## Facts

- Roger Aubuchon applied for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) on behalf of his son, David Aubuchon, seeking benefits for a **closed period** from **December 31, 1999, through August 16, 2001**, alleging David had been continuously disabled since he stopped working in 1999.
- David Aubuchon fell off a ladder at work in **1997** and injured his back, but he returned to work after the accident.
- By **1999**, he reported **chronic low-back pain radiating down his leg**, worsening with sitting, standing, walking, coughing, and sneezing.
- From **1999 through 2001**, he was treated with **physical therapy**, **steroid injections**, and **prescription pain medication**; examinations noted limitations such as decreased spinal range of motion, sensory deficits, gait changes associated with pain, and continuing complaints of significant pain.
- During treatment for his back condition, physicians also documented **liver disease associated with alcohol abuse**, including abnormal liver-function findings and **anemia**.
- On **August 17, 2001**, he was hospitalized with **acute liver disease** (including chronic hepatitis C and cirrhosis) and serious complications including **esophageal varices** requiring banding.
- David Aubuchon later **died on October 8, 2004**, from complications of liver disease.
- Aubuchon’s benefit applications were denied initially and on reconsideration.
- After an initial hearing, an ALJ issued a **partially favorable** decision on **December 18, 2001**, finding David disabled starting **August 17, 2001**, but **not disabled** from **December 31, 1999 through August 16, 2001**.
- The Appeals Council affirmed the post–August 17, 2001 disability finding but **vacated and remanded** the adverse portion because the **hearing tape could not be located**, requiring a new hearing.
- After a second hearing, the ALJ again found **no disability** during the closed period in a **May 28, 2004** decision, concluding David’s impairments did **not meet or medically equal** any listed impairment.
- At that rehearing, the **only medical expert** testified that while no single impairment met a listing, the **combination** of impairments was **medically equivalent** to the listing for **chronic liver disease**.
- The Appeals Council denied review on **April 1, 2005**, making the May 28, 2004 decision the Commissioner’s final decision.
- Roger Aubuchon sought judicial review in the **U.S. District Court for the District of Massachusetts** under **42 U.S.C. §§ 405(g) and 1383(c)(3)**; with party consent, the case proceeded before a magistrate judge for all purposes.

## Issues

1. Whether substantial evidence supported the ALJ’s step-three finding that, during the closed period, Aubuchon’s impairments did not meet or medically equal a listed impairment when the only medical expert testified that the combined impairments equaled the chronic liver disease listing.
2. Whether the ALJ could reject the sole, unrebutted medical-expert opinion on medical equivalence without an adequate medical explanation grounded in the record.
3. Whether the appropriate remedy under 42 U.S.C. § 405(g) was a remand for further proceedings or a reversal with an order to pay benefits for the closed period.

## Decision

- The court **allowed** the plaintiff’s motion for judgment on the pleadings.
- The court **denied** the Commissioner’s motion to affirm.
- The court **reversed** the Commissioner’s denial of benefits for the closed period **December 31, 1999 through August 16, 2001**.
- The court **ordered that benefits be paid** for the closed period, concluding further administrative proceedings were unnecessary on this record.

## Legal Principles

- Under **42 U.S.C. § 405(g)** (and **§ 1383(c)(3)** for SSI), a federal court reviews whether the Commissioner applied the correct legal standards and whether the decision is supported by **substantial evidence** in the record as a whole.
- **Substantial evidence** is more than a scintilla and means such relevant evidence as a reasonable mind might accept as adequate to support the agency’s conclusion.
- At **step three** of the disability analysis, whether an impairment (alone or in combination) **medically equals** a listed impairment is a **medical judgment**; an ALJ may not replace medical judgment with lay evaluation.
- When the record contains **uncontradicted** medical-expert testimony on medical equivalence, an ALJ must give a reasoned explanation supported by medical evidence for rejecting it; a conclusory step-three finding is not enough for judicial review.
- A reviewing court may **reverse and order payment of benefits**—instead of remanding—when the record compels a disability finding and additional administrative proceedings would not materially aid the decision.

## Conclusion

The district court reversed and directed payment of benefits for the closed period because the ALJ’s step-three finding was not supported by substantial evidence where the only medical expert testified that Aubuchon’s combined impairments were medically equivalent to the chronic liver disease listing, and the record supported that testimony such that further proceedings were not warranted.


Aubuchon v. Barnhart, 403 F. Supp. 2d 152 (2005)