Delamater v. Schweiker

• Decision Date: 25 October 1983
• Docket Number: D,No. 1440,1440
• Parties: Paul J. DELAMATER, Plaintiff-Appellant, v. Richard SCHWEIKER, in his official capacity as Secretary of the United States Department of Health and Human Services, Defendant-Appellee. ocket 83-6029.
• Court: U.S. Court of Appeals — Second Circuit

Page 50

721 F.2d 50

3 Soc.Sec.Rep.Ser. 218

Paul J. DELAMATER, Plaintiff-Appellant, v. Richard SCHWEIKER, in his official capacity as Secretary of the United States Department of Health and Human Services, Defendant-Appellee.

No. 1440, Docket 83-6029.

United States Court of Appeals Second Circuit.

Argued June 13, 1983.

Decided Oct. 25, 1983.

Gary J. Grayson, Walton, N.Y., for plaintiff-appellant.

Frederick J. Scullin, Jr., U.S. Atty., N.D.N.Y., Albany, N.Y., Nancy S. Jones, Asst. U.S. Atty., Syracuse, N.Y., for defendant-appellee.

Before FRIENDLY, KEARSE and CARDAMONE, Circuit Judges.

PER CURIAM:

The significant issue presented by this appeal is whether, in a proceeding to terminate social security disability benefits, the Secretary of Health and Human Services ("Secretary") may be bound by his prior administrative decision to award such benefits. Plaintiff Paul J. Delamater appeals from a judgment of the United States District Court for the Northern District of New York, Howard G. Munson, Chief Judge, dismissing his complaint for review of the Secretary's termination of Delamater's disability and disability insurance benefits under Title II of the Social Security Act, as amended (the "Act"), 42 U.S.C. Secs. 401-433 (1976) (amended 1977-1983). The district court dismissed the complaint on the ground that there was substantial evidence to support the Secretary's finding that as of October 1979 Delamater was not disabled within the meaning of the Act. See 42 U.S.C. Sec. 405(g) (Supp. V 1983); Mathews v. Eldridge, 424 U.S. 319, 339 n. 21, 96 S.Ct. 893, 905 n. 21, 47 L.Ed.2d 18 (1976); Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 1427, 28 L.Ed.2d 842 (1971). Since we agree and conclude that such a finding was not barred by the Secretary's prior administrative determination to grant Delamater disability benefits as of October 1975, we affirm.

I. BACKGROUND

On October 30, 1975, Delamater was injured in an automobile accident, suffering a fracture of the left femur, dislocation of the right wrist, fracture of the left ulna and radius, and posterior dislocation of the left hip. In March 1976 he applied to the Social Security Administration ("SSA") for disability benefits. His application was supported by two reports of his treating physician, Dr. Edward J. Carey, Jr., indicating that Delamater's left leg was able to bear his full weight with a slight limp, that his right wrist was recovering well, and that his left wrist suffered limitations in its dorsiflexion and grip abilities. The SSA initially denied his application. Delamater thereafter submitted a third report from Dr. Carey, dated April 27, 1976, that apparently caused the SSA to reconsider. In this report, Dr. Carey described Delamater's left wrist as healed with marked limitation of motion, thus precluding Delamater's use of this wrist for ordinary activities; described an x-ray showing a narrowing of the left hip joint and indicating necrosis of the cartilage, which required Delamater to use a cane or crutch during walking; noted the possibility that replacement of Delamater's hip might be required at some later date; and described Delamater's prospects for further recovery that would enable him to engage in "sustained gainful activities by October of 1976" ¹ as "extremely guarded." After the submission of this report, the SSA granted Delamater benefits commencing as of October 30, 1975.

Following the grant of benefits, the SSA, through the Bureau of Disability Determinations of the State of New York ("Bureau"), undertook periodic reviews of Delamater's condition. ² In July 1980, the SSA determined, and later affirmed upon reconsideration, that Delamater's eligibility for disability benefits had ceased as of October 1979. Delamater sought and obtained de novo review of his case before an administrative law judge ("ALJ").

A hearing was held in June 1981, at which Delamater was represented by counsel.

The ALJ considered medical reports filed by three physicians, two x-ray reports, testimony of Delamater regarding his work history and asserted disability, and testimony of a vocational expert regarding Delamater's employment-related skills and the availability of suitable jobs in the area in which Delamater resides. We summarize the evidence insofar as it relates to Delamater's condition after the beginning of October 1979.

