Wilson Bahaga v. Commissioner of Social Security

• Court: District Court, S.D. New York
• Decided: July 2, 2020
• Docket: 1:19-cv-05014
• Status: Unknown

Opinion

Mier, warlt DOCUMENT UNITED STATES DISTRICT COURT □□□ FILED SOUTHERN DISTRICT OF NEW YORK << _______—_— eeee □□ □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ DATE FILED: — 7/2/2020 JANIS CHARLENE WILSON BAHAGA, : : 19 Civ. 05014 (KPF) (RWL) Plaintiff, : : ORDER - against - :

COMMISSIONER OF SOCIAL SECURITY, Defendant. nnn eK ROBERT W. LEHRBURGER, United States Magistrate Judge. On July 2, 2020, the Court issued its Report and Recommendation ("R&R") in this social security appeal. The Court previously had issued multiple extensions of Plaintiff's time to respond to the Commissioner's motion for judgment on the pleadings. The final deadline for any response was June 23, 2020. No response was filed. Accordingly, the Court issued its R&R. On the same day the opinion issued, however, the Court received the attached email from the New York County Lawyers Association (NYCLA), which previously had placed Plaintiff with pro bono counsel. In light of the information provided in that email, the Court sua sponte extends the time for the parties to object to the R&R to a total period of 28 days, during which time (1) NYCLA may attempt to locate Plaintiff and find new representation for Plaintiff, and (2) Plaintiff, whether pro se or represented by counsel, may make any application to the undersigned they believe is appropriate.

SO ORDERED.

ROBERT W. LEHRBURGER UNITED STATES MAGISTRATE JUDGE Dated: July 2, 2020 New York, New York Copies transmitted to all counsel of record. The Clerk’s Office is directed to mail a copy of this Order to Plaintiff at the following address and note service on the docket: Janis Charlene Wilson Bahaga 1205 College Avenue, Apartment 6E Bronx, NY 10456

Begin forwarded message: From: Anthe Maria Bova  Date: July 2, 2020 at 9:51:08 AM EDT To: Bob Lehrburger Cc: "alexander.broche@ssa.gov"  Subject: Mail Received by NYCLA for Civil Docket Case 1:19‐cv‐05014‐KPF‐RWL (Request for Extension)

Good morning Judge Lehrburger,

I hope this email finds you well. I received the attached last Friday when our administrative assistant went to our offices to check and scan the mail (our offices are still closed due to the pandemic circumstances). Thank you very much for having your offices forward this. Jonathan Garvin was referred this case some time ago (and has handled cases for us before), so of course we are very concerned to hear that he has not been in touch with the court for several months. We have tried to contact Mr. Garvin, with no success. We also tried contacting Ms. Wilson Bahaga, and have also not heard back from her.

Reviewing PACER I see that your Report and Recommendations have not yet been issued. Understanding that I am not attorney of record, I respectfully request an extension of time to possibly find new representation for Ms. Wilson Bahaga. Mr. Garvin has been a longtime member of NYCLA and it is unusual for him not to respond to us (or the court). We fear something may have happened to him, and while we further investigate this, we do not want Ms. Wilson Bahaga’s case to reach final determination without attempting to find her new counsel—and we know the clock is ticking.

Happy to discuss further, and thank you for your consideration.

Kind regards,

Anthe Maria Bova General Counsel & Director of Pro Bono Programs Fax (212) 406-9252 abova@nycla.org

NYSD_ECF Pool@nysd.uscourts.gov Tuesday, June 02, 2020 3:41 PM CourtMail@nysd.uscourts.gov [EXTERNAL] Activity in Case 1:19-cv-05014-KPF-RWL Wilson Bahaga v. Commissioner of Social Security Order

is an automatic e-mail message generated by the CM/ECF system. Please DO NOT RESPOND to e-mail because the mail box is unattended. TO PUBLIC ACCESS USERS*** There is no charge for viewing opinions. U.S. District Court Southern District of New York of Electronic Filing following transaction was entered on 6/2/2020 at 3:40 PM EDT and filed on 6/2/2020 Name: Wilson Bahaga v. Commissioner of Social Security Number: 1:19-cv-05014-KPF-RWL

Number: 34 Text: On May 18, 2020, the Court issued an order directing the Commissioner to provide answers to certain questions. (Dkt. 29.) A copy of the order is attached. On June 1, the Commissioner filed answers to the questions. (Dkt. 33.) A copy of the letter is attached. If Plaintiff wishes to respond, any such response must be no later than June 23, 2020. Absent any response, the Court will proceed to render its and Recommendation on the current record. The Court also notes that Plaintiff's of record has not been in communication with the Court for several months. The is directed to serve, by June 5, 2020, a copy of this Order and its attachments mail and email on Plaintiff's counsel of record and onPiaintiff directly at her last known SO ORDERED. (Signed by Magistrate Judge Robert W. Lehrburger on 6/02/2020) ama)

Notice has been electronically mailed to: Broche alexander.broche@ssa.gov, NY-OGC.DOJ.SDN Y@ssa.gov Fredric Garvin garvinjonathan@gmail.com Notice has been delivered by other means to: following document(s) are associated with this transaction:

eA OPN WL LE eT ee EN ee DOCUMENT ELECTRONICALLY FILED UNITED STATES DISTRICT COURT ene | SOUTHERN DISTRICT OF NEW YORK DATE FILED: __6/2/2020__f JANIS OHARLENE WILSON BAHAGA, 19 Civ. 5014 (KPF) (RWL) Plaintiff,

- against - : ORDER COMMISSIONER OF SOCIAL SECURITY, . Defendant. ene nnneennnnannnne cernnenenennnenne ntsnnamaen K ROBERT W. LEHRBURGER, United States Magistrate Judge. On May 18, 2020, the Court issued an order directing the Commissioner to provide written answers to certain questions. (Dkt. 29.) A copy of the order is attached. On June 1, 2020, the Commissioner filed answers to the questions. (Dkt. 33.) A copy of the Commissioner's letter is attached. If Plaintiff wishes to respond, any such response must be filed no later than June 23, 2020. Absent any response, the Court will proceed to render its Report and Recommendation on the current record. The Court also notes that Plaintiffs attorney of record has not been in communication with the Court for several months. The Commissioner is directed to serve, by June 5, 2020, a copy of this Order and its attachments by mail and email on Plaintiffs counsel of record and on Plaintiff directly at her last known address.

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ROBERT W. LEHRBURGER UNITED STATES MAGISTRATE JUDGE

Dated: June 2, 2020 New York, New York

IS ee NREL SID SEITEN I BA ERISA EEE “OSB SORRY OT | BOCUMENT ELECTRONICALLY FILED UNITED STATES DISTRICT COURT DOC #: SOUTHERN DISTRICT OF NEW YORK DATE FILED:__5/18/2020 JANIS CHARLENE WILSON BAHAGA. 19 Civ. 5014 (KPF) (RWL) Plaintiff, :

- against - : ORDER COMMISSIONER OF SOCIAL SECURITY, . Defendant. . nnenne nee cenmnn earner □□ ROBERT W. LEHRBURGER, United States Magistrate Judge. By June 1, 2020, the Commissioner shall file a letter addressing the following issue: The claimant identified at least the following treating doctors: Giovanni Franchin, Marta Sales, Ferdinand Banez, Arelene Tieng, and Upendar Bhatt. (See R. 525- 26.) While the record contains opinions of eight consultative or agency physicians, there does not appear to be a medica! source opinion from a treating physician in the record. Accordingly, 1. If there is a medical source opinion from a treating doctor in the record, identify where it appears in the record and ideniify the physician. 2. if there is no such opinion, identify what attempts were made to obtain a medical source opinion from a treating physician, particularly in regard to the mentai health issues. 3. lf there is no such opinion, explain and provide case law for why the case should not be remanded for failure to obtain or seek to obtain a medical source opinion from a treating physician.

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4. If there is a medical source opinion from a treating physician in the record, explain and provide case law for why the case should not be remanded for failure to accord proper weight to the treating physician. Within three (3) days of the date of this order, the Government shall mail a copy of this order to Plaintiff and file proof of such service on ECF. If counsel is unable to complete this mailing as a result of COVID-19 and related disruptions, counsel shali promptly notify the Court by letter filed on ECF.

ROBERT W.LEHRBURGER—i«*” UNITED STATES MAGISTRATE JUDGE

Dated: May 18, 2020 New York, New York Copies transmitted this date to all counsel of record.

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U.S. Department of Justice

ee United States Attorney ee, Southern District of New York SEZ Civil Division

c/o Social Security Adminisivation tel: (212) 264-1331 Office of the General Counsel fax: (212) 264-6372 26 Federal Plaza, Room 3904 Alexander. broche @ssa. gov New York, New York 10278 June 1, 2020 Via CM/ECF Honorable Robert W. Lehrburger United State Magistrate Judge Daniel Patrick Moynihan Courthouse 500 Pearl St. New York, New York 10007 Re: Wilson-Bahaga v. Saul, 19-cv-05014-KPF-RWL

Dear Judge Lehrburger: This Office represents the Defendant, the Commissioner of Social Security (“Commissioner”), in the above-referenced action brought pursuant to 42 U.S.C. § 405(g), challenging a decision by the Commissioner to deny Plaintiffs application for benefits, The Commissioner writes in response to this Court’s May 18, 2020 Order, directing the Commissioner to answer four inquiries. As the Court notes, Plaintiff identified Drs. Giovanni Franchin, Ferdinand Banez, Arlene Tieng, and Upendar Bhatt as treating physicians. See CM/ECF No. 29, referring to Tr. §25-526,' The record contains numerous contemporaneous treatment notes from each of these doctors, as well as the opinions of seven consultative physicians. See Commissioner’s Memorandum of Law in Support of His Motion for Judgment on the Pleadings (“C. Br.”) 6-29. The Commissioner maintains that the totality of the evidence of record—including these sources’ treatment notes, copious medical source opinion evidence, and Plaintiff's reported activities of daily living— constitute substantial evidence supporting Administrative Law Judge (ALJ) Hilton Miller’s determination finding that Plaintiff was no longer disabled as of May 10, 2016. Furthermore, the

! Plaintiff also identified Marta Sales as a treating physician. However, this appears to be an error as Ms. Sales is a nurse practitioner. See □□□□□□□□□□□□□□□□□□□□□□□ org/highlights/our-highlights. Under the regulations in effect at the time of the ALJ’s decision, nurse practitioners, like Ms. Sales, were not considered acceptable medical sources whose opinions were entitled to controlling weight. See 20 C.F_R. §§ 404.1543{(a), (dj(1), 404.1527(a){2), (c)(2), 416.913(a),(d\(2), 404, 1527(a\(2), (e)(2) (2016),

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decision is free of legal error, as the ALJ appropriately evaluated the evidence in accordance with the Commissioner’s regulations and rulings in effect at the time of the ALJ’s decision.’ 1. If there is a medical source opinion from a treating doctor in the record, identify where it appears in the record and identify the physician. Dr. Banez’s Global Assessment of Functioning (GAF) scores appear in the record at Tr. 547- 548, 549-550, 557-558, and 562-567. The regulations define medical opinions as “statements from physicians and psychologists or other acceptable medical sources that reflect judgment about the nature and severity of [a claimant’s] impairment(s), including [the claimant’s] symptoms, diagnosis, and prognosis, what [she] can still do despite impairment(s), and [her] physical and mental restrictions. 20 C.F.R. 416.927(a)(2). GAF scores constitute medical source opinion evidence. See Gonzalez v. Colvin, No. 14-CV-06206, 2015 WL 1514972, at *18 (S.D.N.Y. Apr. 1, 2015) (“Generally, the guidance instructs ALJs to treat GAF scores as opinion evidence. ... .”) (internal citations omitted); see also Tilles v. Comm’r of Sac. Sec., No. 13-CV- 6743, 2015 WL 1454919, at *33 (S.D.N.Y. Mar. 31, 2015). In April 2015, Dr. Banez opined that Plaintiff had a GAF score of 60 (Tr. 545-546), and that score improved to 65 at subsequent visits in May, August, September, and October 2015. A GAF score of 60 indicates moderate (nearly mild) difficulty in social, occupational or schoo! functioning, while a GAF score of 65 denotes only mild symptoms or mild difficulty in social and occupational functioning, but the individual is generally functioning pretty well and has some meaningful interpersonal relationships. See Global Assessment of Functioning, New York State Office of Mental Health, available at bttps:/www.albany.edu/counseling_center/docs/GAF. pdf. (last visited May 19, 2020). Tr. 547-548, 549-550, 557-558, 562-567. As explained in point 4 below, the ALJ appropriately considered this opinion evidence and accorded it some weight. See Tr. 22-23; C. Br. 6, 9. In addition, consistent with Dr. Banez’s GAF scores demonstrating improvement, Drs. Roomana Qayyum and Vicente Liz also provided GAF scores assessing Plaintiffs mental functioning. Tr. 684; Tr. 756, 887. Both Dr. Qayyum and Dr. Liz treated and examined Plaintiff only once at Bronx-Lebanon Hospital. fd. On March 25, 2017, Dr. Qayyum assessed a GAF score of 55. Tr. 684. One month later, on February 26, 2017, Dr. Liz assessed an improved GAF score of 61. Tr.

