Sumpter v. Bowen
| Decision Date | 20 January 1989 |
| Docket Number | No. C88-205-K.,C88-205-K. |
| Citation | 703 F. Supp. 1485 |
| Parties | Gerald L. SUMPTER, Social Security No. XXX-XX-XXXX, Plaintiff, v. Otis R. BOWEN, M.D., Secretary of Health and Human Services, Defendant. |
| Court | U.S. District Court — District of Wyoming |
Lloyd E. Hartford, on the brief, Billings, Mont., for plaintiff.
Toshiro Suyematsu, Asst. U.S. Atty., D. Wyo., on the brief, Cheyenne, Wyo., for defendant.
ORDER AFFIRMING DECISION OF SECRETARY OF HEALTH AND HUMAN SERVICES (WITH FINDINGS)
The above-entitled matter having come on regularly before the Court upon appeal from a decision of the Appeals Council of the Department of Health and Human Services denying plaintiff's request for review of the decision of the Administrative Law Judge (ALJ) finding plaintiff not entitled to disability insurance benefits or supplemental security income benefits, which appeal was submitted on the briefs without the necessity of oral argument upon stipulation of the parties, and the Court having fully and carefully reviewed and considered the record, the briefs of the parties and all matters pertinent thereto, and being fully advised in the premises, FINDS:
This is an appeal from a decision of the Secretary of Health and Human Services (Secretary) denying disability insurance (DI) benefits and supplemental security income (SSI) benefits to plaintiff Gerald Sumpter under Title II of the Social Security Act (Act), 42 U.S.C. §§ 401-433, and Title XVI of the Act, 42 U.S.C. §§ 1381-1383c, respectively. This Court has jurisdiction pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3).
Plaintiff Sumpter, now a 54-year old widower residing in Cody, Wyoming, injured his back in 1971 when, while in the employ of a railroad company as a mason, he slipped on a cement bag on which he was standing as he was unloading cement bags from a boxcar and fell, twisting his lower back. He has not worked since then, maintaining that due not only to his back problems and pain associated therewith but also because of arthritis, hearing impairments, poor eyesight, problems with balance, and depression, he has been rendered disabled. His son and daughter-in-law have moved into Sumpter's home, paying the bills and providing essentials such as cooking meals and washing laundry. Sumpter complains of having difficulty raising a cup of coffee when he gets up in the mornings for about half an hour until his hands and fingers start functioning properly. Record at 71 (Tr. at 20). Sumpter's educational background extends only to a portion of the seventh grade when he withdrew from school. Other than that he has had less than a year of mechanics training. Record at 37-38, 227.
Complaining of low back pain with radiation into his legs since his accident, Sumpter visited Dr. Schoedinger in St. Louis, Missouri. At that time, according to the medical report of June 6, 1972, Dr. Schoedinger suspected sciatic nerve involvement. Record at 162. On October 12, 1973, Sumpter underwent an operation for a herniated nucleus pulposus; a fusion was performed at L5-S1, along with a complete laminectomy at L5 and a partial laminectomy at L4. Record at 173.
Sumpter filed his latest applications for SSI and DI benefits on February 27, 1987 and March 2, 1987, respectively, alleging an onset date of February 14, 1971, the date of his accident.1 He had been receiving DI benefits until it was determined by ALJ Paynter in 1983 that Sumpter's disability ceased on November 30, 1982 due to medical improvement. Record at 192-197. The ALJ concluded that Sumpter's entitlement to a period of disability and DI benefits ended January 31, 1983. See also Record at 141-142. On reconsideration, that decision was upheld. Record at 150. No further appeal was taken.
A hearing was held before ALJ Hiaring on September 9, 1987 regarding Sumpter's latest applications. By decision dated December 28, 1987, ALJ Hiaring found Sumpter was not disabled for any period of time since the cessation of his benefits and accordingly disallowed both SSI and DI benefits. Record at 12-25. A subsequent review request to the Appeals Council was denied, leaving the ALJ's decision as final action by the Secretary. Record at 5-6.
On appeal to this Court, plaintiff raises several points of error. Initially, the argument is made that Sumpter's benefits were wrongfully terminated after the first month in 1983. Plaintiff urges the Court to reopen ALJ Paynter's decision of five years ago, contending that medical evidence substantiates his subjective complaints of disabling pain. On this point, defendant counters that this circuit's decision in Belveal v. Heckler, 796 F.2d 1261, 1263 (10th Cir.1986) as well as the Supreme Court's ruling in Califano v. Sanders, 430 U.S. 99, 97 S.Ct. 980, 51 L.Ed.2d 192 (1977) militate against this Court taking any action which would reopen ALJ Paynter's decision.
