Opinion
CIVIL ACTION 99-0640-P-S
April 20, 2000
RECOMMENDATION OF MAGISTRATE JUDGE
This appeal is brought by Plaintiff, Claude J. Woods, pursuant to 42 U.S.C. § 405(g) and Administration (Commissioner) dismissing his request for a hearing regarding his application for disability insurance benefits based on the doctrine of res judicata. This matter has been referred to the undersigned Magistrate Judge for a recommendation pursuant to 28 U.S.C. § 636 (b)(1)(B) and SDAL LR 72.2. The undersigned has determined that oral argument is unnecessary to resolve this matter.See SDAL LR 7.3. Upon careful consideration of the administrative record and the arguments raised by the parties in their memoranda, the following recommendation is entered.
Procedural History and Background
Claude J. Woods (Plaintiff) filed his first application for supplemental security income on March 17, 1993. This application was denied initially and upon reconsideration. Plaintiff filed his second application for supplemental security income on April 13, 1994. This second application was denied initially, and no further appeal was taken. Plaintiff filed his third application for supplemental security income on September 21, 1995. This third application was denied initially, and again no appeal was taken.
Plaintiff filed his fourth and current application for supplemental security income and his first application for disability insurance benefits on October 24, 1996, with an alleged onset date of July 13, 1986. These applications were denied initially and upon reconsideration. On September 24, 1997, an administrative hearing was held before Administrative Law Judge (ALJ) Glay E. Maggard. On November 26, 1997, the ALJ entered a written decision finding that Plaintiff was eligible for supplemental security income but was not eligible for disability insurance benefits, because he was not under a disability as defined by the Social Security Act at the time his insured status expired on December 31, 1990. The ALJ dismissed Plaintiff's request for hearing on his application for disability insurance benefits based on the doctrine of res judicata. On May 20, 1999, the Appeals Council denied Plaintiff's request for review of this decision, making the ALJ's decision the final decision of the Commissioner. The parties agree that this case is now ripe for review and is properly before this Court pursuant to 42 U.S.C. § 405(g) and 1383(c)(3).
Issues on Appeal
Plaintiff presents only one issue on appeal: (1) whether the Commissioner erred by dismissing his request for a hearing regarding his application for disability insurance benefits based on the doctrine of res judicata and in refusing to reopen Plaintiff's prior applications for benefits.
Discussion
As set forth above, Plaintiff's request for an administrative hearing on his application for disability insurance benefits was dismissed by the ALJ. The decision of the ALJ issued on November 26, 1997, reveals that the ALJ considered the evidence and testimony and found that there was no basis for reopening any of the determinations on Plaintiff's prior applications. Administrative Record, page 15 (R. at 15). Thus, the ALJ determined that the doctrine of res judicata properly applied and required the dismissal of Plaintiff's request for hearing pertaining to the issue of disability through November 7, 1995, the date of Plaintiff's prior unfavorable determination. R. at 15. Plaintiff's disability insured status expired on December 31, 1990. After finding that the doctrine ofres judicata applied to the period of time through November 7, 1995, and given that Plaintiff's insured status had expired on December 31, 1990, the ALJ determined that Plaintiff was not entitled to disability insurance benefits. R. at 15, 25.
Plaintiff contends that the ALJ erred in dismissing his request for hearing based on the doctrine of res judicata and in refusing to reopen his prior applications for benefits. Plaintiff argues that his mental retardation prevented him from understanding and pursuing his administrative remedies on his prior claims and that, therefore, he raises a colorable constitutional claim.