2 On January 18, 2017, the Social Security Administration (the “agency”) published final rules titled “Revisions to Rules Regarding the Evaluation of Medical Evidence.” 82 Fed. Reg. 5844: see aiso 82 Fed. Reg. 15132 (Mar. 27, 2017) (amending and correcting the final rules published at 82 Fed. Reg. 3844), These final rules are effective for claims filed under the Social Security Act on and after March 27, 2017, and do not apply to the administrative law judge’s (“ALJ’s”) decision in this case. 3 GAF scores, used in earlier versions of the American Psychiatric Association’s, measured psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. The GAF was a scale promulgated by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (“DSM”) to assist ‘in tracking the clinical progress of individuals [with psychological problems! in global terms.”” Kohler v. Astrue, 546 F.3d 260, 262 n.1 (2d Cir, 2008) (quoting DSM (4th ed. 2000})). A GAF score reports a clinician’s judgment of an individual’s overall level of functioning. DSM, 34 (4th ed. text revision 2000) (DSM-IV). The American Psychiatric Association dropped the GAF scale from its latest edition of the DSM. DSM-V at 16 (Sth ed. text revision 2013).

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756, 887. The ALJ considered both these GAF scores and accorded them some weight as well. Tr. 21. 2. If there is no such opinion, identify what attempts were made to obtain a medical opinion from a treating physician, particularly in regard to the mental health issues. As already noted, the record contains medical opinion evidence from Dr. Banez, Plaintiff's treating psychiatrist. In addition, the record reflects that the agency attempted to obtain medical evidence, including medical source opinion evidence, from Plaintiff's treating providers, and demonstrates that ALJ made substantial efforts to develop the record. In this case, the ALJ took substantial steps to develop the record beyond the evidence supplied by Plaintiff and her representative. Specifically, medical evidence (including psychiatric evidence) was requested from Plaintiff's treating providers, including Bronx-Lebanon Hospital,* Promesa,> and the Arthur Avenue Health Clinic. See Requests for Medical Evidence, collectively attached here as Exhibit A, repeated at Tr. 604, 619; see also Tr. 541 (request for treatment records from Dr. Banez); Tr. 642 (request for medical evidence from Bronx Lebanon Hospital, where Drs. Franehin, Bhatt, Tieng, and Maheswara practiced); Tr. 809 (signed authorization to release medical records from Bronx-Lebanon Hospital). In addition, the record contains two Disability Worksheets, which detail the attempts made by the agency to procure medical evidence, including from Promesa and Bronx-Lebanon, and demonstrate that this evidence was made part of the record. See Tr. 447-553, 465-467. These evidentiary requests demonstrate that the agency sought, infer alia, discharge summaries, pulmonary function summaries, and psychiatric records from Plaintiffs treating providers, i.e., records that would inherently include statements reflecting judgments about the nature and severity of Plaintiffs impairments, such as statements about her symptoms, diagnosis, and prognosis, any restrictions, as well as functionality. See Tr. 541, 604. Indeed, the GAF opinions cited above were included in the record because of the agency’s requests. Thus, in making these evidentiary requests, the agency attempted to obtain medical source opinion evidence from Plaintiff's providers. And the record contains hundreds of treatment notes from Plaintiffs mental and physical health providers, including those of Drs. Franchin, Banez, Tieng, and Bhatt. See Tr. 544, 546, 548, 550, 562, 567, 620, 645, 649, 652, 655, 664-668, 733, 791-794, 808, 863, 963, 985, 1012-1015, 1051. The ALJ also ordered numerous consultative examinations to ensure that he had sufficient information to reach a disability determination, and appropriately considered those opinions along with Plaintiff's GAF scores assessed by Dr. Banez, her treating psychiatrist. Tr. 21-23; see 20 C.F.R. § 416.920 (b) (2) (iti) (listing consultative examinations as an appropriate means to resolve insufficiency in evidence).

4 Plaintiff treated with Drs. Franchin, Tieng, Maheswara and Bhatt while at Bronx-Lebanon Hospital. See, e.g., Tr. 605-607, 620, 645, 649, 652, 655, 656-658, 664-667, 733. * Plaintiff attended medication management with psychotherapy at Promesa {also referred to as “Clay Avenue Health Center”) with Dr. Banez. See Tr. 541-568, see also C. Br. 6-7,

in addition to referring Plaintiff for various consultative examinations, at the hearing, the agency also obtained testimony from two medical experts, Dr. Jurano Brooks and Dr. Sharon Keim, a practicing psychologist who had completed two post-doctorate degrees in narcotics and drug research and group therapy. C. Br. at 15; Tr. 61-67. Dr. Brooks opined that Plaintiff’s lupus did not meet or equal any of the impairments listed in the Listings, and that she had no work-related functional limitations. Tr. 62-63. Dr. Brooks also considered whether any medical opinions in the record differed from his own, and he explained that the only inconsistency was between Dr. Long’s May 2017 internal medicine consultative examination report, containing an opinion that Plaintiff had no limitations, and a concurrent functional assessment endorsing limitations in reaching, pushing, and pulling for which Dr. Brooks saw no explanation. See Tr. 63, referring to Tr. 707-717. Dr. Keim opined that Plaintiff's marijuana and alcohol use accounted for all of her psychological problems. Tr. 67. Dr. Keim further opined that without any drug or alcohol usage, Plaintiff would be able to complete simple, routine, and repetitive tasks with superficial contact with others. Tr. 66-67. Thus, not only did the agency assist Plaintiff in attempting to develop a complete medical record, the ALJ also sought medical source opinion evidence from her treating providers and the opinions of experts to opine on her symptomology. 3. Explain and provide case law for why the case should not be remanded for failure to obtain or seek to obtain a medical source opinion from a treating physician. As noted, Dr. Banez’s GAF scores in the record constitute medical opinion evidence, and the agency made numerous attempts to develop the record, including detailed record requests to Plaintiffs treatment providers. To the extent the Court is specifically inquiring about attempts to secure express function-by-function medical source opinion(s) or statement(s) from Plaintiff's treating physicians, the Commissioner respectfully submits that such efforts are not required by either the regulations or Second Circuit case law. The regulations in effect at the time of the ALJ’s decision required the ALJ to develop Plaintiff's “complete medical history” by making “every reasonable effort to help [Plaintiff] get medical evidence from” her treating sources; every reasonable effort means an initial request for the treating source evidence and a follow-up request if the evidence is not received within 10-20 days after the initial request. 20 C.F.R. § 416.912(b)(1)(i)-(ii). This duty extends to claimants who are represented, as Piaintiff was here. See Pratts v. Chater, 94 F.3d 34, 37 (2d Cir. 1996); Perez y. Chater, 77 F.3d 41, 47 (2d Cir, 1996) (citations omitted). A complete medical history consists of the records and medical sources covering at least the 12 months preceding the month in which the claimant files an application for benefits. See 20 C.F.R. § 416.912(b); Bushey v. Colvin, 607 F. App’x 114, 115 @d Cir. 2015). Furthermore, the regulations in effect at the time of the ALJ’s decision here did not provide that a medical report from an acceptable medical source should contain a statement about what the claimant could do, nor require the agency to request such a statement from a medical source who evaluated the claimant, including her treating sources. In fact, the regulations specified that the absence of a medical source statement about what the claimant could still do despite her impairments did not render a medical report incomplete. 20 C.F.R. §§ 404.15213(b)(6), 416.912(b)\(6) (2016).

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Nor has the Second Circuit required the agency to seek such statements where the record was sufficiently developed for the ALJ to make an informed decision, See Rosa v. Callahan, 168 F.3d 72, 79 n.5 (2d Cir. 1999) (“where there are no obvious gaps in the administrative record, and where the ALJ already possesses a ‘complete medical history,” the ALJ is under no obligation to seek additional information in advance of rejecting a benefits claim”); Pedllam v. Astrue, 508 F. App’x 87, 90 (2d Cir. 2013) (“Under these circumstances ~ especially considering that the ALJ also had all of the treatment notes from Pellam’s treating physicians — we do not think that the ALJ had any further obligation to supplement the record by acquiring a medical source statement from one of the treating physicians” (citing Rosa)). On several occasions, the Second Circuit has reaffirmed that where the record is sufficiently developed to allow an ALJ to make an informed decision, an express function-by-function treating source opinion is not required. See Monroe v. Comm’ r of Soc. Sec., 676 F. App’x 5, 8 (2d Cir. Jan. 18, 2017); Swiantek v. Comm’r of Soc. Sec., 588 F. App’x 82 (2d Cir. 2015); Tankisi v. Comm’r of Soc. Sec., 521 F. App’x 29, 33-34 (2d Cir. 2013); see also Micheli v. Astrue, 501 F. App’x 26, 29-30 (2d Cir, 2012) (ALJ properly determined he could render a decision based on 500-page record despite discrepancies in treating physician’s opinion) (citing Richardson v. Perales, 402 US. 389, 399 (1971)); Streeter v. Comm’r of Soc. Sec., No. 5:07-cv-858 (FJS), 2011 WL 1576959, at *3 (N.D.NLY. Apr. 26, 2011) (“[t]he lack of a medical source statement will not make the record incomplete, provided that the ALJ made his determination or decision based on ‘sufficient’ and ‘consistent’ evidence” (citations omitted)). In Monroe, the Second Circuit upheld the ALJ’s residual functional capacity (RFC) assessment despite the ALJ’s rejection of the only medical source statement from the plaintiff's treating psychiatrist. 676 F. App’x at 8. Citing its prior holdings in Tankisi, 521 F. App’x 29, and Pellam, 508 F. App’x 87, the Court ruled that remand to secure another medical source statement or formal medical opinion as to the plaintiffs functionality was not required where the record contained sufficient evidence to assess the RFC, including “years’ worth of treatment notes” from the treating psychiatrist and evidence of the plaintiff's varied social/recreational activities. Id. Here, as in Monroe, the record contained detailed, contemporaneous treatment records as well as multiple opinions from consultative examiners and testifying experts, and GAF score opinions from Plaintiffs treating psychiatrists, all of which were sufficient for the ALJ to assess Plaintiff's RFC. Specifically, with respect to Plaintiffs alleged physical impairments, the ALJ considered the various treatment notes from Dr. Franchin (Tr. 20-21), reflecting that Plaintiff's lupus was stable and controlled, as well as Dr. Tieng’s treatment note from a May 2016 visit reflecting that Plaintiff was pleasant and reported no tender joints, no rashes, no bursitis, and no swollen joints or joint pain. Tr. 620; see also C. Br. 10.° Plaintiff's repeated physical examinations revealed largely normal findings (Tr. 605-607, 620-626, 648, 708-714, 1051), including an April 2016 discharge note relating to Plaintiff's lupus stating that she could return to physical activity by April 30, 2016. See Tr. 599; C. Br. 22-26. Plaintiff repeatedly exhibited full range of motion throughout her body, and she consistently had full muscle strength, sensation, and grip strength. Tr. 572, 709, 741, 816, 955. The examinations consistently revealed normal gait and ambulation (Tr. 571, 610, 624, 708, 899, 1023) and no swelling in her joints (Tr. 620, 645, 668, 709, 1051). ® Dr. Franchin—Tr. 645, 663-664, 665-667, 791-794, 1051; Dr. Tieng—Tr. 620, 668.

