Aponte v. Sullivan, 92-4586.

• Decision Date: 04 March 1993
• Docket Number: No. 92-4586.,92-4586.
• Parties: Rafael APONTE v. Louis SULLIVAN, Secretary of Health & Human Services.
• Court: U.S. District Court — Eastern District of Pennsylvania

823 F. Supp. 277

Rafael APONTE v. Louis SULLIVAN, Secretary of Health & Human Services.

No. 92-4586.

United States District Court, E.D. Pennsylvania.

March 4, 1993.

Anne L. Cooper, Jacques H. Geisenberger, Jr., Lancaster, PA, for plaintiff.

Dorothea J. Lundelius, Special Asst. U.S. Atty., Health & Human Services, Mark R. Kmetz, U.S. Attys Office, James G. Sheehan, Asst. U.S. Atty., Civ. Div., Philadelphia, PA, for defendant.

MEMORANDUM

GILES, District Judge.

Plaintiff seeks review of the Department of Health and Human Services' denial of his application for benefits under Title II of the Social Security Act ("Act"), 42 U.S.C. §§ 401-33. Defendant has moved to dismiss the complaint for lack of subject matter jurisdiction. For the reasons stated below, defendant's motion is denied.

I. BACKGROUND & PROCEDURAL HISTORY

Title II of the Social Security Act provides disability benefits for a claimant who demonstrates that he suffers a physical or mental disability within the meaning of the Act and that the disability arose prior to the expiration of his insured status. See 42 U.S.C. § 423. The United States Supreme Court has succinctly described the scheme of administrative decision-making and judicial review established by the Act for the determination of Title II eligibility:

The administrative process is begun when the claimant files a claim with the Social Security Administration.... If the claim is administratively denied, regulations permit administrative reconsideration within a six-month period.... Should a request for reconsideration prove unsuccessful, the claimant may, within 60 days, ask for an evidentiary hearing before an administrative law judge, ... and a discretionary appeal from an adverse determination of the law judge lies to the Appeals Council.... Finally § 205(g) of the Act, 42 U.S.C. § 405(g), authorizes federal judicial review of "any final decision of the Secretary made after a hearing to which the claimant was a party...."

Califano v. Sanders, 430 U.S. 99, 101-02, 97 S.Ct. 980, 981-82, 51 L.Ed.2d 192 (1977) (citations omitted). Judicial review must be sought within sixty days after the Appeals Council mails notice of its decision. 42 U.S.C. § 405(g).

Plaintiff's attempt to secure Title II benefits began more than seven years ago.¹ He first filed an application for Title II disability benefits in October, 1985 alleging that he had been disabled since November 1, 1981. That application was denied in March, 1986. No appeal was taken.

In January, 1987, plaintiff again applied for Title II benefits, again alleging disability since November 1, 1981. This application was denied initially and upon reconsideration in March and May, 1987. Plaintiff did not request a hearing before an administrative law judge ("ALJ") following the denial upon reconsideration.

In July, 1989, plaintiff filed a third application for disability insurance benefits, alleging disability since May 1, 1981.² This third application was denied initially and upon reconsideration in September and November, 1989. Following this denial upon reconsideration, plaintiff filed a timely request for a hearing before an ALJ. In August, 1990, an ALJ dismissed plaintiff's request for a hearing. The ALJ held that the May, 1987 denial of plaintiff's claim became the final decision of the Secretary when plaintiff failed to further pursue his administrative remedies. The ALJ further found that the evidence submitted by plaintiff with his request for a hearing was either duplicative of the evidence submitted in his previous applications, or was irrelevant to his claim. Because the new claim involved the same facts and issues as the earlier denied claim, the ALJ held that the May, 1987, denial was res judicata of the issues raised in the new claim. Consequently, plaintiff's request for a hearing was dismissed.³

In October, 1990, plaintiff requested Appeals Council review of the ALJ's dismissal. In November, 1991, the Appeals Council declined to review the ALJ's decision. Plaintiff did not seek judicial review of the Appeals Council's action.

In February, 1992, plaintiff filed a fourth application for Title II benefits, alleging disability since October 1, 1981. The application was dismissed initially and upon reconsideration in April, 1992. Plaintiff requested a hearing before an ALJ. On June 5, 1992, the ALJ issued an order dismissing plaintiff's request for a hearing. The ALJ held that the November, 1991 refusal by the Appeals Council to review the previous ALJ's use of res judicata became a final, binding decision when plaintiff neglected to seek judicial review within sixty days. Therefore, the current application was not properly before him. Plaintiff was notified that he had 60 days to request an Appeals Council review of the order. Plaintiff did not request Appeals Council review, but instead filed this civil action on August 5, 1992. Defendant now moves pursuant to Fed.R.Civ.P. 12(b)(1) to dismiss the complaint for lack of subject matter jurisdiction.