The jurisdiction of a federal court to review adverse administrative decisions is sharply circumscribed in social security cases. Under the Social Security Act, a court may only review a "final decision of the Secretary made after a hearing. . . ." 42 U.S.C. § 405(g). Federal courts generally lack subject matter jurisdiction over any non-substantive or discretionary decisions by the Secretary. Thus, decisions not to reopen a case, or not to entertain a claim which is barred by the doctrine of res judicata are reviewed as ministerial decisions not amenable to judicial review. See Holland v. Heckler, 764 F.2d 1560 (11th Cir. 1985). In Califano v. Sanders, 430 U.S. 99, 97 S.Ct. 980, 51 L.Ed.2d 192 (1977), the Supreme Court expressly stated that administrative decisions not to reopen a closed claim are not subject to judicial review, even in cases of alleged abuses of agency discretion, because such decisions can be made by the Secretary without a hearing.See also Ellis v. Schweiker, 662 F.2d 419 (5th Cir. 1981). The Eleventh Circuit has held that "[i]f the Secretary finds res judicata applicable, that finding is generally unreviewable by the federal courts because it is not a `final decision of the Secretary made after a hearing' as required by the Social Security Act for federal jurisdiction." Holland v. Heckler, 764 F.2d at 1562 (citing 42 U.S.C.A. § 405(g); Califano, 430 U.S. at 108, 97 S.Ct. at 985).
A primary principle underlying judicial reluctance to review the Secretary's discretionary decisions is that courts are obligated to defer to an agency's interpretation of its own regulations. Butterworth v. Bowen, 796 F.2d 1379, 1384 (11th Cir. 1986). Under the Social Security Act, the Secretary is expressly granted "full power and authority to make rules and regulations and to establish procedures" for implementing provisions of the statute governing disability benefits. 42 U.S.C. § 405(a). These regulations must be respected by the Court unless they are arbitrary or capricious or were promulgated in excess of statutory authority. Heckler v. Campbell, 461 U.S. 458, 103 S.Ct. 1952, 76 L.Ed.2d 66 (1983).
Social Security Regulations vest almost complete discretion in the Secretary to decide whether to reopen a closed case. 20 C.F.R. § 404.988 provides that a prior decision may be reopened "within four years of the date of the notice of the initial determination if [the Secretary finds] good cause, as defined in § 404.989, to reopen the case." 20 C.F.R. § 404.989 states that good cause will be found if new and material evidence is furnished, a clerical error was made, or the evidence considered in making the determination or decision clearly shows on its face that an error was made.
The Secretary's decision not to reopen a prior determination is not a final decision within the meaning of § 405(g) and is reviewable by district courts only in limited circumstances. Califano v. Sanders, 430 U.S. 107-109, 97 S.Ct. 985-86; Sherrod v. Chater, 74 F.3d 243, 245 (11th Cir. 1996). Nonetheless, the Court of Appeals for this Circuit has held that it has subject matter jurisdiction to review the Secretary's decision not to reopen a prior application where (1) the decision is reconsidered on the merits to any extent at any administrative level, Sherrod, 74 F.3d at 245 (citing Macon v. Sullivan, 929 F.2d 1524, 1529 (11th Cir. 1991)); or (2) a colorable constitutional claim is raised,Sherrod, 74 F.3d at 245 (citing Callis v. Dep't. of Health Human Services, 877 F.2d 890, 891 (11th Cir. 1989)).
In this case, Plaintiff has not argue that the prior decisions were reconsidered on the merits to any extent at any administrative level. Plaintiff does argue, however, that he meets the criteria set forth inElchediak v. Heckler, 750 F.2d 892, 894-95 (1 1th Cir. 1985), for raising a colorable constitutional claim.
InElchediak, the Eleventh Circuit found that,
a claimant suffering from mental illness raises a colorable constitutional claim when he asserts that his mental illness precluded him from litigating his claim because it prevented him from proceeding from one administrative level to another in a timely fashion.Elchediak, 750 F.2d at 894. The plaintiff in Elchediak suffered from paranoid schizophrenia, and had filed two prior applications which were not appealed to any administrative level before filing a third application and obtaining counsel. Id. at 892-93. Finding that his mental illness prevented him from understanding and pursuing his administrative remedies with regard to his prior claims for benefits, the Court of Appeals stated that the plaintiff raised a colorable constitutional claim when he demonstrated the following factors: (1) that he suffered from a medically-documented mental illness which served as the basis for his disability; (2) that, on his first application, he was without the assistance of counsel or other suitable representation; and (3) that he could not assert a new claim because he now lacked insured status. Id. at 894-95.
