Walhood v. Secretary of Health and Human Services

• Decision Date: 16 February 1995
• Docket Number: No. 1:93CV938.,1:93CV938.
• Citation: 875 F. Supp. 1278
• Parties: Merline WALHOOD v. SECRETARY OF HEALTH AND HUMAN SERVICES.
• Court: U.S. District Court — Eastern District of Texas

875 F. Supp. 1278

Merline WALHOOD v. SECRETARY OF HEALTH AND HUMAN SERVICES.

No. 1:93CV938.

United States District Court, E.D. Texas, Beaumont Division.

February 16, 1995.

John Dudley Rutland, Beaumont, TX, for plaintiff.

Steven M. Mason, Asst. U.S. Atty., for defendant.

ORDER

SCHELL, Chief Judge.

CAME ON FOR CONSIDERATION the above-styled and numbered civil action, the court having heretofore ordered that this matter be referred to the Honorable Earl S. Hines, United States Magistrate Judge at Beaumont, Texas, for proper consideration pursuant to applicable laws and orders of this court; and the court having received and considered the Report of the United States Magistrate Judge filed pursuant to such order, along with the record, pleadings and all available evidence, it is found that the findings of fact and conclusions of law of the magistrate judge are correct, and such findings are ADOPTED as the findings and conclusions of this court. It is therefore

ORDERED and ADJUDGED that the Secretary's decision is REVERSED and this case is REMANDED to the defendant Secretary for further proceedings, pursuant to Title 42 U.S.C. § 405(g), sentence 4.

REPORT AND RECOMMENDATION OF UNITED STATES MAGISTRATE JUDGE

HINES, United States Magistrate Judge.

I. Introduction

Plaintiff brings this action pursuant to 42 U.S.C. § 405(g) for judicial review of the final decision of the Secretary of Health and Human Services ("Secretary") denying plaintiff's application for widow's disability insurance benefits. Plaintiff claims disability due to arthritis. She contests the Secretary's decision by asserting that the Administrative Law Judge ("ALJ") erred in finding her not disabled.

This case has been referred to the undersigned United States magistrate judge for review, hearing if deemed necessary, and submission of a report with recommended findings and conclusions. See 28 U.S.C. § 636(b)(1)(B) and Local Rules for the Assignment of Duties to United States Magistrates. For reasons discussed below, it is the magistrate judge's recommendation that the Secretary's decision be reversed.

A. Judicial Review

The limited role of judicial review is to determine whether the Secretary applied the proper legal standards, and whether the Secretary's decision is supported by substantial evidence. Lovelace v. Bowen, 813 F.2d 55, 57 (5th Cir.1987). Substantial evidence is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Marcello v. Bowen, 803 F.2d 851 (5th Cir.1986) (citing Jones v. Heckler, 702 F.2d 616, 620 (5th Cir.1983)).

A determination as to whether there is substantial evidence in the entire record to support the fact findings or decision of the Secretary, as the trier of facts, does not involve reweighing the evidence, or trying the issues de novo, or substituting the judgment of the court for that of the Secretary. Neal v. Bowen, 829 F.2d 528, 530 (5th Cir. 1987); Chaparro v. Bowen, 815 F.2d 1008, 1010 (5th Cir.1987); Milam v. Bowen, 782 F.2d 1284, 1286 (5th Cir.1986). Rather, this court must "scrutinize the record in its entirety to determine whether substantial evidence supports the Secretary's findings." Ransom v. Heckler, 715 F.2d 989, 992 (5th Cir.1983). If supported by substantial evidence, the Secretary's findings are conclusive and must be affirmed. See Richardson v. Perales, 402 U.S. 389, 390, 91 S.Ct. 1420, 1422, 28 L.Ed.2d 842 (1971) (quoting Consolidated Edison Co. v. NLRB., 305 U.S. 197, 229, 59 S.Ct. 206, 217, 83 L.Ed. 126 (1938)).

Elements of proof to be weighed in determining whether substantial evidence exists include: (1) objective medical facts; (2) diagnoses and opinions of treating and examining physicians; (3) claimant's subjective evidence of pain; (4) in the case of a wage earner, the claimant's educational background, age, and work history. Owens v. Heckler, 770 F.2d 1276, 1279 (5th Cir.1985) (citing DePaepe v. Richardson, 464 F.2d 92, 94 (5th Cir.1972)).

B. Eligibility for Widow's Benefits

The Social Security Act ("SSA") provides for payment of widow's insurance benefits to disabled widows and widowers between the ages of fifty and sixty, whose spouses die fully insured. 42 U.S.C. § 402(e) (1976). Historically, a widow had to establish that the physical or mental impairment or impairments possessed are of a level of severity which, under regulations prescribed by the Secretary, is deemed to be sufficient to preclude engagement in any gainful activity. 42 U.S.C. § 423(d)(2)(B) (1976) (emphasis added). This standard was more stringent than that applied to the disabled wage earner, who must be precluded from engaging in substantial gainful employment. 42 U.S.C. § 423(d)(2)(A) (1976) (emphasis added). See Dorton v. Heckler, 789 F.2d 363 (6th Cir. 1986).

