Baker on Behalf of Baker v. Sullivan, 88-3113
| Decision Date | 10 August 1989 |
| Docket Number | No. 88-3113,88-3113 |
| Citation | 880 F.2d 319 |
| Parties | , Unempl.Ins.Rep. CCH 14850A Laurene BAKER on Behalf of Melinda BAKER, Hosie Baker, Jr. Plaintiffs-Appellants, v. Louis SULLIVAN, Secretary of Health and Human Services, Defendant-Appellee. |
| Court | U.S. Court of Appeals — Eleventh Circuit |
Lester C. Wisotsky, Orlando, Fla., for plaintiffs-appellants.
Walter J. Postula, Asst. U.S. Atty., Orlando, Fla., Stanley Ericsson, Dept. of Health & Human Services, Baltimore, Md., for defendant-appellee.
Appeal from the United States District Court for the Middle District of Florida.
Before RONEY, Chief Judge, COX, Circuit Judge, and MORGAN, Senior Circuit Judge.
This is an appeal of a final decision of the Secretary denying children's benefits under the Social Security Act. 42 U.S.C.A. Sec. 416(h)(2)(A). We affirm the denial of benefits concerning the 1979 application. We reverse the district court's determination concerning benefits granted in 1985, however, on the ground that the Secretary improperly reopened a prior award of benefits.
The facts are a bit unusual. In 1979, Laurene Baker applied for children's insurance benefits claiming Elton Lowery as the insured father of her two children, Melinda Baker, age 11, and Hosie Baker, Jr., age 9. The claim was made under Title II of the Act which provides benefits for a child of a person who is entitled to old-age insurance benefits. Lowery was entitled to old-age benefits. The birth records of the children, however, showed their father to be Hosie Baker, Laurene Baker's husband.
The Administrative Law Judge found insufficient evidence to overcome the state law presumption of the legitimacy of a child born in wedlock, and denied the claims, holding that neither claimant is a "child" of Lowery. The Appeals Council denied review.
In 1982, plaintiff filed suit in federal district court for review of the denial of the 1979 application. Before the case had been decided, the district court remanded the case to the Secretary on plaintiff's motions, because of three events that had occurred subsequent to the filing of her complaint: (1) in December 1984, a Florida state court entered a judgment of paternity adjudicating Lowery the natural father of each claimant; (2) in January 1985, plaintiff filed a second application to the Secretary for children's insurance benefits; and (3) the Secretary in March 1985, approved the 1985 application and awarded benefits from December 1984 onward. The district court thought that the Secretary should resolve the inconsistency in the factual determination that the claimants are Lowery's natural children from December 1984, but not from December 1979 to November 1984, and remanded for that purpose.
The Appeals Council resolved this inconsistency by withdrawing the award made in 1985. In April 1987, it held that: (1) the component of SSA that issued the "initial determination" in the January 1985 application did not have jurisdiction over the case; (2) the Appeals Council retains jurisdiction over the entire period at issue; (3) the state court judgment is neither consistent with state law nor is binding on the Secretary; and (4) the claimants are not Lowery's children and are not entitled to benefits on his record on either the 1979 or 1985 applications.
The difficulty with this decision is that it resulted in reopening the 1985 award of benefits without following proper procedure as required by the law of this Circuit in Kennedy v. Bowen, 814 F.2d 1523 (11th Cir.1987). Kennedy was a case involving two claims for disability. The decision of the Secretary on the first application denied benefits. Kennedy reapplied filing a second application for benefits which was approved by the ALJ. He appealed the date of onset of disability only, and the Appeals Council sua sponte revisited the issue of disability and remanded to a new ALJ, who then issued a decision denying all benefits. Kennedy then filed an action in federal district court claiming a due process violation. On appeal, the Eleventh Circuit held that absent notice (required by 20 C.F.R. Sec. 404.973) to the claimant of the Appeals Council's intent to re-examine issues not challenged by the claimant, that it was precluded from sua sponte expanding the scope of review and upsetting the decision in favor of the claimant. The notice must set forth "the reasons for review and the issues to be considered." Kennedy v. Bowen, 814 F.2d at 1527.