Indeed, Plaintiff often reported to treating and/or other medical sources that she was doing better, well, or “okay” (Tr. 786, 982, 1051, 1084) and that she enjoyed going on walks (Tr. 1031) and running (Tr. 595). She even mentioned during counseling that she was looking for sober peers to go to the gym with. Tr. 1057. Plaintiff also reported no limitations in reaching or using her hands. Tr. 444. With respect to Plaintiff's mental impairments, the record contains contemporaneous treatment notes from Drs. Banez and Bhatt, which the ALJ considered in assessing Plaintiffs RFC. As the ALJ observed, the medical evidence reveals that while sober, Plamtiff's mental status examination findings were repeatedly unremarkable after the comparison point decision, and even after the May 10, 2016 alleged disability onset date. (See Tr. 21). Indeed, clinical observations revealed that while Plaintiff was sober, her mood was “okay” with a congruent affect, and she had coherent thought process, normal thought content, intact memory, good or intact attention, concentration, cognition, insight, and judgment, and normal reasoning. Compare treatment observations while sober, Tr. 562-564, 646, 697, 786, 787-790, 829, 825, 852, 1068, 1070, 1076, 1084. with treatment observations while intoxicated, Tr. 670-679, 735-762, 828; see also C. Br, at 23-26. Indeed, Plaintiff's treating psychiatrist, Dr. Bhatt, repeatedly noted that while sober, she was “psychiatrically stable.” Tr. 650-652, 656-661, 787-790, 982-985, 1081. Her mental status examinations while intoxicated present a stark difference from those when she was sober, which is consistent with the ALJ’s determination that Plaintiff’s substance abuse is a material contributing factor in determining her disability. See Tr. 18-22. Moreover, a comparison of Plaintiff's mental status examinations while intoxicated with those while she was sober demonstrates that her mental impairments met the requirements of Listing 12.03 while intoxicated but not while sober. Tr. 15-16, 65-68; see 20 C.F.R. Part 404, Subpart P, Appendix 1, Section 12.03. Furthermore, at the hearing, Plaintiff made no mention of any limitations relating to her mental impairments; she explained that she believed she was disabled because of her lupus. Tr. 60 (“Please explain why you feel you are disabled?” “I have Lupus since 2009 . .. .”); see White v. Berryhill, 753 F. App’x 80, 81 (2d Cir. 2019) (affirming the ALJ’s decision where the plaintiff never specified how a condition (obesity) limited his functioning (citation omitted)). Indeed, Plaintiff's varied activities further support the ALJ’s decision. Specifically, Plaintiff reported that she enjoyed reading, watching movies and television, doing word puzzles, and playing chess— activities that are commensurate with a level of mental functionality compatible with simple, unskilled medium work. Tr. 571, 595, 884. Similarly, Plaintiff regularly attended her appointments (Tr. 646, 650, 731), was capable of taking public transportation (Tr. 442, 589, 595, 1033), shopped (Tr. 595), interacted with her peers, and actively participated in group and individual counseling (Tr. 1046-1067). The medical opinion evidence further supported the ALJ’s determination. See Tr. 22. State agency physician Dr. R. Gauthier, on May 10, 2016—the date medical improvement was found to have occurred—reviewed Dr. Dipti Joshi’s findings and conclusions upon the March 2016 internal medicine consultative examination, among other evidence. Dr. Gauthier opined that Plaintiff had no limitations, had demonstrated significant physical improvement, and was no longer disabled. Tr. 613-618; see Tr. 570-763. Dr. Joshi observed that Plaintiffs gait was

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normal, she was in no acute distress, she could walk on her heels and toes without difficulty, her squat was full, and her stance was normal. Tr. 571. Dr. Joshi further noted that Plaintiff exhibited full (5/5) strength in her upper and lower extremities, full grip strength, and full range of motion throughout, and no sensory deficits or muscle atrophy were present. Tr. 572. Similarly, the medical expert in internal medicine, Dr. Jurano Brooks, testified at the August 7, 2018 administrative hearing that Plaintiff's physical impairments were not severe, did not meet the requirements of a Listing-level impairment, and would not result in any work-related functional limitations. Tr. 62-63. Dr. Carol McLean Long, who also conducted an internal medicine examination less than a year later in May 2017, likewise opined that Plaintiff had no physical limitations. Tr. 710, As to Plaintiffs psychiatric impairments, State agency psychologist Dr. T. Harding, after reviewing the available evidence, opined in April 2016 that Plaintiff largely had no significant limitations, or at most no more than moderate limitations, in her ability to sustain concentration and persistence, adapt, or interact socially. Tr. 588-589. Dr. Harding, like Dr. Gauthier, reached the conclusion that Plaintiff had demonstrated significant medical improvement and was no longer disabled after reviewing all the evidence in her file and comparing it with the comparison point decision (CPD) of April 8, 2011. Tr. 102-112, 590. Thus, as in Monroe, the record here contained sufficient evidence for the ALJ to assess Plaintiff's RFC. See Monroe, 676 F. App’x at 5-8. Indeed, the Second Circuit has affirmed an ALJ’s decision where, as here, the record contains consultative findings consistent with the ALJ's conclusions, even where the claimant alleged a failure to request records from a treating medical source. Pellam, 508 F. App’x at 90 n.2 (“Because [the consultative examiner’s] opinion was largely consistent with the ALJ’ s conclusions, we need not decide whether a record would be rendered incomplete by the failure to request a medical source opinion from a treating physician if the ALJ made his residual functional capacity determination without the support of any expert medical source opinion concerning the claimant’s limitations.”). Therefore, the ALJ adequately developed the record in this case. 4. If there is a medical source opinion from a treating physician, explain why the case should not be remanded for failure to accord proper weight to it As noted, Dr. Banez’s GAF scores in the record constitute medical opinion evidence. The ALJ properly accorded some weight to Dr. Banez GAF scores. Tr. 22-23. Dr. Banez assessed Plaintiff with GAF scores ranging from 60 in April 2015, to 65 in May, August, September, and October 9015. See C. Br. 6, 9; Tr. 545-546, 547-548, 549-550, 557-558, 562-567. These GAF scores denote mostly mild symptomology consistent with the RFC finding. Dr. Banez’s score denoting improvement, are also largely consistent with the GAF scores of Drs. Qayyum and Liz, which similarly show improvement within a month. See Tr. 21-23, 684, 756, 887. The ALJ properly accorded only some weight to the GAF scores because they were vague and simply a snapshot assessment of Plaintiffs overall mental health. Tr. 21-23; see Kaczkowski v. Colvin, No. 15 CIV. 9356 (GWG), 2016 WL 5922768, at *20 (S.D.N.Y. Oct. 11, 2016) (ALJ finding giving GAF score limited weight was appropriate, in part, because a “GAF score is merely a “snapshot opinion . . . at a specific point in time,” while “[a] determination of disability

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must be based on the entire record” (internal citations omitted)); Velez v. Celvin, No, !5-CV- 0487, 2015 WL 8491485 at *9 (S.D.N.Y. 2015) (GAF score is merely a snapshot opinion of one or more doctors as to an individual’s level of social, psychological and occupational function at a specific point in time[,]” whereas “[a] determination of disability must be based on the entire record” (internal citations omitted)); see also Rock v. Colvin, 628 F. App’x 1, 4 n.3 (2d Cir. 2015) (reliability of GAF scores questioned by numerous courts both before and after the GAF scale was removed from the DSM). The Commissioner also notes that Dr. Bhatt completed a wellness plan report on September 7, 2017, in which, consistent with the ALJ’s decision, he checked a box noting that Plaintiff's depression, bipolar disorder, and lupus were resolved or stabilized. However, Dr. Bhatt did not render an assessment of Plaintiffs functional capacity, Tr. 798-801, and thus it was not a medical opinion that the ALJ was required to weigh as such, sk oR In sum, the ALJ properly considered the record as a whole and the relevant regulatory factors in evaluating Plaintiffs disability claim. Remand is not required in this case because the ALJ already possessed a “complete medical history,” and was under no obligation to seek additional! information. See Rosa, 168 F.3d at 79 n.5. Accordingly, the Commissioner respectfully requests that the Court grant his motion for judgment on the pleadings, and affirm his final decision. In addition, the ALJ’s determination is entitled to deference, as it is the function of the ALJ to weigh the evidence in the record and appraise the statements of witnesses, including Plaintiff. See Biestek v. Berryhill, ~ US. -, 139 S. Ct 1148, 1154 (2019) “Under the substantial-evidence standard, a court looks to an existing administrative record and asks whether it contains “sufficien[t] evidence” to support the agency’s factual determinations. And whatever the meaning of “substantial” in other contexts, the threshold for such evidentiary sufficiency is not high.”); Halloran v. Barnhart, 362 F.3d 28, at 31 (2d Cir. 2004); Salmini v. Comm of Soc. Sec., 371 F. App’x 109, 113 (2d Cir. 2010), We thank the Court for its consideration of this letter. Respectfully submitted, Geoffrey S. Berman United States Attorney Alexander Broche Alexander Broche Special Assistant United States Attorney tel. (212) 264-1331 fax (212) 264-6372 alexander. broche@ssa.gov ce: Jonathan Garven, Esq (via CM/ECF) Plaintiff's Pro Se Counsel Janis Wilson-Bahaga (via U.S.P.S. (first class)) Plaintiff Pro Se

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i lage BaeE ot THR pa ALE eh New York State Office of I emporary and Disability Assistance Division of Disability Determinations Request #) H90494555 Request for Medical Field Contact Date: 04/18/17 To: Medical Relations Officer ~ Region: 3 From: E. Sousa 7 ¢ B OOL / 3865 Tel: (607} 741-4109 Claimant Name: JANIS ©. WILSON EAHAGA SSN: 064-66-4420 DOB: 05/13/81 Address: 1205 COLLEGE AVE #65 BRONX, NY 10456 Facility: BRONX LEBANON HOSPITAL CTR "TD Number at Facility: 1650 GRAND CONCOURSE N293-7494 I/P - O/P RECORES BRONX, NY 10457 __INPATIENTDATES OUTPATIENT 93/28/10 - 04/18/27 □□□ per pape eee 40/00/00 - 90/00/00 Clinic(s) Attended: ALL CLINICS

