United States District Court, D. New Jersey
Kevin McNulty, United States District Judge
Marisol Ramos brings this action pursuant to 42 U.S.C.
§§ 405(g), 1383(c)(3), to review a final decision
of the Commissioner of Social Security
("Commissioner") denying her claims to Disability
Insurance Benefits ("DIB") and Supplemental
Security Income ("SSI") under Title II and XVI of
the Social Security Act. Ramos seeks to reverse the finding
of the Administrative Law Judge ("ALJ") that she
has not met the Social Security Act's definition of
disabled for a period of March 31, 2014, the alleged
injury-onset date, through February 2016.
issue presented is whether the decision of the ALJ to deny
Ramos's application for DIB and SSI is supported by
substantial evidence. For the reasons stated below, this
Court affirms the ALJ's decision.
Ramos was born in Puerto Rico (R. 40) and is 54 years old.
(R. 62). She graduated from high school in Puerto Rico. (R.
41). Prior to 2014, Ms. Ramos had various jobs, including
home health aide (R. 41) and work at a daycare center (R. 42)
and a uniform factory. (R. 42-43).
Treatment of Foot Pain
Ramos was diagnosed with diabetes in 2002. (R. 410). On April
8, 2014, Ms. Ramos presented to The University Hospital in
Newark, NJ, with pain in her right foot. (R. 363, 369). She
was diagnosed with inflammation consistent with cellulitis.
days later, on April 11, 2014, Ms. Ramos presented at a
clinic for further evaluation of her right heel. (R. 400).
Her doctor determined that Ms. Ramos would need surgery to
drain an abscess from her foot. (R. 401). On April 14, 2014,
Ms. Ramos was admitted to the hospital for treatment. (R.
452). She then underwent two surgical debridement procedures
to treat the abscess and MRSA infection. (R. 452). She was
discharged on April 22, 2014. (R. 443).
followup appointments in May and June, Ms. Ramos reported
either no pain or minor pain to her right foot. (R. 672, 675,
678). During this time she began placing more weight on her
right foot and ultimately returned to wearing regular shoes,
using a diabetic heel cup as needed. (R. 672). By June 6,
2014, the incision on her right foot had healed. (R. 671).
24, 2014, the State requested an internal medical examination
of Ms. Ramos. (R. 716). Rambhai C. Patel, M.D. conducted an
examination of Ms. Ramos on July 8, 2014. (R. 717). Dr. Patel
noted that Ms. Ramos experienced pain when walking or
standing and that she walked with a nonprescription cane. (R.
717). Dr. Patel's diagnosis included "possibility of
neuritis" and "Possibility of diabetic retinopathy
and neuritis cannot be rule out." (R. 718 (sic in
October 2014 through December 2014, Ms. Ramos had a handful
of followup appointments with her doctors. Her September 2014
podiatric examination found decreased sensation in her feet,
but no motor deficits. (R. 788). At some of these
appointments Ms. Ramos reported pain in her foot. (R. 779,
788-89, 791). In each instance, Ms. Ramos was treated with
ibuprofen, Tylenol, ice, and stretching, and was told to wear
diabetic shoes. (R. 768, 779, 788-89, 791). In October 2014,
Ms. Ramos was offered a steroid shot, but she declined. (R.
780). There are no records that Ms. Ramos sought treatment
for this condition after December 2014.
Treatment for Mental Health
18, 2014, Ms. Ramos was examined by David Bleich, M.D. (R.
665). During this appointment, Ms. Ramos complained of
anxiety, stated that she was crying often, and reported
hearing voices. (R. 665). Dr. Bleich reported that plaintiff
was agitated, was crying, and could not sit still. (R. 666).
Dr. Bleich referred Ms. Ramos to the ER, where she had a
psychiatric consultation. (R. 650). During the consultation,
Ms. Ramos stated that she had anxiety, shaking, suicidal
thoughts, and tremors, and said she heard voices. (R.
641-42). She initially appeared anxious but became calmer
after having lunch. (R. 643). Dr. Cheryl Kennedy, M.D., noted
that Ms. Ramos was a poor historian and had decreased
concentration and energy. (R. 641-42). She was prescribed
Ativan, which yielded "good results." (R. 642).
later, on June 24, 2014, she was evaluated at an outpatient
clinic at Rutgers University Behavioral Health Care. (R.
724). Ms. Ramos was described as being a poor historian but
did not present with abnormal thoughts or behavior. (R. 729).
She further denied any ongoing symptoms of depression,
crying, or voices, but stated that she had ongoing anxiety
and nervousness. (R. 729). Ms. Ramos was prescribed Zoloft
and Ativan and was enrolled in therapy. (R. 724-25). In July
2014, Ms. Ramos presented for a followup appointment. (R.
742). She reported that the medication was helping her sleep,
but she had little appetite and reported feeling "tired
of life." (R. 742).
August 27, 2014, Alexander Iofin, M.D., conducted an
evaluation of Ms. Ramos at the request of the State. (R.
751). Dr. Iofin observed that she appeared anxious, but did
not present as delusional or paranoid. (R. 753). Dr, Iofin
further reported that Ms. Ramos did not appear agitated,
unmanageable, or disruptive; however, she reported having
anger control difficulties and mood swings. (R. 751-53). Dr.
Iofin observed that Ms. Ramos's thought process was
logical, but that she complained of memory loss. (R. 753).
Tested, she repeated two out of three words immediately and
zero out of three words five minutes later; was able to
repeat four digits forward and two digits backwards; was
unable to spell in English; had difficulties subtracting her
serial 7s; knew the current President; provided simplistic
proverb interpretations; and had reasonable impulse control.
followup appointments in 2014 and 2015, Ms. Ramos did not
report continued anxiety or mood concerns. (R. 758, 763, 767,
April 29, 2014, Ms. Ramos applied for DIB and SSI. (R.
203-216). The application was denied initially and on
rehearing. On February 23 and June 5, 2017, the ALJ held
hearings. (R. 17).
August 30, 2017, the ALJ issued a decision (R. 17-29) denying
disability benefits on the ground that Ms. Ramos was still
able to perform work at step five of the sequential
Ramos appealed. On August 15, 2018, the Appeals Council
concluded that there were no grounds for review and affirmed
the decision of the ALJ. (R. 1).
September 21, 2018, Ms. Ramos filed this action seeking to
overturn the ALJ's decision to deny benefits. Initially
assigned to Chief Judge Linares, it was reassigned to me upon
Judge Linares's retirement. (DE 11).
Standard of Review
all legal issues, this Court conducts a plenary review.
See Schaudeck v. Comm'r of Soc. Sec, 181 F.3d
429, 431 (3d Cir. 1999). As to factual findings, this Court
adheres to the ALJ's findings, as long as they are
supported by substantial evidence. Jones v.
Barnhart,364 F.3d 501, 503 (3d Cir. 2004) (citing 42
U.S.C. § 405(g)). Where facts are disputed, this Court
will "determine whether the administrative record
contains substantial evidence supporting the findings."
Sykes v. Apfel,228 F.3d 259, 262 (3d Cir. 2000).
"Substantial evidence is such relevant evidence as a
reasonable mind might accept as adequate to support a
conclusion." Zirnsak v. Colvin,777 F.3d 607,
610 (3d Cir. 2014) (internal quotation marks and citation