State of N.Y. v. Sullivan
| Decision Date | 27 June 1990 |
| Docket Number | Nos. 1346,1520,D,s. 1346 |
| Citation | 906 F.2d 910 |
| Parties | , 30 Soc.Sec.Rep.Ser. 321, Unempl.Ins.Rep. CCH 15501A The STATE OF NEW YORK; Cesar Perales, as Commissioner of the New York State Department of Social Services; the City of New York; the County of Suffolk; Peter F. Cohalan, as County Executive of the County of Suffolk; Anita Romero, as Commissioner of the Suffolk County Department of Social Services; and Walthon White, Haydee Guzman, Anibal Villanueva, Rafael Rivera, Gladys Dominguez, Hector Muniz, Luis Diaz, Cathryn Gibbons, Maria Gonzalez, Jorge Perez, Edwarda Rivera, Herminia Gonzalez, all others similarly situated, Plaintiffs-Appellees, Cross-Appellants, v. Louis W. SULLIVAN, M.D., as Secretary of the United States Department of Health and Human Services; Docas Hardy, as Commissioner of the Social Security Administration; and the United States Department of Health and Human Services, Defendants-Appellants, Cross-Appellees. ockets 90-6044, 90-6092. |
| Court | U.S. Court of Appeals — Second Circuit |
Evelyn M. Tenenbaum, Asst. Atty. Gen., State of N.Y., New York City (Robert Abrams, Atty. Gen., State of N.Y., Yvonne Powe, Asst. Atty. Gen., Neil Corwin, William J. Thom, Asst. Corp. Counsel of New York City, Victor A. Kovner, Corp. Counsel, New York City, Joyce D. Long, Asst. Suffolk County Atty., E. Thomas Boyle, Suffolk County Atty., Hauppage, N.Y., of counsel), for Governmental plaintiffs-appellees, cross-appellants.
David S. Udell, Legal Services for the Elderly, New York City (Toby Golick, Jonathan A. Weiss, Legal Services for the Elderly, Wayne G. Hawley, Jill A. Boskey, MFY Legal Services, New York City, Jill A. Siegal, Kenneth J. Barnes, Bronx Legal Services, Bronx, N.Y., Lewis Golinker, Legal Services of Central New York, Syracuse, N.Y., of counsel), for individual plaintiffs and plaintiff class-appellees-cross-appellants.
Diogenes P. Kekatos, Asst. U.S. Atty. (Otto G. Obermaier, U.S. Atty., S.D.N.Y., Edward T. Ferguson, III, Asst. U.S. Atty., New York City, of counsel), for defendants-appellants, cross-appellees.
David Orentlicher, Kirk B. Johnson, Edward B. Hirshfeld, American Medical Ass'n and American College of Cardiology, Chicago, Ill., as amici curiae.
Before KAUFMAN, KEARSE and MINER, Circuit Judges.
As the agency charged with administering the Social Security Act (the "Act"), the Department of Health and Human Services ("HHS") has a vital responsibility to evaluate the claims of those with debilitating heart diseases fairly and accurately. This is especially the case when afflictions disable people from working and adverse agency decisions threaten claimants and their families with indigency.
This action challenges the policies used by the Secretary of the Department of Health and Human Services ("the Secretary") to parcel out disability benefits to applicants claiming to suffer from ischemic heart disease. A December 4, 1989 Order and Judgment implemented an earlier decision, State of New York v. Bowen, 655 F.Supp. 136 (S.D.N.Y.1987), in which Judge Carter, in a carefully reasoned opinion, granted summary judgment and invalidated the Secretary's policy of relying exclusively on treadmill exercise test results when evaluating disability claims for cardiovascular disease as contravening the Act. The district court ordered the readjudication of unfavorable disability determinations received by members of a subclass that was certified earlier. State of New York v. Heckler, 105 F.R.D. 118 (S.D.N.Y.1985). The Secretary appeals from these orders and judgment. The appellee subclass of claimants and the State of New York cross appeal as to the scope of relief awarded. We conclude that summary judgment was appropriately granted and affirm the decision of the court below.
This case centers on the procedures used to evaluate the functional capacity of claimants with ischemic heart disease ("ischemia"). Administration of the Act in this area affects large numbers of people. More than sixty percent of all individuals with heart disorders suffer from ischemic heart disease, an affliction caused by narrowing of the arteries, usually due to coronary atherosclerosis. Atherosclerosis is the pathological process whereby deposits of cholesterol and other substances narrow and obstruct the artery walls of the heart. When the coronary arteries are blocked by atherosclerosis, not enough blood, and therefore not enough oxygen, reaches the heart muscle. Individuals with ischemic heart disease typically suffer chest pain ("angina") upon exertion. See E. Braunwald, Heart Disease: A Textbook of Cardiovascular Medicine 1191, 1314 (3d ed. 1988).