Date First Seen: O03 729/10 | Most Recent: Present ALLEGATIONS: ALLEGED ONSET DATE: 50/06/90 LUPUS BND LUPUS FLARES ARTHRITIS, HEP AKA & PREVIOUS ADDRESS

ann TIONREQUESTED CSC NOTE TO FACILITY/VENDOR: FIELD REP IS ONLY AUTHORIZED TO REMOVE ENCRYPTED, ELECTRONICALLY CAPTURED RECORDS FROM SITE IN ACCORDANCE WITH THIS REQUEST FORM. PAPER RECORDS SHOULD ONLY BE IMAGED BY THE FIELD REP ON SITE, AND SHOULD NOT BE TAKEN OFF SITE! ~ PULM-FUNC: DISCHSUMM: xX PSYCHIATRIC. ADM-HIST: % EYEEXAM: AUDIO TESTING: ER RECORDS: x EKG: OPER-NOTES: EEGREPORT: | PSYCH. TESTING: x URINALYSIS: □ □□□ X-RAY REPORTS: All BLOOD CHEM: x PATH REPORTS: x _IMAGING ne □□ IEP: CLINIC NOTES: x SPEECH & LANG: PHYSICAL: x EDUCATIONAL: ~ PLS SEND TEST,CLINIC, CONSULT, PROCEDURE REPORTS. PLS SEND IN/OUTPT TX/PROG NOTES, & MED/PSYCH RECS. THANKS. TAUTHORIZATIONONFIE FIELD ANALYST RESPONSE/REMARKS Status __ Date: _____ Scanned by _ Pages

7/0002 □□□□□□□□□□□□□□□□□□□□□□□□ LEBANON HOSPITAL CTR /DOD-4G83 Page i of 4

New York State Office of Temporary and Disability Assistance Division of Disability Determinations Request #: HO045 9A08 Request for Medical Field Contact Date: 06/03/16 To: Medical Relations Officer - Region: 3 From: B. Slater 7 / KR OOL / 9251 Tel: (607) 741-4041 Claimant Name: JANIS C. WILSON BAHAGA SSN: 064+-66~4420 DOB: 05/29/81 Address: 1205 COLLEGE AVE APT 6E BRONEK, NY 10456 Facility; BRONX LEBANON HOSPITAL CTR ~ ID Number at Facility: L650 GRAND CONCOURSE 0293+7494 IT/P - O/P RECORDS BRONX, NY 10457 INPATIENT DATES __ a ____ OUTPATIENT 04/28/16 - 05/19/16 OO 80/00/00 ~ 00/00/00 Clinie(s) Attended:

Date First Seen: / f Most Recent: ff ALLEGATIONS: ALLEGED ONSET DATE: 00/00/00 lupus, arthritis, htn “AKA & PREVIOUSADDRESS

eee MEDICAL INFORMATION REQUESTED □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ NOTE TO FACILITY/VENDOR: FIELD REP IS ONLY AUTHORIZED TO REMOVE ENCRYPTED, ELECTRONICALLY CAPTURED RECORDS FROM SITE IN ACCORDANCE WITH THIS REQUEST FORM. PAPER RECORDS SHOULD ONLY BE IMAGED BY THE FIELD REP ON SITE, AND SHOULD NOT BE TAKEN OFF SITE! PULM-FUNC: PISCH SUMM: PSYCHIATRIC: x ADM-HIST: x EYE EXAM: AUDIO TESTING: ER RECORDS: □□ EKG: OPER-NOTES: — □□ EEGREPORT: PSYCH. TESTING: xX URINALYSIS: □□ X-RAY REPORTS: All BLOOD CHEM: =X PATHREPORTS: =X TEP: CLINIC NOTES: x SPEECH & LANG: PHYSICAL: EDUCATICNAL: Clmtwas in BR 4/28/16 and saw Dr. Tieng on May 19, 2016

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EEE IIE DE SI ag Form Approved BRONX LEBANON HOSPITAL CTR WHOSE Aecords io be Disclosed OMB No. 0960-0829 med recs . meee 1650 GRAND CONCOURSE NAME {First, Middle. hast Sufix} L/P - Of/P RECORDS Janis Charlene Wilson Bahaga ONX, N¥ 10457 Birthd BR SN 064-66-4420 inmideyy} 05/19/81

_____THE SOCIAL SECURITY ADMINISTRATION (SSA) “~ PLEASE READ THE ENTIRE FORM, BOTH PAGES, BEFORE SIGNING BELOW ** Voluntarily authorize and request disciosure (including paper, oral, and electronic inferchange): OF WHAT Aff my medical records: also education records and other information related to my ability to performtasks. This includes specific permission to release: 1. All records and other information regarding my treatment, hospitalization, and outpatient care for my impairment(s} including, and not limited te : « Psychological, psychiatric or ciher mental impairmant(s) {excludes "psychotherapy notes” as defined in 45 CFR 164.501} + Drug abuse, aiccholism, or other substance abuse * Sickle cell anemia + Records which may indicate the presance of a communicable or noncommunicable disease; and tests for or records of HIV/AIDS + Gans-related impairments (including ganetic test results) 2. Information about how my impairment(s} affects my ability to complete tasks and activities of dally living, and affects my abillty to work. 3. Copies of educational tests or evaluations, including Individualized Educational Programs, triennial assessments, psychological and speech evaluations, and any other records that can heip evaluate function; aiso teachers’ observations and evaluations. 4. Information created within 12 months after the date this authorization Is signed, a5 well as past Information. FROM WHOM THIS BOX TO BE COMPLETED 8Y SSA/DDS (as needed) Additional information ic identity on tinal a, . ‘ini the subject (e.g., other names used}, the specific source, or the material to be disclosed: All medical sources (hospitals, clinics, fabs, physicians, psychologists, atc.) including mental health, correctional, addiction treatment, and VA health care facilitias + All educationai sources (schools, teachers, records administrators, counselers, etc.) * Social workers/rehabilitation counselors * Consulting examiners used by SSA Employers, insurance companies, workers’ compensation programs * Others who may know about my condition (family, neighbors, friends, public officiats) TO WHOM The Social Security Administration and to the State agency authorized to process my case (usually called “disability determination services"), including contract copy services, and doctors or other professionals consulted during the process. [Also, for international claims, to the U.S. Department of State Foreign Service Past.] PURPOSE Determining my eligibliity tor benefits, induding locking at the combined effect of any impairments that by themselves would not meet SSA's definition of disability; and whether | can manage such benefits. □□ Datermining whether | an capable of managing benefits ONLY (check only if this applies) EXPIRES WHEN This authorization is good for 12 months fram the date signed (below my signature). + | authorize the use of a copy (including electronic copy) of this form for the disclosure of the information described above. tunderstand that there are some circumstances in which this information may be redisclosed to other parties (see page 2 for details). + may write to SSA and my sources to revoke this authorization at ary time (see page 2 for details). + SSA wil give me a copy of this form if | ask; | may ask the source to allow me to inspect or get a copy of matarial to be disclosed, « have read both pages of this form and agree to the disclosures above from the types of sources fisted. PLEASE SIGN USING BLUE OR BLACK INK ONLYHF not signed by subject of disclosure, specify basis for authority to sign INDIVIDUAL authorizing disclosure ["] Parent of minor ["]Guardian [7] Other personal representative □□□□□□□□□ SIGN > eee eae. Wenis Charfene Wilson Bahaga (Parent/guarclan’parsonal representative sign > here if twe signatures required by State law} Date Signed Street Addrass 05/16/16 1205 COLLEGE AVE APT GE Phan Number (with area code} City State ZIP 718-598-7807 BRONX NY 10456 WITNESS / know the person signing this form er am satisfied of this person's identity: Attested by S64 or Designated State Agency Employee: iF needed, second witness sign here (e.g., if signed with "X" above) SIGN B® cwhite SIGN > Phone Number {or Address} Phone Number (or Address) 955-531-1684 BRONX NY 10451-3528 This general and special authorization to disclose was developed fo comply with the provisions ragarding disctosure of medical, educational, and other information under P.L. 104-181 (*HIPAA"): 46 CFR parts 160 and 164: 42 U.S. Code section 290dd-2; 42 CFR part 2; 38 U.S. Code section 73382; 38 CFR 1.475; 20 US. Code section 1232y ("FERPA"); 34 CFR parts $2 and 300; and State law. a Rn ITs Form SSA-827 (11-2012) ef (14-2012} Use 4-2009 and Later Editions Unti Supply is Exhausted Paget of 2

* SANT “NEXplataon SSA-82/, °° “Authorization to Disclose information te the Social Security Administration (SSA)” We need your written authorization to help get the information required to process your application for benefits, and to determine your capability of managing benefits. Laws and regulations require that sources of personal information have a signed authorization before releasing it to us. Also, laws require specific authorization for the release of information about certain conditions and from educational sources. You can provide this authorization by signing a Form SSA-827. Federal law permits sources with information about you to release that information if you sign a single authorization to release ali your information from all your possible sources. VVe will make copies of it foreach source. A few States, and some individual sources of information, require that the authorization specificaily name the source that you authorize to reiease personal information. In those cases, we may ask you to sign one authorization for each source and we may contact you again if we need you to sign more authorizations. You have the right to revoke this authorization at any time, except to the extent a source of information has already relied on itto take an action. To revoke, send a written statement to any Social Security Office. If you do, also send a copy directly to any of your sources that you no longer wish to disclose information about you; SSA can tell you if we identified any sources you didn’t tell us about. Information disciosed prior to revocation may be used by SSA to decide your claim. It is policy to provide service to people with limited English proficiency in their native language or preferred mode of communication consistent with Executive Order 13166 (August 11, 2000) and the Individuals with Disabilities Education Act. SSA makes every reasonable effort to ensure that the information in the SSA-827 is provided to you in your native or preferred language. IMPORTANT INFORMATION, INCLUDING NOTICE REQUIRED BY THE PRIVACY ACT Ail personal information collected by SSA is protected by the Privacy Act of 1974. Once medical information is disclosed to SSA, it is no longer protected by the health information privacy provisions of 45 CFR part 164 (mandated by the Health Insurance Portability and Accountability Act (HIPAA). SSA retains personal information in strict adherence to the retention schedules established and maintained in conjunction with the National Archives and Records Administration. At the end of a record’s useful life cycle, it is destroyed in accordance with the privacy provisions, as specified in 36 CFR part 1228. SSA is authorized to collect the information on form SSA-827 by sections 205(a}, 223 (d\{(5)(A), 4(aiS)(H} (i), 1631 (d)(1) and 4631 {e)(1}{A) of the Social Security Act. We use the information obtained with this form to determine your eligibility for benefits, and your ability te manage any benefits received. This use usually includes review of the information by the State agency processing your case and quality contro! people in SSA. In some cases, your information may aiso be reviewed by SSA personnel that process your appeal of a decision, or by investigators to resolve allegations of fraud or abuse, and may be used in any related administrative, civil, or criminal proceedings. Signing this form is voluntary, but failing to sign it, or revoking it before we receive necessary information, could prevent an accurate or timely decision on your claim, and could result in denial or loss of benefits. Although the information we obtain with this form is almost never used for any purpose other than those stated above, the information may be disclosed by SSA without your consent if authorized by Federal laws such as the Privacy Act and the Social Security Act. For example, SSA may disclose: 1, To enable a third party (e.g., consulting physicians) or cther government agency to assist SSA to establish rights to Secial Security benefits and/or coverage, 2. Pursuant to law authorizing the release of information from Social Security records (e.g., to the Inspecter General, to Federal or State benefit agencies or auditors, or to the Department of Veterans Affairs(VA)). 3. For statistical research and audit activities necessary to assure the integrity and improvement of the Social Security programs (e.g., to the Bureau of the Census and private concems under contract with SSA). Other than the above limited circumstances, SSA will not redisclose without proper prior written consent information (4) relating to and/or drug abuse as covered in 42 CFR part 2, or (2) from educational records for a minor obtained under 34 CFR part 99 (Family Educational Rights and Privacy Act (FERPA)), or (3) regarding mental health, developmental disability, AIDS or □□□□ We may also use the information you give us when we match records by computer. Matching programs compare our records with those of other Federal, state, or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The jaw allows us to do this even if you do not agree to it Explanations about possible reasons why information you provide us may be used or given out are available upon request from any Social Security Office. PAPERWORK REDUCTION ACT STATEMENT This information collection meets the clearance requirements of 44 U.S.C. section 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. SEND OR DELIVER THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S. Government agencies in your telephone directory or you may call 800 772-1213 for the address. You may send comments on our estimate of ihe fime needed to complete the form to: SSA, 1338 Annex Building, Baltimore, MD 21235-0007. Send only comments relating to our time estimate to this address, not the completed form.