II. DISCUSSION

Defendant argues that the only possible source of federal jurisdiction for review of Social Security benefit determinations is through the judicial review provisions of § 205(g) of the Social Security Act, 42 U.S.C. § 405(g).⁴ The Act specifies that judicial review is available only from a "final decision of the Secretary made after a hearing." Id. In the instant case, the last action taken by the Secretary, in June, 1992, was a dismissal of plaintiff's request for a hearing.⁵ Defendant argues that a dismissal of a hearing request is not a "final decision of the Secretary made after a hearing" within the meaning of § 405(g). Therefore, defendant concludes, this court is without jurisdiction to hear plaintiff's complaint.

Defendant is correct that judicial review of Title II benefits decisions is routed through the provisions of § 405(g). It is also true that a dismissal of a hearing request without holding a hearing is not a "final decision of the Secretary made after a hearing," and so judicial review of such a dismissal is generally not available. However, such review is available when the plaintiff makes a colorable constitutional claim against the Social Security Administration. Because such a claim is presented in the instant case, this court does have jurisdiction, and defendant's motion must be denied.

A. Judicial Review is Available to a Plaintiff who Makes a Colorable Constitutional Claim

The jurisdictional question presented in the instant case was addressed by the Supreme Court in Califano v. Sanders, supra. Respondent Sanders filed a Title II claim with the Social Security Administration in January, 1964. His claim was denied initially and upon reconsideration. Sanders then requested a hearing before an ALJ. The ALJ found that Sanders was ineligible for benefits because he had not demonstrated a relevant disability of sufficient severity. The Appeals Council sustained this decision, and Sanders did not pursue the judicial review of the Secretary's final decision which was available to him under 42 U.S.C. § 405(g).

Almost seven years later Sanders filed a second claim alleging the same bases for eligibility. His claim was again processed through administrative channels under the Secretary's regulations, denied at the initial and reconsideration stages, and then presented to an ALJ. The ALJ viewed the new application as barred by res judicata, but also treated the application as requiring determination of whether Sanders was entitled to have his prior application reopened. The ALJ concluded that Sanders' evidence was merely repetitious and cumulative, and found that there were no errors on the face of the evidence. Therefore, the ALJ declined to reopen and dismissed the claim. Sanders thereupon filed an action in federal district court challenging the Secretary's decision not to reopen. Jurisdiction was argued to exist through the general grant of federal question jurisdiction, 28 U.S.C. § 1331, and § 10 of the Administrative Procedure Act, 5 U.S.C. §§ 701-04, as well as 42 U.S.C. § 405(g).

The United States Supreme Court held that the district court was without jurisdiction to review the Secretary's decision not to reopen Sanders' claim. The Court first reaffirmed its earlier decision that judicial review of Title II disability determinations is not available under the general grant of federal question jurisdiction, 28 U.S.C. § 1331. Sanders, 430 U.S. at 103 n. 3, 97 S.Ct. at 983 n. 3 (citing Weinberger v. Salfi, 422 U.S. 749, 95 S.Ct. 2457, 45 L.Ed.2d 522 (1975)). The Court further held that the Administrative Procedure Act does not provide an implied grant of subject matter jurisdiction which would allow judicial review of agency action. Sanders, 430 U.S. at 104-07, 97 S.Ct. at 983-85. Thus, all judicial review of Social Security benefits determinations must be routed through 42 U.S.C. § 405(g).⁶

Having concluded that the only route to judicial review of the Social Security Administration's decision was through § 405(g), the Sanders Court held that § 405(g) itself does not authorize judicial review of the Secretary's decision not to reopen a claim. 430 U.S. at 107-09, 97 S.Ct. at 985-86. Section 405(g) provides: "any individual, after any final decision of the Secretary made after a hearing to which he was a party, ... may obtain a review of such decision by a civil action commenced within 60 days." The Supreme Court held that the plain language of § 405(g) "clearly limits judicial review to a particular type of agency action, a `final decision of the Secretary made after a hearing.'" The decision of the Secretary not to reopen the prior final decision was made without a hearing, and therefore was not reviewable under § 405(g). Sanders, 430 U.S. at 107-08, 97 S.Ct. at 985-86; Penner v. Schweiker, 701 F.2d 256, 260 (3d Cir.1983).⁷

This interpretation of the Act's judicial review provisions is essential to the preservation of the Act's...