Lucas v. Finch

• Decision Date: 12 June 1970
• Docket Number: Civ. A. No. 3728.
• Citation: 322 F. Supp. 1209
• Parties: Romie Clifford LUCAS v. Robert H. FINCH, Secretary of Health, Education, and Welfare.
• Court: U.S. District Court — Southern District of West Virginia

322 F. Supp. 1209

Romie Clifford LUCAS v. Robert H. FINCH, Secretary of Health, Education, and Welfare.

Civ. A. No. 3728.

United States District Court, S. D. West Virginia.

June 12, 1970.

Franklin W. Kern, Charleston, W. Va., for plaintiff.

W. Warren Upton, U. S. Atty., Robert B. King, Jr., Asst. U. S. Atty., Charleston, W. Va., for Robert H. Finch.

MEMORANDUM OPINION

FIELD, Chief Judge.

This action was brought to review a decision of the Secretary of Health, Education, and Welfare which denied the plaintiff's claim for a period of disability under 42 U.S.C.A. Section 416(i) and for disability insurance benefits under 42 U.S.C.A. Section 423. The defendant has moved for summary judgment, while the plaintiff has opposed that motion by brief and has moved that the case be remanded to the Secretary.

Plaintiff first applied for a period of disability and for disability insurance benefits on February 27, 1959. The application was denied on November 20, 1959, and plaintiff took no further action on it. Subsequently, on January 27, 1965, plaintiff filed another application, which was denied initially and upon reconsideration. Plaintiff thereafter requested a hearing on his claim, and the hearing was held in Charleston, West Virginia, on September 16, 1966. The hearing examiner's decision of October 31, 1966, was affirmed in part and reversed in part by the Appeals Council on September 28, 1967. The determination by the Appeals Council denied plaintiff a period of disability and disability insurance benefits and became the final decision of the Secretary. Plaintiff then timely filed the instant action for review under 42 U.S.C.A. Section 405(g).

The hearing examiner found that a lumbosacral injury suffered by the plaintiff from October 9, 1957, to February 13, 1959, would not entitle him to a period of disability or to disability insurance benefits as of the date of his first application, since at that time an impairment had to be of long-continued and indefinite duration to constitute a disability under the Social Security Act. However, the 1965 amendments to the Act liberalized the duration requirement so that an impairment had only to last or be expected to last for 12 months. The hearing examiner applied the amended definition to plaintiff's back impairment and determined that he was entitled to a closed period of disability from October 9, 1957 to February 13, 1959.

The Appeals Council overruled this determination on the ground that the application of January 27, 1965, was filed more than 12 months after the end of the period of disability and therefore, under 42 U.S.C.A. Section 416(i) (2) (E), could not be accepted for the purpose of establishing a period of disability which ended six years earlier. The Appeals Council also concluded that the rule of administrative finality applied to the application filed in 1959 since plaintiff did not pursue it after it was initially denied.

In his brief, counsel for plaintiff contends that there was error on the face of the evidence in the first determination and therefore, under Grose v. Cohen, 406 F.2d 823 (4th Cir. 1969), fundamental fairness precludes use of that determination as a foundation for administrative res judicata. This court is of the opinion that even if the doctrine of administrative res judicata had not been applied in this case, plaintiff would still be precluded from establishing the period of disability in question because of the specific bar of 42 U.S. C.A. Section 416(i) (2) (E), which expressly prohibits a period of disability from being established if the period has terminated more than 12 months prior to the date of filing the application. Thus, plaintiff's application of January 27, 1965, insofar as it attempted to establish a period of disability from 1957 to 1959, could not be accepted.

Therefore, the next question is whether with respect to the 1965 application, the balance of the Secretary's decision otherwise denying plaintiff's claim is supported by substantial evidence. 42 U.S.C.A. Section 405(g). The decision of this court is that the requisite substantial evidence existed and that plaintiff is not entitled to a period of disability or to disability insurance benefits.

Plaintiff last met the special insured status requirements of the Social Security Act on September 30, 1962. To qualify for a period of disability and for disability insurance benefits, he had to establish that a medically determinable physical or mental impairment, expected to last at least 12 months, prevented him from engaging in any substantial gainful activity while he was under the special insured status. 42 U.S.C.A. Sections 416(i) (1) (A) and 423 (d) (1) (A).

The evidence showed that plaintiff was born in 1925 and completed the third grade in school. After working as a farmer, truck driver, press machine operator, and metal melter, he was employed as a railroad laborer from 1947 to 1957, and for two years of that period he was a railroad cook. On October 9, 1957, he injured his back and thereby became unable to work until February 13, 1959, as discussed above. Shortly thereafter, he expressed interest in participating in a rehabilitation course for cooks and bakers, but failed to follow through with the training. In 1961, he entered the A.D.C.U. program and worked as a school custodian, timekeeper, and messenger. He continued these activities off-and-on until 1964, and in 1966, he purchased and operated a small restaurant for several months. In September of 1966, plaintiff went to work for the Department of Welfare Services as a janitor's helper.

Plaintiff's alleged disabling impairments consisted of the 1957 back injury, bronchial asthma, kidney trouble, and a deteriorated heart condition. On February 13, 1959, plaintiff was examined by Dr. Kuhn, an orthopedic surgeon, who found that plaintiff had great subjective complaints but very little objectively wrong with him. He concluded that plaintiff was not disabled from an orthopedic standpoint and should be referred for vocational rehabilitation. Thereafter, plaintiff reported for cooks' and bakers' training, as discussed above, but remained at the school for only one hour. The vocational counsellor felt that the attempts to train him had failed because of his lack of co-operation and because he had no motivation to work.

Dr. Walden examined plaintiff on June 3, 1959, and found an essentially normal heart, asthmatic, and arthritic condition. His only diagnoses were "nucleus pulposus (questionable)" and "atrophy left testicle." Dr. Scott, in a letter dated July 27, 1959, to the C & O Hospital, recommended that plaintiff "go...