□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ LEBANON HOSPITAL CTR /DDD-4083 Page 4 of &

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NA GEES 1 LSA EGU eT TOE A, ELA, ke PR ae a □□ a et NOV-03-20i16 14:64 P.002-002 BRONX LEBANON HOSPITAL CTR 1656 GRAND CONCOURSE I/F - O/P RECORDS Fenn Approved BRONX, NY 10457 WHOSE Records to be Disclosed OMB Ne, □□□□□□□□ . NAME (First, Middle, Last, Suffix) Janis Chartane Wilson Bahage 084.868.4420 O5719/1981

AUTHORIZATION TO DISCLOSE INFORMATION TO THE SOCIAL SECURITY ADMINISTRATION (SSA) ~ PLEASE READ THE ENTIRE FORM, BOTH PAGES, GEFORE SIGNING BELOW *" i voluntarily authorize and request disclosure (including paper, oral, and electronic interchange}... ---_. -- □ - WHAT Altmy medical records: alsg sducation records and other information related to my ability to perform tasks, This includes epacific permission to miesse: 1. All rocords and other Information regarding my treatraent, hospitalization, and cutpationt caro for my Impzirment{a) - including, ahd not limped to : » Psychological, psychisiric or other mental impalment(s) (excludes “psychotherapy notes” as defined in 45 CPR 164.904) « Orug shuae, alcoholism, or other substance abuss = Sickle cell enemia « Records which may indicate the presence of a communicable or noncommunicable disease, and tests fee or sacords of HIV/AIDS = - + Gene-reiated impairments (including genetic ast results; 2. information about how my inpairment(s) affects my ability to complete take and activities of dally living, and affects my ability to work. 3. Ceéples of educational tests or evaluations, Including Individualized Educational Programs, tlennial assessments. paychologicel and speech #valuations, and any other records that can help evaluate function; alse teachers’ obgervetions and evaluations. 4. information created within 12 months after tha date this euthorization Is signed, a8 wall a6 paat information. FROM WHOM THIS BOX TO BE COMPLETED BY SSA/DDS (as onal internation te identify the = Ail medieal sources (hospitals, clinics, labs. subjeci (6.g., other names used), the specific source, or the matecal io be dleclosed: physicians, psychologisis, etc) induding i rnental health, correctional, addiction i . : treatment, and VA health care faciities i + All educadenal sourmes (schools, taachars, -facerds administrators, counselors, etc) \ « Sociol workerc/mhabiltation counseors eet Cotmulting axBrainers DYSSA oe mmrmen se . Employers, Insurance companies, workers’ . : . compensation programs . Others who may know about my condition : ffamity, neighbors, friends, publle officlais) TO WHOM The Social Security Administration and to the State agency authorized to process my case (usually called “disability TT determination services’), Including contract copy services, and doctors or other professionals consulted during the process. [Also, for ntemational claims, ia the U.S. Department of State Foreign Service Post] : PURPOSE Datamining my oligibtlity for benefits, including looking af ‘hé combined affact of any impairments that by themselves would not maei 5S4‘s definition of disabifity, and whelner | can manage such benefits. (0 Determining whether | am capable of managing benefits ONLY (chack only if this applies) EXPIRES WH EN This authorization good for 12 months fram the date signed (below my Signatur). : authorize tha use of a copy (including electronic copy) of thls form for the disclosure of the information cascribed above. | understand that thera are some clroumetances in which thie information may be redisciosed to other parties (an6 page 2 fordetails), « [may write to SSA and my Sources to revoke thi authorization at any tmeé (see page 2 for details). . SSA will give me 6 copy of this form Ifl ask: |] may ask fhe source te allow me to Inspect or get a copy of material to be disclosed. « __Lhave read both pages of this form and agree to the disclosures above from to of ROurces Usted. J IGN SING BLUE OR BLACK I IF not signed by subject of disclosure, specify Sasis for authority to gign INDIV! IDUAL authorizing disclosure CO) parentor minor [1] Guardian (] otner personal representative (axplaln} > a Ay df i f ('arentiguandian persone! representative » oO AA fo A sign here If two signatures required By State Tr by LAG aw! Date Signer aS Street Address oe, - — UF | 1205 College Avenue. Aptse . 1B}538-7807 NY 10856) WITNESS = / know the person signing this form or am satisied of thls person's ERS ECW SRS EE) (IF needed, second witness sign fave (8.9.. It slaned with "X" above) | SIGN » —— . : Phone Number (or rans) 124 —Bfg~ 45 | Phone Number (or Address) a ors This general and special authorization to disclose was developed to comply wih the provisions regarding disciosire of maceal, educational and other information under PL. 104-191 (HIPAA): 45 CER paris 180 and 164, 42 U.S. Code section 2900-2; 42 CFR part 2; 38 U.S. Code section 7332; 38 CFR 1.478; 20 U.S, Cada section 12309 PFERPA: 34 GER parte 88 end 300; ard Stent ee artnet nn rer Form SSA-687 (1 2012) af (14-2072) Use 4-200 and Later Editions Until Supply is Exnausted Page 1 of2

Meigs Rhee A Ae TE OPES EE SXplanavon of ron SoA-Ge2s, ————————— TO Se ee “Authorization to Disclose Information to the Social Security Administration (SSA)” We need your written authorization to help get the information required to process your application for benefits, and to determine your capability of managing benefits. Laws and regulations require that sources of personal information have a signed authorization before releasing it to us. Also, faws require specific authorization for the release of information about certain conditions and from educational scurces. You can provide this authorization by signing a Form SSA-827. Federal law permits sources with information about you to release that information if you sign a single authorization to release all your information from all your possible sources. We will make copies of it for each source. A few States, and some individual sources of information, require that the authorization specifically name the source that you authorize to release personal information. in those cases, we may ask you to sign one authorization for each source and we may contact you again if we need you to sign more authorizations. You have the right to revoke this authorization at any time, except to the extent a source of information has already relied on it to take an action. To revoke, send a written statement to any Social Security Office. If you do, aiso send a copy directly to any of your sources that you no longer wish te disclose information about you; SSA can tell you if we identified any sources you didn't tell us about. Information disclosed prior to revocation may be used by SSA to decide your claim. It is SSA's policy to provide service to people with Jimited English proficiency in their native language cr preferred mode of communication consistent with Executive Order 13466 (August 11, 2000) and the individuals with Disabilities Education Act. SSA makes every reasonable effort to ensure that the information in the SSA-827 is provided to you in your native or preferred language. IMPORTANT INFORMATION, INCLUDING NOTICE REQUIRED BY THE PRIVACY ACT All personal information collected by SSA is protected by the Privacy Act of 1974. Once medical information is disclosed to SSA, it is na longer protected by the health information privacy provisicns of 45 CFR part 164 (mandated by the Health Insurance Portability and Accountability Act (HIPAA). SSA retains personal information in strict adherence to the retention schedules established and maintained in conjunction with the National Archives and Records Administration. At the end of a record's useful life cycle, it is destroyed in accordance with the privacy provisions, as specified in 36 CFR part 1228. SSA is authorized to collect the information on form SSA-827 by sections 205(a), 223 □□□□□□□□□□□□□□□□□□□□□□□□□□□ 1631 {d){4) and 1831 (e}{4)(A) of the Social Security Act. We use the information obtained with this form to determine your eligibility for benefits, and your ability to manage any benefits received. This use usually includes review of the information by the State agency processing your case and quality contral people in SSA. In some cases, your information may also be reviewed by SSA personnel that process your appeal of a decision, or by investigators to resolve allegations of fraud or abuse, and may be used in any related administrative, civil, or criminal proceedings. Signing this form is voluntary, but failing to sign it, or revoking it before we receive necessary information, could prevent an accurate or timely decision on your claim, and could result in denial or loss of benefits. Although the information we obtain with this form is almost never used for any purpose other than those stated above, the information may be disclosed by SSA without your consent if authorized by Federal laws such as the Privacy Act and the Social Security Act. For example, SSA may disclose: 4. To enable a third party (e.g., consulting physicians) or other government agency to assist SSA to establish nghts to Social Security benefits and/or coverage: 2. Pursuant to law authorizing the release of information from Social Security records (e.g., to the Inspector General, to Federal or State benefit agencies or auditers, or to the Department of Veterans Affairs(VA)); 3. For statistical research and audit activities necessary to assure the integrity and improvement of the Social Security programs (e.g., to the Bureau of the Census and private concerns under contract with SSA). Other than the above limited circumstances, SSA will net redisclose without proper prior written consent information (1) relating to alcohol and/or drug abuse as covered in 42 CFR part 2, or (2) from educational records for a minor obtained under 34 CFR part 99 (Family Educational Rights and Privacy Act (FERPA)), or (3) regarding mental health, developmental disability, AIDS or HIV. We may also use the information you give us when we match records by computer. Matching programs compare our records with those of other Federal, state, or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do not agree fo it. Explanations about possible reasans why information you provide us may be used or given out are available upon request from any Social Security Office. PAPERWORK REDUCTION ACT STATEMENT This information collection meets the clearance requirements of 44 U.S.C. section 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. SEND OR DELIVER THE COMPLETED FORM TC YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. 5. Government agencies in your telephone directory or you may ca!l 800 772-1213 for the address. You may send □□□□□□□□ on our estimate of the time needed fo complete the form fo. SSA, 1338 Annex Building, Baltimore, MD 21235-0001. Send only comments relating to our time estimate to this address, not the completed form.

7/O00276478002/3865/B001/BRONK LEBANON HOSPITAL CTR /DDN-4083 Page 4 of 4

. ee Oiitce of Temporary al Awa RTCA AAS CA EA SE New York State Office of Temporary and Disability Assistance Division of Disability Determinations Request #: HO0459722 Request for Medical Field Contact Date: 06/02/16 To: Medical Relations Officer— Region: 3 From: B. Slater 7 4 A OGL / 9251 Tel: (607) 741-4041 Claimant Name: JANIS □□□ WILSON BAHAGA SSN: 064-66-4420 DOB: 65/19/81 Address) 1205 COLLEGE AVE APT 6E BRONX, NY 10456 Facility, BRONX LEBANON HOSPITAL CTR 1D Number at Facility: 1650 GRAND CONCOURSE GZ95-7494 L/P - O/P RECORDS BRONX, NY 16457 04/28/16 ~ 05/31/16 Clinic(s} Attended: ae/o0/00 - GO/eo/san | Date First Seen: 01/01/21 MostRecent: Present. ALLEGATIONS: ALLEGED ONSET DATE: 60/60/06 arthritis, htn, psychiatric lssues □□□□□□□□□□□□□□□□□□□□□

fn aa ON REQUESTED NOTE TO FACILITY/VENDOR: FIELD REP IS ONLY AUTHORIZED TO REMOVE ENCRYPTED, ELECTRONICALLY CAPTURED RECORDS FROM SITE IN ACCORDANCE WITH THIS REQUEST FORM. PAPER RECORDS SHOULD ONLY BE IMAGED BY THE FIELD REP ON SITE, AND SHOULD NOT BE TAKEN OFF SITE! ~—"PULM-FUNC. ~ ~DISCH SUMM:. ok” PSYCHIATRIC, xX ADM-HIST: x EYEEXAM: — AUDIO TESTING: — ER RECORDS: x EKG: ~ OPER-NOTES: EEGREPORT: PSYCH. TESTING: URINALYSIS: □ X-RAY REPORTS: All BLOOD CHEM: PATH REPORTS: □ x TEP: CLINIC NOTES: x SPEECH & LANG: PHYSICAL: EDUCATIONAL: was in ER on 4/28/2016 and had follow up in May.

