Picon-Gonzalez v. Commissioner of Social Security

CourtDistrict Court, D. Puerto Rico
DecidedSeptember 26, 2024
Docket3:23-cv-01297
StatusUnknown

This text of Picon-Gonzalez v. Commissioner of Social Security (Picon-Gonzalez v. Commissioner of Social Security) is published on Counsel Stack Legal Research, covering District Court, D. Puerto Rico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Picon-Gonzalez v. Commissioner of Social Security, (prd 2024).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO

ELADIO P.G.1, Plaintiff, Civil No. 23-1297 (GLS) v.

COMMISSIONER OF SOCIAL SECURITY, Defendant.

OPINION AND ORDER

Plaintiff seeks review of the Commissioner of the Social Security Administration’s (the “SSA” or “agency”) decision to redetermine and terminate his Social Security Disability Insurance (“SSDI”) benefits. Docket Nos. 1, 11. The termination occurred after a rehearing on remand. See Picón-González v. Comm’r of Soc. Sec., No. 18-1016 (BJM), 2019 WL 4187701 (D.P.R. Sept. 4, 2019) (“Picón-González I”). The SSA opposed. Docket No. 16. Plaintiff replied. Docket No. 18. The parties consented to the entry of judgment by a United States Magistrate Judge under the provisions of 28 U.S.C. §636(c). Docket No. 6. After careful review of the administrative record and the parties’ briefs, the SSA’s decision is REVERSED and REMANDED for proceedings consistent with this opinion. I. Procedural Background Plaintiff worked for Abbot Labs for nearly nineteen years as a purchasing section manager and later as a senior planner. Picón-González, 2019 WL 4187701, at *3. On October 27, 2009, Plaintiff applied for SSDI and last met insured status requirements on December 31, 2012. Id.; Tr. 1936. Plaintiff claims to have been disabled since January 25, 2007, due to a spinal disorder which prevented him from bending, kneeling, walking, and using stairs. Id. He testified that he left his job for medical reasons in 2007. Id. He engaged the help of a non-attorney representative, Samuel

