Casey v. Secretary of Health and Human Services

Decision Date08 February 1993
Docket NumberNo. 92-1668,92-1668
Citation987 F.2d 1230
Parties, Unempl.Ins.Rep. (CCH) P 17208A Josie CASEY, Plaintiff-Appellant, v. SECRETARY OF HEALTH AND HUMAN SERVICES, Defendant-Appellee.
CourtU.S. Court of Appeals — Sixth Circuit

Marc W. Mulder (briefed), Wayne County Neighborhood Legal Services, Highland Park, MI, for plaintiff-appellant.

Ted Yasuda (briefed), Grace M. Kim, Dept. of Health and Human Services, Office of the Gen. Counsel, Region V, Chicago, IL, Elizabeth Larin, Asst. U.S. Atty., Detroit, MI, for defendant-appellee.

Before: MERRITT, Chief Judge; and KENNEDY and GUY, Circuit Judges.

PER CURIAM.

Plaintiff, Josie Casey, appeals from the denial of social security disability benefits and the denial of supplemental security income benefits. Casey originally filed for social security benefits in 1983 and again in 1985. Each time, the Secretary determined that Casey was not disabled and therefore denied her application for benefits. Those determinations were not appealed. Plaintiff filed a third application alleging a new onset date, and she also filed a claim for SSI benefits. Casey's application was denied initially and on reconsideration. An administrative law judge held a hearing and considered her case de novo. The ALJ found her not disabled, and the appeals council denied review. After an appeal to the district court, the matter was referred to a magistrate. The magistrate's report and recommendation concluded that summary judgment should be granted in favor of the Secretary. After considering plaintiff's objections, the district court adopted the magistrate's report and recommendation. Plaintiff timely appealed.

After review of the record, we find that there is substantial evidence to support the Secretary's determination and therefore affirm.

I. Denial of Social Security Benefits

Casey, who was born in 1931, graduated from Alabama State University with a bachelor's degree in elementary education and, prior to her claimed disability, worked for 11 years as the administrative director for a day-care center. She left her employment in 1982 when the day-care center went out of business. Her first application for disability benefits, filed in 1983, was denied in an initial determination and was never appealed. Her second application, filed in 1985, was ultimately denied in a decision issued by an ALJ on September 5, 1986. Again, plaintiff did not appeal that decision. In 1989, Casey filed her third application for benefits, alleging her disabilities began on September 6, 1986. Plaintiff's insured status expired on December 31, 1986.

As an initial matter, we note that the earlier decisions of the Secretary that were not appealed are final and binding. 20 C.F.R. § 404.955. Given these earlier decisions, plaintiff may not be found disabled prior to September 6, 1986, as that issue has been decided and must be given res judicata effect. Carver v. Secretary of Health and Human Servs., 869 F.2d 289, 291-92 (6th Cir.1989). Therefore, it is plaintiff's burden to show by clear and convincing evidence that she was disabled during the relevant four-month period, September 6 to December 31, 1986. Further, when a plaintiff previously has been adjudicated not disabled, she must show that her condition so worsened in comparison to her earlier condition that she was unable to perform substantial gainful activity.

This court reviews the final decision of the secretary to determine whether it is supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence exists when a reasonable mind could accept the evidence as adequate to support the challenged conclusion, even if that evidence could support a decision the other way. See Smith v. Secretary of Health & Human Servs., 893 F.2d 106, 108 (6th Cir.1989). Plaintiff has the ultimate burden of establishing the existence of a disability. The ALJ concluded that "[e]ssentially, there is no medical evidence in the record describing the claimant's physical condition from September 6, 1986, through December 31, 1986." We find this conclusion appropriate.

The evidence on which plaintiff relies to support her claim of disability during this relevant period fails to establish disability. The exhibits that plaintiff argues support her claim fall short of their mark. Exhibits 16 and 17 contain no information regarding the relevant four-month period, as they are reports from hospital stays in 1982 and 1984. Exhibits 20 and 21 are reports completed in 1989 by Casey's treating physician, Dr. Mendiratta. Although these reports discuss her medical history in general, no reference is made to any change in condition during the final months of 1986. 1

Plaintiff also argues that additional evidence submitted to the appeals council shows that the ALJ's decision was not supported by substantial evidence. When the appeals council denies review, the decision of the ALJ becomes the final decision of the Secretary. Wilkins v. Secretary, Dep't of Health & Human Servs., 953 F.2d 93, 96 (4th Cir.1991) (en banc); 20 C.F.R. § 404.955. While new material evidence may be submitted for consideration to the appeals council pursuant to 20 C.F.R. § 404.970, on appeal we still review the ALJ's decision, not the denial of review by the appeals council. Phelps v. Secretary of Health and Human Servs., 961 F.2d 1578 (6th Cir.1992).

While it is possible that a court "may at any time order additional evidence to be taken before the Secretary," a court may only do so "upon a showing that there is new evidence which is material and that there is good cause for the failure to incorporate such evidence into the record in a prior proceeding." 42 U.S.C. § 405(g). Plaintiff has not only failed to make a showing of good cause, but also has failed to even cite this relevant section or argue a remand is appropriate.

Additionally, even if we were to consider the additional evidence as part of the record in determining whether the ALJ's decision was supported by substantial evidence, our conclusion would not change. This additional evidence does not further her cause in any significant way. The only relevant items regarding the four-month period in question show no marked departure from previous examinations. The rest of the material contained in the additional evidence pertains to a time outside the scope of our inquiry.

II. Denial of SSI Benefits

The proper inquiry in an application for SSI benefits is whether the plaintiff was disabled on or after her application date. Claimant's application was filed on March 13, 1989. Plaintiff alleges disability stemming from several different conditions: asthma, hypertension, loss of hearing, thyroid abnormalities, urinary tract problems, diabetes, arthritis or arthritis-like pain, gastrointestinal problems, heart problems, and chest pains. Despite these various impairments, the ALJ determined that plaintiff retained the ability to meet the demands of light and sedentary work.

Plaintiff's main argument is that the ALJ's decision is not...

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