FIELD ANALYST RESPONSE/REMARKS Status Cate Seamed by Pages

7/08023503868/9251/A001/BRONX LEBANON HOSPITAL CTR /DDE~4083 Page 1 of 4

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7/00023503888/9251/A001/BRONX LEBANON HOSPITAL CTR /DDD-4083 Page 2 of 4

ViPS BCU UVCARDLLESHN □□□ WV AL LAUR CTRL RECA Raa? CAR AL □□ Tht 1 am Form Approved: ERCNX LEBANON HOSPITAL CTR WHOSE Records to be Disclosed OMB No 0866-0523 1650 GRANT CONCOURSE “aes — = I/P - O/P RECORDS NAME (First, Middie, fast, Suffix) BRONX, N¥ 10457 danisCharfene Wilson Bahaga SSN Rirthday 064-66-4420 (nmitid/yy) 05/19/81

(SSA) PLEASE READ THE ENTIRE FORM, BOTH PAGES, BEFORE SIGNING BELOW ** voluntarily authorize and request disclosure (Including paper, Oral, and Slectronc interchange): OF WHAT All my medical records; also education records and other information related to my ability to perform tasks. This includes specific permission to release: 1. Allrecords and other information regarding my treatment, hospitalization, and outpatient care for my impairment(s} including, and not limited to - + Psychological, psychiatric or other mental impairment(s) (excludes "psychotherapy notes" as defined in 45 CFR 164.501} - Drug abuse, alcoholism, ar other substance abuse + Sickie cell anemia * Records which may indicate the presence of a communicable or noncommunicable disease; and tests for or records of HIV/AIDS + Gene-related impairments (including genetic test results) Information about how my impairment(s} affects my abliity to complete tasks and activities of dally tiving, and affects my ability to work. 3. Copies of educational tests or evaluations, including Individualized Educational Programs, triennial assessments, psychotogical and speech evaluations, and any other records that can help evaluate function; also teachers’ observations and evaluations. 4. Information created within 12 months after the date this authorization Is signed, as well as past Information. FROM WHOM THIS BOX TO BE COMPLETED BY SSA/DDS {as needed} Additional information to identiy Allmedieal sources (hospitais, clinics, labs, the subject (e.g, other names used}, the specific source, or the material to be disclosed physicians, psychologists, etc.) including mental health, correctional, addiction treatment, and VA health care facilities - All educational sources (schools, teachers, records administratars, counselors, etc.) - Social workers/rehabilitatian counselors + Consulting examiners used by SSA + Employers, insurance companies, workers’ compensation programs + Others whe may know about my condition (family, neighbors, friends, public officials} TO WHOM The Social Security Administration and to the State agency authorized to process my case (Usually cailed “disability determination services”), including contract copy services, and doctors or other professionals consuited during the process. (Also, for international claims, te the U.S. Deparsment of State Foreign Service Post] PURPOSE Determining my eligibHity tor benefits, including /ooking at the combined effect of any impairments igibility that by themselves would not meet SSA’s dafinition of disability; and whether | can manage such benefits. oO Determining whether | am capable of managing benefits ONLY (check only if this applias) EXPIRES WHEN This authorization is good for 12 months from the date signed (below my signature}. « | authorize the use of a copy {including electronic copy) af this form for the disclosure of the information described above. - understand that there are some circumstances in which this information may be redisclosed to other parties (see page 2 for details). may write ta SSA and my sources to revoke this authorization at any time (see page 2 for details). + SSA will give me a copy of this form if | ask: | may ask the source to allow me to inspect or get a copy of material to be disclosed. * [have read both pages of this form and agree to the disclosures above from the types of sources listed. PLEASE SIGN USING BLUE OR BLACK INK ONLYIIF not signed by subject of disclosure, specify basis for authority to sign INDIVIDUAL authorizing disclosure ["] Parent of minor [[]Guardian —_[[] Other personal representative (explain) SIGN □□ Bectronicalty Signed By: Janis Charlene Wilson Bahaga (Parent /quarchan/personal represaniakve sign > here if two signatures required by State jaw} Date Signed Street Address 05/16/16 1208 COLLEGE AVE APT 6E Phong Number (with area code) City State ZiP 718-538-7807 BRONX NY 10456 WITNESS / know the person signing this farm or am satistied of this person's identity: Aftested by S64 ar Designated State Agency Employee: iF needed, second witness sign here ta.q., if signed with □□□ above) SIGN cwnite SIGN Phone Number ior Address} Phone Number (or Address} 955-531-1684 BRONX NY 16451-3528 This general and special authorization to disclose was developed to comply with ihe provisions regarding disclosure of medical, educational, and other information under P.L. 104.197 (HIPAA): 45 CFR parts 160 and 164) 42 US. Code section £290dd-2; 42 CFR part 2; 38 U.S. Cade □□□□□□ 7332 38 CFR 1.478: 20 US. Code section 12329 ( TERPA 4; 34 CFA parts 99 and 300; and State ew. ee re a crn ene a A Form SSA-827 (11-2012) ef {11-2042} Use 4-200¢ and Later Editions Until Supply is Exhausted Pagei of2

a □□ Ta el Ee Ee TP EE UU explanation Of FORM SSA-32f, ee ee “Authorization to Disclose Information to the Social Security Administration (SSA)” We need your written authorization to help get the information required to process your application for benefits, and to determine your capability of managing benefits. Laws and regulations require that sources of persenal information have a signed authorization before releasing it fo us. Also, laws require specific authorization for the release of information about certain conditions and from educational sources. You can provide this authorization by signing a Form SSA-827. Federal law permits sources with information about you to release that information if you sign a single authonzaticn to release ali your information from all your possible sources. We will make copies of it for each source. A few States, and some individual sources of information, require that the authorization specifically name the source that you authorize to release personal information. In those cases, we may ask you te sign one authorization for each source and we may contact you again if we need you to sign more authorizations. You have the right to revoke this authorization at any time, except to the extent a source of information has already relied on it to take an action. To revoke, send a written statement to any Social Security Office. If you do, also send a copy directly to any of your sources that you no longer wish te disclose information about you; SSA can tell you if we identified any sources you didn't tell us about. Information disclosed prior to revocation may be used by SSA to decide your claim. ltis policy to provide service to people with limited English proficiency in their native language or preferred mode of communication consistent with Executive Order 13166 (August 11, 2000} and the Individuals with Disabilities Education Act. SSA makes every reasonable effort to ensure that the information in the SSA-827 is provided to you in your native or preferred □□□□□□□□□ IMPORTANT INFORMATION, INCLUDING NOTICE REQUIRED BY THE PRIVACY ACT All personal information collected by SSA is protected by the Privacy Act of 1974. Once medical information is disclosed to SSA, it is no longer protected by the health information privacy provisions of 45 CFR part 164 (mandated by the Health Insurance Portability and Accountability Act (HIPAA). SSA retains personal information in strict adherence to the retention schedules established and maintained in conjunction with the National Archives and Records Administration. At the end of a recard’s useful lite cycle, it is destroyed in accordance with the privacy provisions, as specified in 36 CFR part 1228. SSA is authorized to collect the information on form SSA-827 by sections 205(a), 223 (d)(5)(A),161 4(a)(3)(H) (), 1631(d}{1) and 1631 (e}{(1)(A) of the Social Security Act. We use the information obtained with this form to determine your eligibility for benefits, and your ability to manage any benefits received. This use usually includes review of the information by the State agency processing your case and quality cantrol people in SSA. In some cases, your information may also be reviewed by SSA personnel that process your appeal of a decision, or by investigatars to resolve allegations of fraud or abuse, and may be used in any related administrative, civil, or criminal proceedings. Signing this form is voluntary, but failing to sign it, or revoking it before we receive necessary information, could prevent an accurate or timely decision on your claim, and could result in denial or loss of benefits. Although the information we obtain with this form is almost never used for any purpose cther than these stated above, the information may be disclosed by SSA without your consent if authorized by Federal! laws such as the Privacy Act and the Social Security Act. For example, SSA may disclose: 1. To enable a third party (e.g., consulting physicians) or other government agency to assist SSA to establish rights to □□□□□□ Security benefits and/or coverage; 2. Pursuant to law authorizing the release of information from Social Security records (e.g., to the Inspector General, to Federal or State benefit agencies or auditors, or to the Department of Veterans Affairs(VA)): 3. For statistical research and audit activities necessary to assure the integrity and impravement of the Social Security programs (e.g., to the Bureau of the Census and private concerns under contract with SSA). Other than the above limited circumstances, SSA will not redisclose without proper pricr written consent information {1} relating to alcohal and/or drug abuse as covered in 42 CFR part 2, or (2) from educational records for a minor obtained under 34 CFR part 99 (Family Educational Rights and Privacy Act (FERPA)), or (3) regarding mental health, developmental disability, AIDS or HIV. We may also use the information you give us when we match records by computer. Matching programs compare our recards □□□ those of other Federal, state, or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do not agree to it. Explanations about possible reasons why information you provide us may be used or given out are available upon request from any Soctai Security Office. PAPERWORK REDUCTION ACT STATEMENT This information collection meets the clearance requirements of 44 U.S.C. section 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You da not need te answer these questions uniess we display a valid Office of Management and Budget control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. SEND OR DELIVER THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U.S, Government agencies in your telephone directory or you may call 800 772-1213 for the address. You may send comments on our estimate of the tne needed to complete the form to: SSA, 1336 Annex Building, Baltimore, MD 21235-0001. Send onty comments relating to our time estimate to this address, not the completed form.

7/00023593888/9251/A001/BRONX LEBANON HOSPITAL CTR /DDD-4083 Page 4@ of 4

hn PONY Disability Assist: PUTER ALAA EO RE A Oe New York Siate Office of Temporary and isabuity Assistance Division of Disability Determinations P.O. BOX 8783 LONDON, KY 40742 Phone: (607)741-4168 Tol Free: 1-800-522-5511 Ext. 4168 Fax: 1-866-323-8335 OTDA. State. N¥.us/DDD February 16, 2016 : In Reference to Claimant PROMESA SSN? 064-66-4420 DOR: 5/19/1981 1776 CLAY AVE Name: JANIS ¢<. WILSON BAHAGA MEDICAL RECORDS 1205 COLLEGE AVE #6E HEALTH SERV ADMIN BRONS, NY 10456 RRONX, NY 16457 MBER ORDER#: HOO442078 Please use MER ORDER# for Dictation and Remittance Tracking.