"In 1990, Congress amended the SSA to provide that as of January 1, 1991, the definition of disability for the purpose of determining spouse's ... benefits would conform with that of applications of wage earner disability claims under Title II, Pub.L. 101-508 § 5103." Wachter v. Shalala, 856 F.Supp. 140, 143 (W.D.N.Y.1991). Consequently, vocational factors such as age, past work experience, and education must be considered in a widow's claim. See 42 U.S.C.A. § 423(d)(2)(B) West (1994).

A widow must show an existing impairment listed in Appendix 1 to Subpart P, 20 C.F.R. Part 404, or one or more unlisted impairments that singly or in combination are the medical equivalent of a listed impairment. Reynolds v. Secretary of HHS, 707 F.2d 927, 928 (6th Cir.1983). The impairment also must meet the twelve-month duration requirement. 20 C.F.R. §§ 404.1577, 404.1578 (1986). Additionally, eligibility for benefits elapses seven years after the insured's death. Plaintiff's husband died on May 26, 1977. Plaintiff's period of eligibility for widow's benefits elapsed on May 31, 1984, seven years after her husband's death. 42 U.S.C. § 404. All medical evidence of arthritis or other disabling conditions are confined to the period between the onset date and May 31, 1984, regardless of plaintiff's present condition.

C. Exhaustion of Administrative Remedies (1) General Requirements

Administrative steps which a social security disability claimant must exhaust before bringing suit in federal district court are summarized by the Fifth Circuit as follows:

The Secretary has established a regulatory system for administrative review, leading up to a final decision that may then be appealed to the district court. The process is begun when an individual files a claim with the SSA for benefits. This claim is either granted or denied, creating an initial determination. See 20 C.F.R. §§ 416.1404 to 416.1405. Next, the claimant must file for and receive a request for reconsideration. See generally 20 C.F.R. §§ 416.1407 to 416.1422. The Secretary reviews the claim again, and then issues a reconsidered determination. 20 C.F.R. § 416.1420. After obtaining the initial and reconsidered determinations, a dissatisfied claimant may file for an evidentiary hearing before an ALJ. See generally 20 C.F.R. §§ 416.1429 to 416.1468. If the claimant still objects to the decision, he or she may appeal the ALJ's determination to the Appeals Council. See generally 20 C.F.R. §§ 416.1429 to 416.1468. The decision rendered at the initial, reconsideration, and ALJ stage is binding on the claimant unless further administrative review with the Appeals Council is sought within 60 days. These four steps exhaust the claimant's administrative remedies.

Following this exhaustion of the administrative remedies with a final decision being rendered by the Appeals Council, judicial review may be sought in the district court. 20 C.F.R. §§ 416.1400 and 416.1481. See also Califano v. Sanders, 430 U.S. 99, 108, 97 S.Ct. 980, 986, 51 L.Ed.2d 192, 201 (1977) ("Section 205(g) clearly limits judicial review to a particular type of agency action, a `final decision of the Secretary made after a hearing.'"). Although a decision rendered on a claim at each stage of the proceedings is final and binding on the parties unless they proceed to the next step in the process, the regulatory scheme provides that a "final decision" allowing judicial appeal is rendered by the Secretary for the purposes of section 205(g) of the Social Security Act when the Appeals Council either reviews or denies review of the ALJ's decision. See 20 C.F.R. §§ 416.1405, 416.1421, 416.1455, 416.1481. After such a "final decision," the claimant has 60 days in which to file for judicial review of the decision or else it is binding. 20 C.F.R. § 416.1481.

Harper v. Bowen, 813 F.2d 737, 739 (5th Cir.1987), cert. denied, 484 U.S. 969, 108 S.Ct. 466, 98 L.Ed.2d 405 (1987).

(2) Proceedings in this Case

On February 27, 1989, plaintiff filed an application for widow's insurance benefits under Title II of the Social Security Act on her late husband's account. She alleged she had been disabled since 1982 due to arthritis. (Tr. 91-104). A hearing before an ALJ was conducted on November 27, 1989. (Tr. 23). The ALJ issued an opinion on October 11, 1990, denying plaintiff's application for benefits. (Tr. 156-161). On July 29, 1991, the Appeals Council remanded plaintiff's case for a supplemental hearing due to revisions in the standard for evaluating widow's benefits. (Tr. 166-68). See Social Security Ruling 913(p) ("residual functional capacity will be used in determining whether a widow is disabled."). A second ALJ held a supplemental hearing on May 21, 1992 (Tr. 70). The second decision was issued on June 26, 1992. (Tr. 8-12). Plaintiff again was denied benefits. The Appeals Council denied review. Consequently, plaintiff's claim for widow's disability benefits is properly before the court.¹

II. Factual Background

A. Medical Evidence

Degenerative arthritis with corresponding muscle spasms was noted in plaintiff prior to the onset date designated in these proceedings. In May of 1979, Dr. Y.R. Basha, M.D., of the...