Aikens v. Shalala

• Decision Date: 19 February 1997
• Docket Number: Civil Action No. 92-2441(RMU).
• Citation: 956 F.Supp. 14
• Parties: Franklyn E. AIKENS, Plaintiff, v. Donna E. SHALALA, Secretary, Department of Health and Human Services, Defendant.
• Court: U.S. District Court — District of Columbia

956 F.Supp. 14

Franklyn E. AIKENS, Plaintiff, v. Donna E. SHALALA, Secretary, Department of Health and Human Services, Defendant.

Civil Action No. 92-2441(RMU).

United States District Court, District of Columbia.

February 19, 1997.

Karen N. Walker, Susan K. Fitch, Kirkland & Ellis, Washington, DC, for Plaintiff.

Claire Whitaker, Wyneva Johnson, Assistant U.S. Attorneys Office, Washington, DC, for Defendant.

MEMORANDUM OPINION AND ORDER

URBINA, District Judge.

Adopting in Part and Modifying in Part Magistrate Judge Alan Kay's Report and Recommendation and Remanding the Case to the Social Security Administration

I. Introduction

This matter comes before the court upon plaintiff's (Mr. Aikens) and defendant's (Secretary) objections to the Report and Recommendation (report) issued by Magistrate Judge Alan Kay on February 5, 1996. Pursuant to Section 205(g) of the Social Security Act, 42 U.S.C. § 405(g), Mr. Aikens seeks judicial review of a final decision issued by the Social Security Administration (SSA) terminating the Supplemental Security Income (SSI) benefits he received under Title XVI of the Social Security Act. Pursuant to 28 U.S.C. § 636(b)(1) and Local Rule 504, this court referred plaintiff's motion for judgment of reversal of an Administrative Law Judge's (ALJ) affirmance of the SSA's decision to terminate plaintiff's SSI benefits. The Secretary's motion for judgment of affirmance of that decision was also referred to Magistrate Judge Kay. The principal issue before the Magistrate Judge and now before this court is whether or not the ALJ applied the correct legal standard in determining whether Mr. Aikens was entitled to SSI benefits. That is, the court must determine whether the ALJ should have considered Mr. Aikens' medical condition at the time he was contemplating Mr. Aikens' appeal (at the time of the 1992 disability hearing) or whether the ALJ should have only considered evidence relating to Mr. Aikens' medical condition at the time of the original cessation decision (November 30, 1981).

The Magistrate Judge concluded, relying on a Court of Appeals for the Sixth Circuit case, that the applicable statutory provision of the Reform Act of 1984, 42 U.S.C. § 1382c(a)(4), required the ALJ to consider evidence relating to Mr. Aikens' medical condition at the time of the hearing. In her objections, the Secretary argues that the Magistrate Judge incorrectly construed the governing provision. The Secretary contends that the provision contains ambiguous language and therefore the Magistrate Judge should have deferred to the agency's construction of the statute. The agency construes the provision as requiring the ALJ to only consider evidence of Mr. Aikens' condition at the time of the original cessation decision. After considering the parties' objections, the Magistrate Judge's report, and the applicable law, the court concludes that the ALJ was required to consider Mr. Aikens' condition at the time of the 1992 hearing.

II. Background¹

This case presents a long and tortured factual chronology that spans over 15 years. Mr. Aikens is presently 64 years old. He has suffered from pulmonary tuberculosis for several decades and has been hospitalized on numerous occasions as a result of his medical condition. Mr. Aikens has also suffered (and apparently still suffers) from mental illness. Mr. Aikens first applied for SSI benefits on September 30, 1976. The SSA denied his application. Mr. Aikens then sought a hearing before an Administrative Law Judge (ALJ) who found him to be disabled as of June 13, 1977, because he suffered from pulmonary tuberculosis, class III. He began receiving SSI benefits on June 14, 1977. On November 24, 1981, the SSA notified Mr. Aikens that it terminated his benefits on August 1981 as a result of his failure to submit the names of his treating sources and because of his failure to attend three consultative treating exams.