This agency is responsible for adjudication of disability claims on behalf of the federal government. under the Social Security Act. Your patient has made an application for benefits and we need medical evidence from treating sources to evaluate the claim. Attached is a signed consent for the release of the information. If you receive this request via system-generated FAX, we have retained the consent form in our file. We would appreciate information from your records that is requested on the second page. this would enable us to evaluate the impairment in terms of the standards of this program. Your cooperation is appreciated. Sincerely yours, J. Bartlett Disability Analyst - Unit C002

**PLEASE FOLLOW INSTRUCTIONS TO RECEIVE PAYMENT** VOUCHER INSTRUCTIONS: Billed Amount: $10.00 We are authorized to pay for medical information which is useful and relevant. [f you wish payment, please COMPLETE ALL BOXES BELOW or REVIEW PREPRINTED INFORMATION, Preprinted information needing correction must be authorized via signed correspondence on the facility letterhead and returned with this letter. Payee ID: Enter the 9-Digit Federal ID assigned io you as an employer. Ifyou are operating as an individual in business, enter your Social Seonrity Numher The 1 nomber MIST helnne to the navee.

T/CO02Z2312214/ LEK: 2482/C002/PROMESA /DDD- 3880 Page 1 of 4

Claimant’s Namet JANIS WILSON BAHAt ST Date of Birth: 5/19/1981 Medical Record Number/Patient ID: Unknown AKA: Previous Address: INFORMATION REQUESTED ~~ MRI and CT Scans Urinalysis Psychiatric Records Clinic Notes Blood Chemistry EKG Discharge Summary BER Records Admission History Pulmonary Funct Studies X-Ray Repert(s) of All ALL TREATMENT RECORDS: LUPUS, HBP, ARTHRITIS, PRIMARY CARE, ADHD

Dates of treatment OUTPATIENT FIRST INPATIENT MOST RECENT INPATIENT o2/10/2015 - Present

T/OQ02Z2312214/LEX: 2482/C002/PROMESA /DDD--3880 Page 2 of 4

UAB BE □□□ □□ LEHR Tere VL LAURER ROL EL TCC TAL bd. MAY-09-2015 14:47 □□□□□ 7 . Form □□□□□□□□ PROMESA WHOSE Records to be Disclosed OMB No. 0960-0623 i776 CLAY AVE . . MEDICAL RECORDS NAME (First, Miogio, Last, Suntix) HEALTH SERV ADMIN Janis Charlene

AUTHORIZATION TO DISCLOSE INFORMATION TO THE SOCIAL SECURITY ADMINISTRATION (SSA) “* PLEASE READ THE ENTIRE FORM, BOTH PAGES, BEFORE SIGNING BELOW ** | voluntarily authorize and request disclosure (including paper, oral, and electronic interchange): OF WHAT = Aff my madical records: also education records and other information related to my ability to - perform tasks. This includes specific permission to release: All records and dther information regardiay my treatment, hospitalization, and outpatient care for my impairment(s) facheding, and pottimlted to: + Peychologital, paychistric or other mental impairment(s) (excludes "psychotherapy notes" as dafined in 26 CFR 164,504) * Orag aduse, alcoholism, or other substance abuse . + Sickle cel! anemia “Records which may Indleate the presence of @ communicable of noncommunicable disease, and tests far or records of HIV/AIDS + Gene-related impairments (including genetic test results} Ses 2 Information about how my impairment(s) affects my ability to complete tasks and activities of daily living, aod affects my ubility to work. 3. Copies of educational tests or evaluaiions, including Individosliced Educational Programs, tricanial assessments, psychological and speech evaluations, and aay other records thal can help evaluate function; alke teachers’ observations aad evaluations. 4. information created within 12 months after the date this authorization is signed, ag well as past information, FROM WHOM HIS BOX TO SE COMPLETED BY SSA/DNS (a5 needed) Acditlonal information to identify - All medical sources (hospitals, clinics, labs, RE subjact (e.g, other names used), the + f fthe material I □ physicians, psychologists, ste.) Including : uTH PRONX mental health, correctional, addiction 30 4i2 treatment, and VA heath care facilites a b.9. - Alleducationa’ sources fechoois, teachers, ik? records administrators, counselors, etc.) fy os aats . + Social workers/tehabiltation counselors = APR at - Consulting examiners used by SSA + Employers, insurance companies, workers’ | 4423, . compensation programs zt use Others who may know about my condition qgapastnics ct (family, neighbors, friends, public officials) et . TO WHOM ‘The Secial Security Administration and to the State agency authorized to process my case (usuaily called ‘disability Tee determination services’), including contract copy services, and doctors or other professionals consulted during the process. [Aiso, for imemational claims. te the U.S, Department of State Foreign Service Post} PURPOSE Determining my eligibility for benefita, including ‘ooking at the combined effect of any impairments that by themselves would not meet SSA's definition of disability; and whether | can manage such benefits. Co Determining whether | am capable of managing benefits ONLY (check only if this applies) EXPIRES WHEN This authorization is good for 12 months from the date signed (below my signature). + authorize the use of a copy (including electronic copy) of this form for the disclosure of the information described above. fundesstand that there are sorte cireumstancas in which this inforrestion may be rediscinsed to other parlies (see page 2 for details). > }may write to SSA and my sources to revoke this authorization at any ime (see page 2 for detaiig). + SSA will give me a copy of this forn if! ask: 1 may agk the source t¢ aHow me to inspect or get a copy of material te be disclosed, + thave read both pages of this form and agree to the disclosures above from the types of sources listed. “PLEASE SIGN USING BLUE OR BLACK INK ONLYIF not signed by Subjéct of disclosure, Spacity basia authonty te sign INDIVIDUAL authorizing disclosure Parent of miner [7] Guardian [_] Other personai representative (expiain} SIGN € SRE waren SRS TOSERTAING BQH BSE rn ‘ . “ signatures requirad by State law) 3 Date Signed Street Address ~ - 1205 COLLEGE AVE, APT 6E Phone Number (with area code} City Stata ZIP 718-538-7807 BRONK NY i 10456-4147 WITNESS i knew the person signing this form or am satisfied of this person's identity. . needed, second witness sign here (2.9., if signed with "X" above) SIGN Re SIN Phone Number (or Address) Frone Number (or Address) This general and special authonzation to disclose was developed ta comply with the provisions regarting disclosure of medical, educational, and other information under P.L. 10@797 ("HIPAA 45 GFR parts 160 and 164; 42:U,S, Code section 290002; 42 CFR purl 2; 38 U.S, Code section 7322) 38 CFR 1.475; 20 U.S. Code section 1232g ("FERPA’), 34 OFR parts $9 and 200; and State faw. Form SSA-827 (11-2012) ef (11-2012) Lise 42-2008 and Later Editions Until Supply is Exhausted Page 1 of 2

Ne ill FPO Explanhadotl OT FOmm SSA-G27, 00 0 a a het tert tale “Authorization to Disclose Information to the Social Security Administration (SSA)” We need your written authorization to help get the information required to process your application for benefits, and to determine your capability of managing benefits. Laws and regulations require that sources of personal information have a signed authorization before releasing it to us. Also, faws require specific authorization for the release of information about certain conditians and fram ecucational sources. You can provide this authorization by signing a Form SSA-827. Federal law permits sources with information about you te release that information if you sign a single authorization to release ali your information from aii your possible sources. We will make copies of it for each source. A few States, and some individual sources of information, require that the authorization specifically name the source that you authorize to release personal information. in those cases, we may ask you to sign one authorization for each source and we may contact you again if we need you to sign more authorizations. You have the right to revoke this authorization at any time, except to the extent a source of information has already retied on it to take an action. To reveke, send a written statement to any Social Security Office. if you do, also send a copy directly to any of your sources that you no jonger wish to disclose information about you: SSA can teil you if we identified any sources you didn't tell us abcut. Information disclosed prior to revocation may be used by SSA to decide your claim. It is SSA's policy to provide service to people with limited English proficiency in their native language or preferred mode of communication consistent with Executive Order 13166 (August 11, 2000) and the Individuals with Disabiites Education Act. SSA makes every reasonable effort to ensure that the information in the SSA-827 is provided to you in your native or preferred □□□□□□□□□ IMPORTANT INFORMATION, INCLUDING NOTICE REQUIRED BY THE PRIVACY ACT All personal information collected by SSA is protected by the Privacy Act of 1974. Once medical information is disclosed to SSA, it is no longer protected by the heaith information privacy provisions of 45 CFR part 164 (mandated by the Health insurance Portability and Accountability Act (HIPAA). SSA retains personal information in strict adherence to the retention schedules established and maintained in conjunction with the National Archives and Records Administration. At the end of a record’s useful life cycle, it is destroyed in accordance with the privacy provisions, as specified in 36 CFR part 1228. SSA is authorized to collect the information on form SSA-827 by sections 205(a), 223 (d}(5)(A},1614(a)(3)(H) 1637 (d)(1) and 1631 (e}(1}(A) of the Social Security Act. We use the information obtained with this form to determine your eligibility for benefits, and your ability to manage any benefits received. This use usually includes review of the information by the State agency processing your case and quality control pecple in SSA. In some cases, your information may also be reviewed by SSA personnel that process your appeal of a decision, or by investigators to resolve allegations of fraud or abuse, and may be used in any related administrative, civil, or criminal proceedings. Signing this form is voluntary, but failing to sign it, or revoking it before we receive necessary information, could prevent an accurate or timely decision on your claim, and could result in denial or loss of benefits. Although the information we obtain with this form is almost never used for any purpose other than those stated above, the infonnation may be disclosed by SSA without your consent if authorized by Federal laws such as the Privacy Act and the Social Security Act. For example, SSA may disclose: 4. To enabie a third party (e.g., consulting physicians) or other government agency to assist SSA to establish rights to Social Securty benefits and/or coverage; 2. Pursuant te law authorizing the release of information from Social Security records (e.g., to the Inspector General, to Federal or State benefit agencies or auditors, or to the Department of Veterans Affairs(VA)); 3. For statistical research and audit activities necessary to assure the integrity and improvement of the Social Security programs (e.g., to the Bureau of the Census and private concerns under contract with SSA). Other than the above limited circumstances, SSA will not redisclose without proper prior written consent information (1) relating to alcohal and/or drug abuse as covered in 42 CFR part 2, or (2) fram educational records for a minor obtained under 34 CFR part 99 {Family Educational Rights and Privacy Act (FERPA)), or (3) regarding mental health, developmental disability, AIDS or HIV. We may aiso use the information you give us when we match records by computer. Matching programs compare our records with those of other Federal, state, or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do not agree to it. Explanations about possible reasons why information you provide us may be used or given out are available upon request frorn any Social Security Office. PAPERWORK REDUCTION ACT STATEMENT This information collection meets the clearance requirements of 44 U.S.C. section 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget contro! number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. SEND OR DELIVER FHE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S. Government agencies in your telephone directory or you may call 800 772-1213 for the address. You may send cornments on our estimate of the time needed fo complete the form to: SSA, 1338 Annex Building, Baltimore, MD 27235-0007. Send only comments refating to our time estimate to this address, not the completed form.

F/OOG2Z2312214/LEX: 2482/C002/PROMESA /DDD-3880 Page 4 cf 4

, ere Office of Tem porar A 4 Py Nisability Assist: DIE ACAMAC AC AS TORR OO Oe New York State Office of Temporary and isability Assistance Division of Disability Determinations P.O. BOX 8783 LONDON, KY 40742 Phone: (607)741-4168 Toll Free: 1-800-522-5511 Ext. 4168 Fax: 1-866-323-8335 www. OTDA, State .N¥.UsS/DDD February 16, 2016 In Reference to Claimant ARTHUR AVE HEALTH CLINIC SSN: C64-66-4420 DOB: 5/19/1981 MEDICAL RECORDS Name: JANIS C. WILSON BAHAGA 29° FULTON AVE 1205 COLLEGE AVE #65 BRONX, N¥ 10460 BRONX, NY i456 MER ORDER#: H00442078 Please usé MER ORDER# for Dictation and Remittance Tracking.

