render an adult disabled. (Compl. at ¶ 29 (quoting 42 U.S.C. § 1382c(a)(3)(A)).) From 1974-1990, pursuant to the Commissioner’s regulations implementing the Act, SSI benefits were provided only for those children whose condition met or medically equaled one of the impairments enumerated in a “Listing of Impairments,”'published in the regulations (the “listings”). In February of 1990, however, the Supreme Court held that the regulations the Commissioner used to determine childhood disability failed to implement the comparable severity standard established by the Act because the “ ‘listings-onl/ ” approach was more restrictive than the statutory standard for adults and because it failed to provide an “‘individualized, functional analysis’” of the degree of disability. (Compl. at ¶31 (quoting Sullivan v. Zebley, 493 U.S. 521, 110 S.Ct. 885, 107 L.Ed.2d 967 (1990)).)

In response to the Zebley decision, the Commissioner promulgated new regulations regarding the comparable severity standard. Under the regulations, which went into effect in 1993, childhood disability determinations commenced, as before, with an examination of whether the child’s impairments met or medically equaled a listing. If they did not, the Commissioner then conducted an “individualized functional assessment” (“IFA”), by which it was determined whether a child’s impairments) in (depending on age) five or six developmental or functional “domains” rendered the child disabled. Limitations in each of the domains were labeled “mild,” “moderate,” or “marked.” A child whose IFA showed a “marked” limitation in one domain and a “moderate” limitation in another domain, or “moderate” limitations in three domains, was to be considered disabled. The Commissioner had the flexibility to factor in mild limitations as well: the “ ‘one marked plus one moderate’ ” or “ ‘three moderate’ ” standards were “ ‘only guidelines to illustrate severity.’ ” (Compl. at ¶ 33 (quoting 20 C.F.R. § 416.924e(a) (1993)).) Using those guidelines, the Commissioner decided disability claims on a case-by-case basis, by taking into account all relevant evidence in the record. (Compl. at ¶ 33 (citing 20 C.F.R. § 416.924e(a) (1993)).)

In 1996, Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act (“PRWORA”), which directed the Commissioner to discontinue use of the IFA and to apply a new disability standard in making new childhood disability determinations and in redetermining eligibility of children who had been found to be disabled under the earlier (1993) regulations. The PRWORA changed the Act’s definition of a disabled child: “An individual under the age of 18 shall be considered disabled for purposes of this title if that individual has a medically determinable *466 physical or mental impairment, which results in marked and severe functional limitations .... ” (Compl. at ¶ 37 (quoting 42 U.S.C. § 1382c(a)(3)(C)).) In response to the PRWORA, the Commissioner established a new standard for determining childhood disability in regulations issued in 1997. As under the prior regulations, a child is eligible for disability benefits if his or her impairments meet or medically equal a listing, and age and income requirements are satisfied. If the impairments do not meet or medically equal a listing, the 1997 regulations require that the Commissioner determine whether the child has an impairment that “functionally equals” a listed impairment, rather than assessing functional impairment by conducting an IFA. (Compl. at ¶ 38 (citing 20 C.F.R. §§ 416.924(d), 416.926a(a)).) A child satisfies this criterion if he or she has the requisite number and degree of limitations in one or more of certain “ ‘broad areas of development or functioning.’ ” (Compl. at ¶ 38 (quoting 20 C.F.R. § 416.926a(b)(2)).) Instead of the “one marked plus one moderate,” or “three moderate” limitations required by the earlier regulations, the 1997 regulations require that a child demonstrate an “extreme” limitation in one broad area or “marked” limitations in any two of the identified areas of development or functioning to be eligible for disability benefits. 4

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Encarnacion Ex Rel. George v. Barnhart, 191 F. Supp. 2d 463, 2002 WL 493403 (S.D.N.Y. 2002).

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