The Court stated it was aligning itself with the Third Circuit's holding in Powell v. Heckler, 789 F.2d 176 (3d Cir.1986), which extrapolated its notice requirement from section 404.989, which addresses the Appeals Council's own-motion review. The court in Powell reasoned that when the Appeals Council expands its scope of review in a claimant-initiated appeal, this expansion is equivalent to the Appeals Council's own motion review of the added issues, and the Council is not absolved from the notice requirement under 20 C.F.R. section 404.969. Powell v. Heckler, 789 F.2d at 178.
In Baker's case, no notice was provided that the Appeals Council was expanding its review beyond those issues raised or challenged by the claimants and no notice setting forth the reasons therefore and the additional issues to be considered, in violation of plaintiffs' due process rights.
The issue at this point is not whether the Secretary could reopen the 1985 claim under proper procedures, 20 C.F.R. Sec. 404.987, or would have good cause to change the award. 20 C.F.R. Secs. 404.988-95; see Butterworth v. Bowen, 796 F.2d 1379 (11th Cir.1986).
There are two primary ways for the Secretary to get before it a prior award for reconsideration: (1) pursuant to the statute and the agencies' own rules and regulations; and (2) under a remand from the district court. Kennedy squarely holds the due process requirements for the reopening on the Secretary's own motion, which were not followed here.
The Secretary argues that his action was permitted by the remand order. This overlooks the fact that the district court had no jurisdiction over the 1985 award when it remanded the case for reconsideration of the 1979 claim. No appeal from that claim had been taken to the district court. Nor did the district court seek to assert jurisdiction over the correctness of that decision. The district court approved the magistrate's report which set forth that a "fundamental inconsistency in the [Secretary's] position on benefit entitlement in this case," which "should not be left unresolved." The report then
... [r]ecommended that the cause be remanded to the Secretary for further evaluation of the claimant's 1979 application for Child Insurance Benefits, taking into consideration the Secretary's 1984 (sic) decision on the same claim and for taking further evidence, if necessary.
The district court docket sheet shows a 5/20/86 entry: "Case is remanded to Secretary for further evaluation of claimant's 1979 application for Child Insurance Benefits."
The Secretary had no right to reopen the 1985 determination without following Kennedy. That award remains valid until proper procedures are followed to reopen it. This case must be remanded to the district court for an appropriate order.
The issue remains as to whether the district court was right in affirming the Secretary's denial of the 1979 claim. The role of the federal court in reviewing a benefits determination is a narrow one. We may not decide the facts anew, reweigh evidence, or substitute our judgment for that of the Secretary. It is this Court's duty to engage in a careful review of the record for substantial evidence to support the Appeals Council's conclusions. Even if we find that the evidence preponderates against the Secretary's decision, we must affirm if the decision is supported by substantial evidence. 42 U.S.C.A. Sec. 405(g); see Hale v. Bowen, 831 F.2d 1007 (11th Cir.1987). Substantial evidence is such relevant evidence as a reasonable person would accept as adequate to support a...
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Table of Cases
...702.8 Baker v. Chate r, 957 F. Supp. 75, 78 (D. Md. 1996), §§ 105.3, 107.3, 107.16, 202.4, 206.1, 301.3, 312.5, 1312.5 Baker v. Sullivan, 880 F.2d 319, 320 (11th Cir. 1989), § 509.2 Baldwin v. Barnhart , 349 F.3d 549 (8th Cir. Nov. 13, 2003), 8th-03 Balenton v. Halter , 156 F. Supp.2d 776, ......
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Table of cases
...702.8 Baker v. Chate r, 957 F. Supp. 75, 78 (D. Md. 1996), §§ 105.3, 107.3, 107.16, 202.4, 206.1, 301.3, 312.5, 1312.5 Baker v. Sullivan, 880 F.2d 319, 320 (11th Cir. 1989), § 509.2 Baldwin v. Barnhart , 349 F.3d 549 (8th Cir. Nov. 13, 2003), 8th-03 Balenton v. Halter , 156 F. Supp.2d 776, ......