Byam v. Barnhart

• Decision Date: 31 March 2003
• Docket Number: Docket No. 01-6195.
• Citation: 336 F.3d 172
• Parties: Jean D. BYAM, Plaintiff-Appellant, v. Jo Anne BARNHART, Commissioner, Social Security Administration Defendant-Appellee.
• Court: U.S. Court of Appeals — Second Circuit

336 F.3d 172

Jean D. BYAM, Plaintiff-Appellant, v. Jo Anne BARNHART, Commissioner, Social Security Administration Defendant-Appellee.

Docket No. 01-6195.

United States Court of Appeals, Second Circuit.

Argued: October 8, 2002.

Decided March 31, 2003.

Amended: July 11, 2003.

COPYRIGHT MATERIAL OMITTED

Rodney F. Vieux, Johnson, VT, for Plaintiff-Appellant.

Michael P. Drescher, Assistant United States Attorney, (Peter W. Hall, United States Attorney for the District of Vermont, Carol L. Shea, Chief of Civil Division on the brief), Burlington, VT, for Defendant-Appellee.

Before: WALKER, Chief Judge, CARDAMONE and STRAUB, Circuit Judges.

JOHN M. WALKER, JR., Chief Judge.

Plaintiff-appellant Jean Byam appeals from the judgment of the United States District Court for the District of Vermont (Jerome J. Niedermeier, Magistrate Judge) granting the motion for summary judgment by the defendant-appellee Commissioner of the Social Security Administration ("the Commissioner") and denying the cross-motion for summary judgment by the plaintiff-appellant Byam. The administrative law judge ("ALJ") granted Supplemental Security Income ("SSI") disability benefits dating back to June 1996, but refused to reopen three previous applications filed in 1993, 1994, and 1995 that had been denied and for which no hearing had been requested. The district court ruled that it lacked the jurisdiction to review the decision to deny Byam's request to reopen her earlier applications for SSI disability benefits, because neither did the ALJ constructively reopen the appellant's previous applications nor did the ALJ's decision not to reopen the appellant's previous applications violate due process.

We conclude that the district court erred in two respects: 1) it misapplied Stieberger v. Apfel, 134 F.3d 37 (2d Cir.1997), by focusing solely on whether Byam could "comprehend" notice of denial of disability benefits, and not whether she could "act upon notice," id. at 40; and 2) it misconstrued the administrative law judge's findings of facts in ruling that there was no violation of due process. Accordingly, we vacate the district court's grant of summary judgment and remand for further proceedings on the question of whether Byam was denied due process in her previous applications for SSI benefits.

I. BACKGROUND

We first briefly describe the administrative scheme for SSI applications, and then turn to Byam's medical and psychiatric evaluations as they developed over the course of her four applications.

A. Procedures for SSI Applications

The Social Security Act entitles disabled individuals to receive SSI benefits. See 42 U.S.C. § 1381a. The Act defines disability as an "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 423(d)(1).

A claimant whose application has been denied may request reconsideration within sixty days of receiving the denial. 20 C.F.R. § 416.1409(a). If the claim has been denied on reconsideration, the claimant may request a hearing before an ALJ within sixty days. § 416.1433(b). Following the ALJ's decision, the claimant may request review by the Appeals Council within sixty days. § 416.1468(a). The Appeals Council renders the agency's determination final, and it is subject to judicial review within sixty days. § 416.1481. The claimant may request that her application be reopened within twelve months of notice of the initial determination for any reason, and within two years of the initial determination for good cause. § 416.1488(a)-(b). An applicant establishes "good cause" by furnishing new and material evidence; demonstrating a clerical error; or offering evidence in the administrative record that "clearly shows on its face that an error was made." § 416.1489(a). An application can be reopened at any time if the determination was obtained by "fraud or similar fault ... tak[ing] into account any physical, mental, educational, or linguistic limitations [which the applicant] may have had at the time." § 416.1488(c). When a claimant has failed to request reconsideration, an ALJ hearing, Appeals Council Review, or review by a federal district court, Social Security Ruling 91-5p requires the agency to extend the deadlines for such requests if the claimant had good cause for missing the deadline, such as if "he or she lacked the mental capacity to understand the procedures for requesting review" or had "any mental or physical condition which limit[ed] the claimant's ability to do things for him/herself." Social Security Ruling ("SSR") 91-5p, 1991 WL 208067, at *2 (S.S.A. July 1, 1991); see also Stieberger, 134 F.3d at 38.