1 Plaintiff’s last name is omitted for privacy reasons. Torres Crespo (“Torres-Crespo”), throughout the insurance claims process. In support of his claim, Plaintiff submitted evidence from several doctors, including Dr. José R. Hernández González (“Dr. Hernández”). Id. On March 15, 2010, the SSA found that the evidence supported a disability onset of July 1, 2008. Id. Around that same time, the United States Department of Justice and the Office of the Inspector General (“OIG”) conducted an extensive investigation of doctors in Puerto Rico that were submitting fraudulent medical evidence in SSDI applications. Id. On August 21, 2013, three doctors, Torres-Crespo, and seventy-one disability insurance applicants were indicted for fraud in connection with the OIG investigation. Id. Dr. Hernández, the neurologist who submitted medical evidence in Plaintiff’s case, plead guilty to a conspiracy to make false statements to the SSA. Id. Dr. Hernández admitted that he “would exaggerate medical complaints and symptoms in order to maximize the probability that his patients would be approved for Social Security disability insurance benefits.” Tr. 731. Torres-Crespo pled guilty to having made false and fraudulent statements and representation to the SSA. Id.; Tr. 741-48. As part of his guilty plea, Torres-Crespo admitted that he submitted fraudulent disability reports to the agency. Tr. 741-48. The SSA created a special unit to review nearly 7,000 cases containing evidence submitted by Dr. Hernández, Torres-Crespo, and the other indicted doctors. Picón-González, 2019 WL 4187701, at *4. The special team excluded evidence from those that had been criminally charged and then determined whether sufficient evidence remained to support the disability claims of each claimant. Id. The SSA suspended benefits for those claimants and notified them of the redetermination process pursuant to 42 U.S.C. § 405(u)(1)(A). On January 10, 2014, Plaintiff received notice that his benefits would be suspended pending redetermination because the agency found that he had insufficient evidence to support his benefits allowance. After appealing the denial before an ALJ, the ALJ issued an unfavorable decision in April 2017. Tr. 15-27. Plaintiff sought judicial review. Tr. 2020-21. This District Court held that “Picón’s claim for disability insurance benefits was deemed fraudulent without the opportunity for him to rebut that assertion. Similarly, disregarding evidence absent a direct showing that the evidence has been tainted by fraud denies [] beneficiaries a fair opportunity to make their case.” Picón-González, 2019 WL 4187701, at *16. Consequently, the District Court remanded so that the SSA could provide Plaintiff an opportunity to challenge the finding of fraud and similar fault and the decision to disregard medical reports. Id. at *17. The Commissioner filed an appeal before the First Circuit, but subsequently dismissed the appeal voluntarily. Tr. 2038-39, 2047. In June 2022, the agency sent Plaintiff a “Notice of Hearing” which explained that, under section 405(u), the SSA was required to redetermine his disability case because Dr. Hernández and Torres-Crespo had pled guilty to making false statements to the SSA. Tr. 2176-77. The notice identified evidence that the SSA intended to disregard. See Tr. 2179 (“I will not consider the evidence from Mr. Torres Crespo and Dr. Hernandez-Gonzalez in Exhibits 1B; 2B; 3E; 2F, pages 20-23; 3F, pages 2-11 and 19-22; 11F, pages 81-83 and 128; and 13F, pages 58-60 and 97.”). A rehearing was held before a new ALJ on August 18, 2022. Tr. 1967-87. The ALJ informed Plaintiff that he would have the opportunity to rebut the exclusion of evidence submitted by Dr. Hernández and Torres-Crespo before the ALJ decided whether to disregard any such evidence. Tr. 1968, 1969, 1970. When asked if he wished to rebut the potential exclusion of evidence, Plaintiff referred to a memorandum of facts and law submitted to the SSA.2 Tr. 1970. In his brief, Plaintiff argued that the OIG never found that fraud was present in his case. Tr. 1938. The ALJ relied on the memorandum. Id. And continued to question Plaintiff regarding his symptoms and treatments from 2007 through 2010. At no point during the hearing the ALJ explained how Plaintiff’s records were marred by fraud. On September 6, 2022, the ALJ concluded that Plaintiff was not entitled to disability benefits. Tr. 1936-48. The ALJ reasoned that the Adult Disability Report filled out by Torres-Crespo “contain[ed] a description of symptoms and limitations similar to those that he admitted fabricating.” Tr. 1937. As to the medical records submitted by Dr. Hernández, the ALJ found a reason to believe fraud or similar was involved because Dr. Hernández reported treating Plaintiff monthly, but no treatment notes were available to corroborate that. And because Dr. Hernández “ha[d] admitted to associating himself with Mr. Torres Crespo for a fraudulent purpose, and [] he ha[d] admitted to exaggerating medical complaints and symptoms[.]” Tr. 1938. The ALJ further stated that while Torres-Crespo and Dr. Hernández were indicted and pled guilty in two unrelated cases, they admitted working together in a fraudulent scheme. Id. (“[T]o argue that they only plead guilty in two cases is to ignore their admissions regarding the larger fraudulent scheme.”). The ALJ thus disregarded evidence. Tr. 1938. After considering the remaining evidence in the record, the ALJ found that Plaintiff was not

2 Plaintiff argues that the ALJ failed to consider his memorandum. Docket No. 11 at p. 7. However, the ALJ admitted the memorandum as evidence and discussed its content in her decision. See Tr. 1938, 1970-71. disabled. The Appeals Council denied Plaintiff’s subsequent appeal. Tr. 1921. On June 6, 2023, Plaintiff filed this action. Docket No. 1. II. Discussion Plaintiff’s arguments can be divided into two categories: errors committed by the ALJ and Due Process violations in the redetermination process. The Court begins with the alleged errors in the redetermination process. See Edward J. DeBartolo Corp. v. Fla. Gulf Coast Bldg. & Constr.

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Picon-Gonzalez v. Commissioner of Social Security, Counsel Stack Legal Research, https://law.counselstack.com/opinion/picon-gonzalez-v-commissioner-of-social-security-prd-2024.