Mr. Aikens appealed. He exhausted the administrative appeals process. On July 21, 1983, he filed suit in this court. The SSA moved to remand the case to the Department of Health and Human Services for reconsideration of the decision terminating Mr. Aikens' benefits pursuant to the Social Security Disability Benefits Reform Act of 1984 (Reform Act). The Reform Act requires that there be "substantial evidence" supporting the SSA's findings vis-a-vis the termination of an individual's benefits. The Act set forth a new medical standard of review to assess whether an individual previously declared disabled was entitled to a continuation of benefits. See 98 Stat. 1794, 1796097. On December 6, 1985, the SSA promulgated new regulations that implemented a new "medical improvement review standard" (MIRS). See 50 Fed.Reg. 50, 118 (1985). The regulations set forth an eight-step test for assessing whether an individual who had previously been declared disabled was entitled to a continuation of his benefits. Under MIRS, the SSA is required to determine:

[I]f there has been any medical improvement in your impairment(s) and, if so, whether this medical improvement is related to your ability to work. If your impairment(s) has not so medically improved, we must consider whether one or more of the exceptions to medical improvement applies. If medical improvement related to your ability to work has not occurred and no exception applies, your benefits will continue. Even where medical improvement related to your ability to work has occurred or an exception applies, in most cases ... we must also show that you are currently able to engage in substantial gainful activity before we can find that you are no longer disabled.

20 C.F.R. § 416.994(b) (1994).²

Applying this new standard, the SSA once again denied Mr. Aikens SSI benefits because it found that his disability ceased on November 30, 1981. Mr. Aikens requested reconsideration of that decision by an ALJ. On June 30, 1992, a hearing took place before ALJ Jan J. Michalski. On August 12, 1992 ALJ Michalski issued a decision in which he indicated that the issue before him was "whether the claimant continued to be entitled to disability benefits ... under [the Social Security Act], as of November 30, 1981," the date of the original cessation determination. In applying the MIRS eight-step inquiry, the ALJ limited his findings under steps (ii) through (viii) to Mr. Aikens' condition as it existed on November 30, 1981. See note 2 at 3-4. ALJ Michalski denied Mr. Aikens' appeal because, in his view, as of November 30, 1981 Mr. Aikens was no longer disabled. Mr. Aikens' administrative appeal of the ALJ's decision was denied. On October 30, 1992, Mr. Aikens appealed to this court.

III. Discussion

A. Statutory Framework

This case turns on the correct interpretation of the standard of review that governs the SSA's determination that Mr. Aikens was no longer entitled to SSI benefits. The SSA's determination cannot be upheld if it is the result of an error of law. Smith v. Bowen, 826 F.2d 1120, 1121 (D.C.Cir.1987). Failure on the part of the SSA "to apply the correct legal standards or to provide the reviewing court with the sufficient basis to determine that the correct legal principles have been followed is ground for reversal" of the SSA's decision. Wiggins v. Schweiker, 679 F.2d 1387, 1389 (11th Cir.1982). The applicable standard is set forth in Section 2 of the Social Security Benefits Amendments of 1984, codified at 42 U.S.C. § 1382c(a)(4). This provision provides, in pertinent part,

(4) A recipient of benefits based on disability under this subchapter may be determined not to be entitled to such benefits on the basis of a finding that the physical or mental impairment on the basis which such benefits are provided has ceased, does not exist, or is not disabling only if such finding is supported by —

(A) in the case of an individual who is age 18 or older —

(i) substantial evidence which demonstrates that —

(I) there has been any medical improvement in the individual's impairment or combination of impairments (other than medical improvement which is not related to the individual's ability to work), and

(II) the individual is now able to engage in substantial gainful activity; or []

... Any determination under this paragraph shall be made on the basis of all the evidence available in the individual's case file, including new evidence concerning the individual's prior or current condition which is presented by the individual or secured by the Secretary....

42 U.S.C. § 1382c(a)(4) (West 1992 & Supp. 1995).

The SSA interprets this provision to require the ALJ to only consider evidence of Mr. Aikens' medical condition existing at the time of the original cessation decision, in this case November 30, 1981. The SSA therefore contends that the only relevant time periods are the time of the most recent favorable decision and the time of the cessation determination. Mr. Aikens, on the other hand, contends that the ALJ erred as a matter of law when he limited the application of the new medical improvement review standard to evidence concerning his condition as it existed on November 30, 1981. In his view, the ALJ should have considered his condition as it existed at the time of the 1992 hearing.

"In reviewing an agency's construction of a statute, [the court must] first ask whether Congress has spoken unambiguously with respect to the issue at hand. If it has, [the court must] give effect to Congress' intent. If not ... [the court must] defer to the agency's interpretation if it represents a permissible construction of the statute." Consumer Federation of America and Public Citizen v. U.S. Dept. of Health and Human Services, 83 F.3d 1497, 1503 (D.C.Cir.1996). Relying on the plain meaning of 42 U.S.C. § 1382c(a)(4), the Court of Appeals for the Sixth Circuit concluded that the statute was unambiguous.

The Sixth Circuit is the only court of appeals to have construed the provision at issue in this case. It did so in Difford v....