Rufus Pack v. Margaret M. Heckler, Secretary of Health and Human Services, 740 F.2d 292, 4th Cir. (1984)
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Scribd Government DocsRufus Pack v. Margaret M. Heckler, Secretary of Health and Human Services, 740 F.2d 292, 4th Cir. (1984)
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Scribd Government Docs740 F.
2d 292
6 Soc.Sec.Rep.Ser. 166
Rufus PACK, Appellant,
v.
Margaret M. HECKLER, Secretary of Health and Human
Services, Appellee.
No. 84-1082.
United States Court of Appeals,
Fourth Circuit.
Argued May 7, 1984.
Decided July 31, 1984.
Hazel A. Straub, Charleston, W.Va. (Franklin W. Kern, L.C., Charleston,
W.Va., on brief), for appellant.
Marye L. Wright, Asst. U.S. Atty., Charleston, W.Va. (David A. Faber,
U.S. Atty., Charleston, W.Va., on brief), for appellee.
Before WINTER, Chief Judge, CHAPMAN, Circuit Judge, and
MICHAEL,* District Judge.
HARRISON L. WINTER, Chief Judge:
I.
Pursuant to 42 U.S.C. Sec. 405(g), Rufus Pack seeks review of the final
decision of the Secretary of Health and Human Services denying his
entitlement to continued payment of Social Security disability insurance
benefits. Pack appeals the district court's entry of a summary judgment in favor
of the Secretary. We conclude that Pack, because of an earlier determination of
disability, was entitled to a presumption of continuing disability and was
deprived of that presumption in the Secretary's review. However we conclude
that it is unnecessary for the case to be tried anew. Because the record plainly
demonstrates both that Pack has substantial impairments and that his physical
condition has deteriorated since the previous determination of disability, we
reverse and direct reinstatement of Pack's benefits.
In his 1980 application for disability benefits, Pack alleged inability to work
beginning on January 15, 1974. The medical evidence establishes that Pack
currently suffers from the following impairments: mental retardation with an
I.Q. of 60, moderate hearing loss, a loss of vision in the right eye with
correctable 20/70 vision in the left eye, and minimally obstructive
pneumoconiosis. Pack also complains of severe stomach and chest pain and
was operated on for a hernia in 1974. Pack is illiterate and capable only of
simple mathematics such as that involved in making change.
After a hearing and a medical examination, an administrative law judge ruled
that Pack was not entitled to benefits in an opinion issued on September 17,
1980. That decision became final when it was approved by the Appeals Council
on December 17, 1980. Thereafter, Pack filed this action in the district court.
While his case was pending, Pack's counsel learned that Pack had received
Supplementary Security Income (SSI) based upon a finding of disability in
1974. Pack received SSI benefits from December of 1975 until 1979 when
those benefits were terminated because he no longer met the income
requirements due to an intervening award of black lung benefits. Pack asserted
that the initial determination of disability should have entitled him to disability
insurance benefits as well as SSI beginning in December of 1975. Accepting
this argument, the district court remanded the case for further consideration by
the Appeals Council.
Upon reconsideration, the Appeals Council determined that Pack had indeed
been found disabled in the original proceeding. Accordingly, he was
retroactively awarded disability benefits beginning December 1, 1975. The
Appeals Council held:
5 the doctrine of collateral estoppel must be applied in this case. Therefore, the
that
Council is prepared to issue a title II decision finding that Mr. Pack first became
disabled within the meaning of the Social Security Act, on December 1, 1975,
coinciding with the first month he became eligible for Supplemental Security
Income benefits.
6
However, the Council also concluded that Pack's " 'disability' ceased on
September 17, 1980, the date of the administrative law judge's decision."
Though the Council disclosed that the file containing the original eligibility
determination "can not be located at the present time", it concluded that
evidence from before and after that award demonstrates that the original award
"was incorrect." Thus, the Appeals Council retroactively awarded disability
benefits solely because of the collateral estoppel effect of the prior finding of
disability. It effectively transformed the second administrative determination
into a hearing to terminate those benefits and found that the evidence was
sufficient to show that Pack was not disabled.
7
Pack did not contest the retroactive award of disability benefits but returned to
the district court to contest the cessation of those benefits. Faced with crossmotions for summary judgment, the district court affirmed the Secretary's
decision on November 15, 1983. It is from that judgment that Pack appeals
contending that: he was denied due process at the second administrative
hearing, he clearly meets the requirements for disability within the Act, the
district court erred in its cursory review of the facts, and the Secretary and the
district court failed to consider Pack's impairments in combination.
We agree that Pack was denied the procedural safeguards to which he was
entitled and we think that the record amply demonstrates that Pack's condition
has worsened since 1975. Because these factors alone are sufficient to warrant
reversal and reinstatement of benefits, we do not reach any of Pack's other
contentions.II.