Pursuant to the Act, the federal government provides benefits to disabled persons under two distinct programs administered by the Social Security Administration ("SSA"). Title II of the Act, through the Social Security Disability Insurance program ("SSDI"), provides for the payment of insurance benefits to persons who have previously contributed to the program and suffer from a physical or mental disability, and Title XVI of the Act, through the Supplemental Security Income program ("SSI"), provides for the payment of disability benefits to indigent persons.
Initial disability determinations are generally made by a state agency acting under the authority and control of the Secretary. 42 U.S.C. Secs. 421(a), 1383b(a). In New York, the Office of Disability Determinations ("ODD") of the New York State Department of Social Services assesses requests for benefits. ODD's resolution of claims must be made in accordance with the Act and the standards and criteria contained in the relevant regulations and other written guidelines of the Secretary. Disappointed claimants may seek federal administrative review by the SSA. 42 U.S.C. Secs. 405(b)(1), 1383(c)(1); see Bowen v. City of New York, 476 U.S. 467, 471-72, 106 S.Ct. 2022, 2025-26, 90 L.Ed.2d 462 (1986). Upon exhaustion of administrative remedies, the claimant may seek judicial review in federal district court. 42 U.S.C. Sec. 405(g).
The Secretary has established a five-step sequential evaluation process for determining entitlement to benefits. The first step in the process requires the Secretary to ascertain whether the claimant is currently engaged in "substantial gainful activity." If so, benefits are denied. If the applicant is not engaged in such activity, the second step requires a decision whether the claimant's medical condition or impairment is "severe," i.e., one that significantly limits his ability to work. If the impairment is found to be "not severe," benefits are denied.
If the impairment is severe, step three requires a determination of whether the damage is of sufficient gravity to meet or equal the definitions found in the Listing of Impairments (the "Listings"). See 20 C.F.R. Part 404, Subpt. P, App. 1 (1987). The Listings is a catalog of physical signs, laboratory findings and clinical symptoms that are deemed to be evidence of impairments which are so severe that their presence alone conclusively establishes disability. If the applicant meets or equals the Listings, he or she is considered disabled. If, however, a claimant has a severe impairment that is not considered per se disabling under the Listings, step four compels the Secretary to ascertain his residual functional capacity ("RFC"), a measure of employment capabilities. If he is able to meet the physical and mental demands of his prior work, benefits are denied. If the applicant is unable to perform his past work, he is then evaluated at the fifth step in the process, which requires a finding of whether, given his functional ability (RFC), age, education and past work experience, he could perform other jobs that exist in the national economy. If the claimant is found unable to do such work, benefits are awarded. See generally, 20 C.F.R. Secs. 404.1520, 404.1521, 416.920, 416.921, 416.965.
In this appeal the State of New York and class representatives challenge the Secretary's reliance on certain diagnostic tests used in the evaluation process at steps 3, 4 and 5. Specifically, they challenge the Secretary's heavy reliance on treadmill exercise tests to determine ability to work. These tests are performed by requiring an individual to walk on a treadmill or to pedal on a cycle while electrocardiogram ("EKG") responses are recorded. During the procedure the treadmill's speed and gradient are progressively escalated, placing increasingly greater oxygen demands on the patient. Abnormalities in the EKG response indicate ischemia.
Evidence presented below established that the treadmill test, while recommended by many medical experts as a good diagnostic tool, results in misdiagnosis of ischemic heart disease on more than one third of the occasions. An individual who does not show signs of heart disease during a treadmill test may still be severely disabled from ischemia. False assessments may occur because treadmill testing does not consider the full range of stresses and exertions that arise at the workplace or in daily living. For example, the test does not account for demands placed on the heart by heat, cold, humidity, pollution, altitude, psychological pressures and physical efforts that are sudden or prolonged. See American College of Cardiology, Insurability and Employability of the Patient with Ischemic Heart Disease, 14 J.Amer.Coll.Card. 1003, 1033 (1989).
In certain circumstances, other widely used procedures, including nuclear tests (the exercise thallium test and the equilibrium radionuclide angiogram) and angiography, are more reliable than the treadmill test in measuring the severity of ischemic heart disease. The exercise thallium test produces an image of the heart muscle after injecting small amounts of a radioactive substance into the bloodstream and using a nuclear camera to photograph changes. The equilibrium...
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