A report by Dr. Carey of a July 24, 1980 examination stated that although Delamater was experiencing pain in his left hip, he was no longer awakened at night by pain. Delamater was able to walk short distances and sit for 15-20 minutes before the pain would require him to lie down. Abduction had improved since a 1977 examination to 20 degrees and flexion had improved to 70 degrees. Delamater walked with a marked limp and used a cane. A report by Dr. Carey of a May 19, 1981 examination stated that Delamater was occasionally awakened at night by pain in his hip and could walk perhaps 50 feet without difficulty. Though he had to change his sitting position every 10-15 minutes, there was no indication that the pain required him to lie down. Despite the development of 5 degrees abduction, flexion had decreased to 40 degrees and abduction to 15 degrees.

Dr. Alexander E. Messer had examined Delamater in 1977 and 1979 at the request of the Bureau. Dr. Messer's report of an examination on October 25, 1979, stated that "[e]xamination reveals a 49 year old male in no apparent distress." He stated that Delamater no longer had a serious problem with his left wrist. Placing his full weight on his left leg, however, continued to cause pain. His left quadriceps remained weakened and slightly atrophied. Flexion was 30 degrees; abduction was 30 degrees. Dr. Messer concluded that Delamater was "definitely totally disabled." He stated the same conclusion in a report of a May 22, 1981 examination.

Dr. Freeman Burton Webber, who examined Delamater on May 8, 1980, at the request of the SSA, also submitted a report. His report noted that Delamater's right wrist showed some enlargement and limitation upon movement, but that flexion, extension, abduction, and adduction of the wrist were without significant pain. He concluded that Delamater's left wrist also had substantially recovered. Dr. Webber found that Delamater's stance was nearly normal and that he could walk with a limp, but that his left hip was not fully extended in walking. Flexion was limited to 25 degrees during walking; the left hip could be flexed passively to 80 degrees. Internal and external rotation were each 5 degrees. Delamater did not complain of pain during the examination of his hip. Dr. Webber concluded that Delamater had the residual functioning capacity to sit for up to 4 hours, stand for up to 4 hours, walk for up to 2 hours, lift up to 50 pounds occasionally, lift 20 pounds frequently, bend and climb occasionally, and carry up to 20 pounds occasionally. Dr. Webber also noted that Delamater's hands could be used for grasping, pushing, pulling, and fine manipulations.

The ALJ also considered two x-ray reports compiled after the beginning of October 1979. A report dated October 24, 1979, indicated extensive degenerative changes, narrowing of the joint space, and extensive heterotopic bone formation of the left hip. This report concluded that there had been little change since a 1977 x-ray report. The second report, dated May 19, 1980, showed degenerative changes in the left hip that had advanced since the 1977 x-ray report.

Delamater testified before the ALJ that he walks 75 feet to and from his barn twice a day; that he makes his own breakfast and dresses himself; and that he assists in the daily care of his disabled wife, who also was injured in the 1975 car accident. He also testified that he is able to stand and walk for periods of up to two hours, drive an automobile for up to an hour, and carry up to 10 pounds occasionally. Although Delamater claimed to suffer from constant, sometimes severe, pain, he had taken no medication other than aspirin for pain in the five-and-one-half years since his accident.

He visited his physician only once a year.

In a decision dated September 11, 1981, the ALJ concluded that Delamater's eligibility for disability benefits had ceased as of October 1979, finding that as of that date Delamater "had the functional capacity to engage in substantial gainful activity" and did not suffer "bodily pain of such severity and duration as to constitute disability ... or as to preclude him from performing sedentary work on a sustained basis ...." The decision of the ALJ became the final decision of the Secretary when it was approved by the Appeals Council.

Delamater then commenced the present action for judicial review of the Secretary's determination. The district court dismissed the action on the pleadings, adopting the recommendation of the United States Magistrate to whom the matter had been referred and who had concluded that the ALJ's decision was supported by substantial evidence. This appeal followed.

II. DISCUSSION

Delamater seeks reversal of the Secretary's denial of benefits on the grounds that substantially the same medical evidence presented to the ALJ was available to the Secretary when he made his initial determination of disability and that therefore either (1) the Secretary was barred by the doctrine of administrative res judicata from making a finding different from his initial determination of disability, or (2) the Secretary failed to meet his burden of proving an improvement in Delamater's condition. We reject both contentions.

A. Administrative Res Judicata

Delamater's claim that the Secretary's decision to terminate is barred by administrative res judicata must be rejected for the fundamental reason that the initial decision to award benefits was an administrative decision, whereas res judicata may be applied only to determinations made after an adjudication.

The concept of administrative res judicata was...