This agency is responsible for adjudication of disability claims on behalf of the federal government under the Social Security Act. Your patient has made an application for benefits and we need medical avidence from treating sources to evaluate the claim. Attached is a signed consent for the release of the information. If you receive this request via system-generated PAX, we have retained the consent form in our file. We would appreciate information from your records that is requested on the second page. This would enable us to evaluate the impairment in terms of the standards of this pregram. Your cooperation is appreciated. Sincerely yours, J. Bartlett. Disability Analyst - Unit C02

**PLEASE FOLLOW INSTRUCTIONS TO RECEIVE PAYMENT** VOUCHER INSTRUCTIONS: Billed Amount: $16.00 We are authorized to pay for medical information which is useful and relevant. If you wish payment, please COMPLETE ALL BOXES BELOW or REVIEW PREPRINTED INFORMATION. Preprinted information needing correction must be authorized via signed correspondence on the facility letterhead and returned with this letter. Payee ID: Enter the 9-Digit Federal ID assigned io you as an employer. If you are operating as an individual in business, enter your Social Security Number. The ID number MUST belong to the payee. Payee Name: Enter your name and address AS YOU WISH IT TO APPEAR ON THE CHECK.

| Payee ID: | Payee Certification: — ayee el ] certify that the above is just, true and correct and that no i | Payee Name: | part thereof has been paid except as stated and that the teenie balance is actually due and owing, and that taxes fom : Address: ! which the State is exempt ate excluded. i eee henge ene ne nee nee een □□□□□□□□□□□□□□□□□□□□□□ emit ean ene on eee enn Ae enemememce enema ta fem □□□□□□□ ; Address: Payee's Signature in ink: City, State, ZIP: | Title: Date: see a et Off. Use Only: RO Signature/Date: CO - Signature/Date/Interest: PLEASE RETURN THIS LETTER WITH YOUR REPLY IN THE ENCLOSED ENVELOPE OR FAX TO THE NUMBER ABOVE

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Claimants “Name? JANDTS □□□ WiLSON “BATA AER Date of Birth: 5/19/1981 Medical Record Number/Patient Ib: Unknown AKA: Previous Address: INFORMATION REQUESTED □ — MRT and CT Scans Urinalysis Psychiatric Records Clinic Notes Blood Chemistry EKG Discharge Summary BR Records Admission History Pulmonary Funct Studies Report({s) of Ali ALL TREATMENT RECORDS: ALLERGIES, LUPUS, ARTHRITIS, HBP

Dates of treatment OUTPATIENT FIRST INPATIENT MOST RECENT INPATIENT O1/01/2015 - Present

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CAGE AOD SOAR PWV Tal, LRU A OR AA □□ TOR CORD MAY-03-2015 14:47 □□□□□ Form ARTHUR AVE HEALTH CLINIC WHOSE Records fo be Disclosed OME Ko, 9960-082 MEDICAL RECORDS " " 277 FULTON AVE NAME (Furst, Midate, Last, Suttr) BRONX, NY 19460 Janis Charlene _ Wilson Bahaga N Birthday 064-546-4428 rarnidetlyy S/LS/ LOSE

AUTHORIZATION TO DISCLOSE INFORMATION TO THE SOCIAL SECURITY ADMINISTRATION (SSA) “ PLEASE READ THE ENTIRE FORM, BOTH FAGES, SEFORE SIGNING BELOW “* i voluntarily authorize and request disclosure (including paper, oral, and electronic interchange): OF WHAT Ail my medical records: also aducation records and other information related to my ability to - perform tasks. This includes specific permission to release: i. Alrecords and other tnlor mation regarding my treatment, hospitalization, and outpatient care for my impairmest(s) dacteding, and pot iinlted 10; + Psychotogical, psychiatric or other mental impairment(s) (excludes "psychotherapy notes” as defined in 45 CFR 164,501} + Drug aduse, alcoholism, or other supstance abuse . * Sickle cell anemia + Records which may indleate the prasence of a communicable of noncertimunicable disease; and tests for or records of HIV/AIDS * Generelated impairments (including genetic test results) Be 2 Information about how my impairment(s) affects my ability te complete tasks and activities of daily living, and affects my ability te work. 3. Copies of educational tests or evaluations, including Individualicod Educational Programs, triennial assessments, psychological and specch evaluations, and any other records that can help evaluate function; alse teachers’ observations wad evaluations. 4. Information created within 12 months after the date this authorization is signed, as well ax past information. EROM WHOM HIS BOX TO BE COMPLETED BY SSA/DDS (as needed) Additional Information to identify - All medical sources (hospitals, clinics, labs, he subject (2 9 other names used) the s ae rt rial a: physicians, psychologists, ate.) including . . RONK mental heath, correctional, addiction & souTi a . treatment, and VA haath cara facilities Ve 0.0. + Alladucationa! sources (schools, teachers, int : records administrators, counselors, etc.) as ats . + Social workars/rehabiltation counselors TPR at - Consulting examiners used by SSA * Employers, insurance companies, workers’ 4 eich ‘ compensation programs 2 eRe + Others who may know about my condition gqpauastnit ce (famiy, neightors, fiends, public officials) . TO WHOM The Social Security Administration and to the State agency authorized te process my case (usvally called ‘disability mn determination services’), including contract copy services, and docters or other professionals consulted during the process. [Also, for imemational claims, to the U.S, Department of State Foreign Service Post] PURPOSE Determining my eligibility for benefits, including looxing at the combined effect of any impaiments ve that by themselves would not meet SSA‘s definition of disability; and whether | can manage such benefits. 0 Determining whether Lam capable of managing benefits ONLY (check only if this applies) EXPIRES WHEN ‘This authorization is good for 12 months from the date signed (below my signature). > [authorize the use of a copy (including electronic copy) of this form for the disclosure of the information described above. Lunderstend that there are some citcurstences in which this infarnation may bo radisclosed to other parties (sae page 2 for details). + + may write to SSA and my sources to revoke this authorization at any time (see page 2 for details). + will give me a Copy of this form Fl ask. J may ask tne Source {0 allow me te inspect or get a copy of material to be disclosed, have read both pages of this form and agree tc the disciosures above from the types of sources listed. PLEASE SIGN USING BLUE OR BLACK INK ONLYIF not signed by subject of disclosure, specify basia for aunty □ sign INDIVIDUAL authorizing disclosure [7] Parent of minor ["] Guardian [| Other personal representative (explain) SIGN ¢ FCAT □□□ FORT OORT QR SB signatures requirad by State iaw) Date Signed ee Street Address ~ ~ 1205 COLLEGE AVE, APT 6E Phone Number (with area code) City Stata Zip 718-538-7807 BRONX NY 1 10456-4147 WITNESS | know the person signing this forn or am satisfied of this person's identity: . □ HE needed, second witness sign here (@.9., f signed with "X" above) SIGN RO SIGN Phone Number (or Address) Phone Number (or Address} This general and special authorization to disclose was developed to compiy with ihe provisions regarding disclosure of medical, educational, arid other information under F.L. 104-197 ("HIPAA 45 CFR parts 160 and 164; 42-U.S. Code section 2800-2; 42 CFR part 2; 38 U.S, Cada section 38 CPR 1.475: 20 U.S. Code section 12329 (FERPA, 34 CFR parts 99 and 300; and State law. Form SSA-G27 (41-2012) of (11-2042) Use 4-2008 and Later Editions Until Supply ig Exhausted Page 7 of 2

” — en RATIO OP Pom SSA-G2f, “Authorization to Disclose Information to the Social Security Administration (SSA)” We need your written authorization to help get the information required to process your application for benefits, and te determine your capability of managing benefits. Laws and regulations require that sources of persenal information have a signed authorization before releasing itto us. Also, laws require specific authorization for the release of information about certain conditions and from educational sources. You can provide this authorization by signing a Form SSA-827. Federal law permits sources with information about you to release that information if you sign a single authorization to release al! your information fram all your possible sources. We will make copies of it for each source. A few States, and some individual sources of information, require that the authorization specifically name the source that you authorize to release personal information. In those cases, we may ask you to sign one authorization for each source and we may contact you again if we need you toe sign more authorizations. You have the right to revoke this authorization at any time, except to the extent a source of information has already reliec on it tc take an action. To revoke, send a written statement te any Social Security Office. # you do, also send a copy directly to any of your sources that you no longer wish to disclose information about you; SSA can tell you if we identified any sources you didr’t tell us about. Information disclosed prior to revocation may be used by SSA ta decide your claim. Itis SSA's policy to provide service to people with limited English proficiency in their native language or preferred mode of communication consistent with Executive Order 13166 {August 11, 2000) and the Individuals with Disabilities Education Act. SSA makes every reasonable effort to ensure that the information in the SSA-827 is provided to you in your native or preferred language. IMPORTANT INFORMATION, INCLUDING NOTICE REQUIRED BY THE PRIVACY ACT All personal information collected by SSA is protected by the Privacy Act of 1974. Once medical information is disclosed to SSA, it is no longer protected by the heaith information privacy provisions of 45 CFR part 164 (mandated by the Heaith Insurance Portability and Accountability Act (HIPAA). SSA retains personal information in strict adherence to the retention schedules established and maintained in conjunction with the National Archives and Records Administration. At the end of a record's useful life cycle, it is destroyed in accordance with the privacy provisions, as specified in 36 CFR part 1228. SSA is authorized to callect the information on form SSA-827 by sections 205(a), 223 □□□□□□□□□□□□□□□□□□□□□□□□□□□□ 1631 (d}(1) and 4631 (e}(1}(A) of the Social Security Act, We use the information obtained with this form to determine your eligibility for benefits, and your ability to manage any benefits received. This use usually includes review of the information by the State agency processing your case and quality control people in SSA. In some cases, your information may also be reviewed by SSA personnel that process your appéal of a decision, or by investigators to resolve allegations of fraud or abuse, and may be used in any related administrative, civil, or criminal proceedings. Signing this form is voluntary, but failing to sign it, or revoking it before we receive necessary information, could prevent an accurate or timely decision on your claim, and could result in denial or loss of benefits. Although the information we obtain with this form is almost never used for any purpose other than those stated above, the information may be disclosed by SSA without your consent if authorized by Federal! laws such as the Privacy Act and the Social Security Act. For example, SSA may disclose: +. To enable a third party (¢.g., consulting physicians) or other government agency ta assist SSA to establish rights te Social Security benefits and/or coverage: 2. Pursuant to law authorizing the release of information from Social Security records (e.g., to the Inspector General, ta Federal or State benefit agencies cr auditors, or to the Department of Veterans Affairs(VA)); 3. For statistical research and audit activities necessary to assure the integrity and improvement of the Social Security programs (e.g., to the Bureau of the Census and private concerns under contract with SSA). Other than the above limited circumstances, SSA will not redisclose without praper prior written consent information (1} relating to alcchol and/or drug abuse as covered in 42 CFR part 2, ar (2} from educational records for a minor obtained under 34 CFR part 99 (Family Educational Rights and Privacy Act (FERPA)), or (3) regarding mental health, developmental disability, AIDS or HIV. We may also use the information you give us when we match records by computer. Matching programs campare our records with those of other Federal, state, or local government agencies. Many agencies may use matching programs to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even if you do not agree to it. Explanations about possible reasons why information you provide us may be used or given out are available upon request from any Social Security Office. PAPERWORK REDUCTION ACT STATEMENT This information collection meets the clearance requirements of 44 U.S.C. section 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget contro! number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. SEND OR DELIVER THE COMPLETED FORM TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S. Government agencies in your telephone directory or you may call 800 772-1213 for the address. You may send comments on our estimate of the time needed to complete the form to. SSA, 1338 Annex Building, Baltimore MD 21235-0001. Send only comments relating to our time estimate to this address, not the completed form.

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