Plaintiff argues that his case meets the three prong Elchediak test for establishing a colorable constitutional claim supported by the results of the psychological evaluation conducted by consultative psychologist Robert DeFrancisco, Ph.D. Defendant argues that the overall concern inElchediak was that it is necessary to help those claimants who are so mentally ill as to be incapable of exercising their rights pro se and that Plaintiff does not fall into this category. Defendant maintains that, while the results of Plaintiff's examination by a consultative psychologist demonstrate some level of mental impairment, Plaintiff is not so mentally ill as to be unfamiliar with the processes involved in applying for Social Security benefits.
The first showing required by Elchediak is that the claimant suffers from a medically documented mental illness which serves as the basis for the claimant's disability claim. In Elchediak, the plaintiff suffered from paranoid schizophrenia, a medically-documented mental illness. Here, Plaintiff underwent a consultative psychological evaluation by Dr. DeFrancisco, a clinical psychologist and board certified forensic examiner, at the request of the Commissioner. Dr. DeFrancisco administered the Wechsler Adult Intelligent Scale-Revised (WAIS-R), and Plaintiff obtained a Verbal IQ of 66, a Performance IQ of 67, and a Full Scale IQ of 64. R. at 236. Based on Plaintiff's Full Scale IQ score, Dr. DeFrancisco estimated that he was currently functioning in the mentally defective range of intelligence. R. at 236.
Dr. DeFrancisco also completed a Supplemental Questionnaire As To Residual Functional Capacity. R. at 238-241. Dr. DeFrancisco indicated that Plaintiff had a moderate restriction of activities of daily living (R. at 238), that Plaintiff experience continual episodes of deterioration or decompensation in work or work-like settings (R. at 239), that Plaintiff had a moderate restriction in his ability to understand, carry out, and remember instructions (R. at 239), that Plaintiff had a marked limitation in responding appropriately to customary work pressures (R. at 239). and that Plaintiff had moderate restrictions in performing simple or repetitive tasks (R. at 239). Dr. DeFrancisco stated that these functional limitations have existed at this level of severity since 1985. R. at 240.
The Court finds that Plaintiff suffers from a medically-documented mental illness which serves as the basis for the claimant's disability claim. In his decision, the ALJ found that Plaintiff had the severe impairment of a mentally deficient range of intelligence and found that Plaintiff was entitled to supplemental security income based on his severe impairments, including his mental impairment. Therefore, Plaintiff meets the first prong of the Elchediak test.
Plaintiff also satisfies the second part of the Elchediak test. In his memorandum, Plaintiff submits that he was without the assistance of counsel or other suitable representation during his prior applications for benefits. Defendant has not argued otherwise, and there is no evidence to the contrary.
Plaintiff also satisfies the third part of the Elchediak test because he cannot assert a new claim for disability insurance as he now lacks insured status. As the ALJ noted, Plaintiff's insured status expired on December 31, 1990.
Having satisfied the three-prong test in Elchediak, the Court finds that Plaintiff has raised a colorable constitutional claim. Accordingly, it is the recommendation of the undersigned Magistrate Judge that this case be remanded to the Commissioner for a determination, after considering such evidence as the parties may submit, whether Plaintiff's mental impairment prevented him from understanding and pursuing his administrative remedies following the denial of his prior applications for benefits.
Conclusion
Accordingly, the undersigned Magistrate Judge recommends that this case be REMANDED to the Commissioner for a determination, after consideration of such evidence as the parties may submit, whether Plaintiff's mental impairment prevented him from understanding and pursuing his administrative remedies following the denial of his prior applications for benefits.
The attached sheet contains important information regarding objections to this recommendation.