B. Byam's Psychiatric Background and Previous Applications

Byam, who was born in 1950, has been unable to work since June 1, 1969, which she attributes to depression, headaches, and arthritis. According to her psychiatric records, Byam has been hospitalized three times after suicide attempts in 1969, 1974, and 1981.

Byam, unassisted by counsel, first applied for SSI benefits on September 13, 1993. The application included a "Mental Residual Functional Capacity Assessment" ("MRFCA") and a "Psychiatric Review Technique" by Dr. Gayle Frommelt. The MRFCA form begins by explaining, "Each mental activity is to be evaluated within the context of the individual's capacity to sustain that activity over a normal workday and workweek, on an on going basis." Similarly, the Psychiatric Review Technique uses categories established by 20 C.F.R. § 416.925 and 20 C.F.R. § 404, Subpt. P, Appendix 1, which "are so constructed that an individual with an impairment(s) that meets or is equivalent in severity to the criteria of a listing could not reasonably be expected to do any gainful activity." 20 C.F.R. § 404, Subpt. P, Appendix 1, 12.00 Mental Disorders, Introduction. Thus, these evaluations focus specifically on employment.

Dr. Frommelt noted that Byam had an affective disorder, which the regulations characterize as "a disturbance of mood, accompanied by a full or partial manic or depressive syndrome," and a personality disorder, defined as "typical of the individual's long-term functioning." 20 C.F.R. § 404, Subpt. P, Appendix 1, listings 12.04 and 12.08. Dr. Frommelt checked boxes indicating that Byam had "[i]nflexible and maladaptive personality traits which cause either significant impairment in social or occupational functioning or subjective distress," including "[p]ersistent disturbances of mood or affect," "[p]athological dependence [and] aggressivity," and "[i]ntense and unstable interpersonal relationships and impulsive and damaging behavior." Dr. Frommelt also checked boxes indicating that Byam was "moderately limited" in her ability to understand, remember, and carry out detailed instructions, her ability to maintain attention and concentration for extended periods, and her ability to set realistic goals or make plans on her own, in addition to other moderate work-related limitations. Dr. Clifford Rivers, in a separate psychological assessment, also noted that her mood disorder affects her concentration and attention, that she "may be becoming more dependant and coping increasingly poorly," and that she lacks judgment and "insight into many of her problems." On November 19, 1993, the Social Security Administration ("SSA") denied her 1993 application initially and denied it again upon reconsideration on April 6, 1994.

Byam's denial notice informed her of a right to a hearing, and explained that some benefits might be lost if, instead of requesting a hearing, she filed a new application. Byam did not request a hearing; and instead, again without counsel, she filed a second claim for benefits on September 29, 1994. Five days later, she reported to the Washington County Mental Health Hospital, so that she would "not act on suicidal thoughts." Byam began treatment there, although the record is unclear whether she was ever hospitalized. The staff at the hospital noted "memory loss and vagueness" and "dissociative presentation," which is a disruption in "the usually integrated functions of consciousness, memory, identity, or perception of the environment." Dr. Rafael Garcia observed depression, suicidal ruminations, impaired concentration, and social phobia. In November 1994, the hospital staff noted the same disorders, and also "PTSD [post-traumatic stress disorder] with suicidal ideation." Dr. Edward Hurley, completing Byam's MRFCA for her 1994 application, found mental conditions similar to the ones in Dr. Frommelt's 1993 evaluation: She was "moderately limited" in her ability to understand and carry out detailed instructions, but "not significantly limited" in following simple instructions; and she had "slight" restriction in daily living activities, "moderate" difficulty in social functioning, and "often" had deficiencies in concentration. The regional commissioner of the SSA denied her 1994 application on January 11, 1995, and she did not request reconsideration or a hearing.

Byam, again unaided by counsel, filed a third application on July 26, 1995. Her 1995 evaluations indicate that her depression and poor concentration continued. Dr. Hurley completed her MRFCA for the 1995 application and found some improvement over the past year, but continued to observe moderate limitations in her ability to carry out detailed instructions. The acting regional commissioner denied her 1995 application initially on September 12, 1995 and on reconsideration on November 29, 1995. As with her previous applications, she did not request a hearing. Even though at any time within a year of the denials of her 1993, 1994, and 1995 applications she could have requested that her applications be reopened, she never did so, despite the denial notices' warnings that she may lose benefits by filing a new...