When the 1980 administrative hearing and subsequent medical examination
were conducted, all parties believed that Pack was applying for benefits he was
not then receiving. After a remand from the district court, the Secretary
concluded that there had been a ruling in 1975 that Pack was disabled within
the meaning of the Act. Accordingly, Pack was retroactively awarded disability
benefits as of the date of that previous determination. The Secretary then
characterized the administrative proceeding in this case as one to decide
whether those benefits should be terminated, even though none of the parties
viewed it this way at the time.
10
In a proceeding to terminate benefits, the recipient is provided a number of
procedural safeguards set forth in 20 C.F.R. 404.1588 et seq. These protections
include inter alia: advance notice of termination and the right to request
reconsideration, Secs. 404.1595-404.1597. Needless to say, the procedures for
terminating benefits were not followed in this administrative proceeding
because no one knew that there had been a previous finding of disability at the
time the proceedings were conducted.
11
Perhaps the most important safeguard that was denied Pack because of the
posture of this case was the presumption of continuing disability to which he
was clearly entitled. In Dotson v. Schweiker, 719 F.2d 80 (4 Cir.1983), we
ruled that an initial determination of disability gives rise to a presumption that a
recipient is still disabled at the time of the second hearing. This presumption
"requires the Secretary to come forward with evidence that [Pack] is not
disabled." Id. at 83. In Dotson, we agreed with the Ninth Circuit's reasoning in
Patti v. Schweiker, 669 F.2d 582 (9th Cir.1982). Id. at 81 and 83. In Patti, the
court reasoned that this presumption required the Secretary to come forward
with evidence that the claimant's "condition had improved in the interim." 669
F.2d at 587.1
12
In this case, the Secretary obviously came forward with no such evidence of
improvement in Pack's condition. Indeed, the record clearly demonstrates that
Pack's condition has significantly deteriorated since the 1975 disability
determination. Since 1975, Pack has completely lost the vision in one of his
eyes and experienced partial loss of vision in the other eye.2 Furthermore, we
are at a loss to see how the Secretary, short of proof that Pack presently has no
substantial impairments, could ever come forward with a showing that Pack's
condition has improved in light of her admission that the original file, in which
the initial finding of disability is located, cannot be found.
13
The Secretary's attempts to justify her position are unpersuasive. First, the
Secretary suggests that "it is not at all clear that the doctrine of collateral
estoppel is applicable" to begin with. This line of argument is particularly
untenable in light of the fact that the Secretary has conceded earlier in the case
that she is bound by the previous determination of disability. We decline to
permit the Secretary to recant when benefits have already been retroactively
restored on the basis of this concession.
14
The Secretary further contends: "any benefits which were terminated were SSI
benefits" and that "Pack does not contend that when his SSI benefits were
terminated he did not receive the requisite notice of his rights..." The procedural
protections afforded during the termination of Pack's SSI benefits are not now
at issue, and therefore, the Secretary's argument is obviously beside the point.
True, Pack's previously awarded SSI benefits were presumably terminated
through the proper procedures in 1979 when he began receiving black lung
benefits. However, in this case the Secretary determined that Pack was
retroactively entitled to disability benefits along with SSI benefits because of
the original 1975 finding of disability. The Secretary does not contend that the
disability benefits should have been terminated in 1979 along with the SSI
benefits. Rather, she argues that the disability hearing on September 17, 1980 is
the point at which disability benefits were properly terminated. Thus, there
were disability benefits which were terminated and that termination was
accomplished when the Appeals Council transformed the September 1980
decision from one denying entitlement to one terminating benefits. Pack was
deprived of these benefits without the procedural safeguards to which he was
entitled.
III.
15
It is manifest that a fifty-seven-year-old man who is: blind in one eye, deaf, has
an I.Q. of 60, and a case of black lung, has substantial impairments. In addition,
the record does not show that Pack's condition has improved. The Secretary's
loss of the original file and the obvious deterioration in Pack's condition make
it so remote that the Secretary will ever be able to come forward with any
showing of improvement that the summary judgment entered by the district
court is reversed with directions to instruct the Secretary to restore Pack's
disability benefits.
16
REVERSED WITH DIRECTIONS.
Honorable James H. Michael, Jr., United States District Judge for the Western
District of Virginia, sitting by designation
In both Dotson and Patti the courts acknowledge that a claimant "bears a
continuing burden of showing that he has a physical or mental impairment",
Mathews v. Eldridge, 424 U.S. 319, 336, 96 S.Ct. 893, 903, 47 L.Ed.2d 18
(1976). The presumption does not affect the ultimate burden of proof but
imposes an initial burden on the Secretary to come forward with evidence that
conditions have changed since the initial determination. Patti, 669 F.2d at 587
The fact that Pack's vision deteriorated was overlooked by the district court
which concluded: "Claimant apparently suffered from these impairments when
he worked at his past various jobs as a janitor and it does not appear from the
evidence that any of his impairments occurred since he last worked." The
Secretary concedes this was error but concludes: "when he lost the vision in his
right eye is legally irrelevant since it is not a severe impairment." We are
unable to comprehend the logic of the Secretary's contention. The legal
relevance is plainly that Pack's condition deteriorated rather than improved
since the initial disability determination
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