Administrative regulations provide for the reopening of previous decisions from which an appeal was not taken within the prescribed time period. See 20 C.F.R. § 404.988. Upon request made within four years of the decision sought to be revised, the matter will be reopened only if good cause exists. § 404.988(b). Although the "good cause" standard is not mentioned beyond four years, § 404.988(c) enumerates specific circumstances under which a decision may be reopened at any time, the first such reason being for "fraud or similar fault...." § 404.988(c)(1). The regulations clarify "good cause" as existing if "(1) new and material evidence is furnished; (2) a clerical error in the computation or recomputation of benefits was made; or (3) the evidence that was considered in making the determination or decision clearly shows on its face that an error was made...." § 404.989(a).
Congress clearly spoke when, under the jurisdictional statute, 42 U.S.C. § 405(g), it limited federal district court review of final decisions of the Secretary to appeals brought within sixty days of any such final decision. No appeal was taken beyond the request for reconsideration of ALJ Paynter's decision. Sanders specifically recognizes that § 405(g) does not authorize judicial intervention for alleged abuses of agency discretion in the decision to not reopen a claim for benefits. Sanders, 430 U.S. at 107-108, 97 S.Ct. at 985-86.
However, the inquiry does not end here. With his request to reopen the prior decision, plaintiff raises an issue of constitutional magnitude, one which Sanders found more suited to determination by the courts rather than administrative agencies. Id. at 109, 97 S.Ct. at 986. Plaintiff argues that medical evidence proves that his disability had not ceased in 1982 and that the decision to the contrary works not only a manifest injustice but a denial of due process.
Due process has its underpinnings in the belief that "a person in jeopardy of serious loss must be given notice of the case against him and opportunity to meet it." Joint Anti-Fascist Refugee Committee v. McGrath, 341 U.S. 123, 171-172, 71 S.Ct. 624, 648-49, 95 L.Ed. 817 (1951) (Frankfurter, J., concurring). Termination of DI benefits does not require that a pre-termination hearing be held in order to satisfy this essential constitutional guarantee. Mathews v. Eldridge, 424 U.S. 319, 349, 96 S.Ct. 893, 909, 47 L.Ed.2d 18 (1976). But cf. Goldberg v. Kelly, 397 U.S. 254, 90 S.Ct. 1011, 25 L.Ed.2d 287 (1970) (). Goldberg remains the only instance in the realm of statutory entitlements where a hearing prior to termination is an essential. This is appropriately so when one considers that continued entitlement to welfare benefits turns on credibility and veracity determinations while the decision to terminate DI benefits depends solely upon documentary medical evidence of a recipient's condition. See Goldberg, 397 U.S. at 269, 90 S.Ct. at 1021.
To evaluate plaintiff's due process challenge, the Court looks to the evidence considered at the administrative level. On November 4, 1982, plaintiff was notified that, as per a previous letter, his continued entitlement to benefits was in doubt. Record at 125-126. The reports of Drs. Mitchell, Robinson, and Rehder were indicated as considered in the process. Record at 125. Acknowledging the existence of some discomfort, the conclusion nonetheless was that Sumpter's ability to stand, walk, and use his arms was not seriously limited. Id. As for the hearing loss, the use of a hearing aid convinced the agency of Sumpter's ability to engage in everyday social communication. Id. Plaintiff was informed of his right to submit any contrary evidence within ten days. Sumpter submitted a personal letter as well as letters written by friends, including a housekeeper, relating to the disability evaluation. Record at 127-134. By notice dated November 26, 1982, Sumpter was informed that his disability ended in November 1982 and that benefits would be discontinued January 31, 1983. Record at 141-142. Along with that notice was included information about procedures to be followed in the event of disagreement with the termination decision. Record at 142. Based upon that information, Sumpter requested a reconsideration. Record at 143. Upon reconsideration, the prior decision was found proper and plaintiff again was specifically told how to pursue further remedies. Record at 148-150. Accordingly, Sumpter requested a hearing before an ALJ. Record at 151. That hearing culminated in ALJ Paynter's decision finding no impropriety in the agency's previous actions.
A review of the medical evidence available to the agency at the time the termination question was being considered supports the conclusion reached. Dr. Mitchell's report of July 19, 1982, which was considered, shows that Sumpter had a full range of motion of the cervical and thoracic regions with an ability to flex the lumbar spine forward approximately forty degrees. Record at 179. Noting that ...
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