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Steward v. Berryhill

United States District Court, D. Maine

December 14, 2017



          John C. Nivison U.S. Magistrate Judge

         On Plaintiff Tracey Steward's application for disability insurance benefits (DIB) under Title II and supplemental security income benefits (SSI) under Title XVI of the Social Security Act, Defendant, the Acting Social Security Administration Commissioner, found that Plaintiff's Title II claim was barred by res judicata, granted Plaintiff's Title XVI claim in full, and reopened and granted partial relief on a prior Title XVI claim.

         Plaintiff filed this action to obtain judicial review pursuant to 42 U.S.C. § 405(g). Plaintiff argues that Defendant should have granted complete relief on the Title XVI claim, and should have reopened the Title II claim.

         Following a review of the record, and after consideration of the parties' arguments, I recommend the Court dismiss Plaintiff's appeal on the Title II claim, and remand the Title XVI claim for further proceedings.

         The Administrative Proceedings

         Plaintiff filed prior applications for Title II (DIB) and Title XVI (SSI) benefits on February 24, 2011. When Plaintiff filed the prior applications, Plaintiff's disability insurance had expired, but Plaintiff claimed a disability onset prior to the expiration of his insured status. Defendant denied the applications on May 20, 2011. Plaintiff did not timely request review of the decision, and the decision became final.

         On April 22, 2013, Plaintiff again filed applications in which he requested DIB and SSI benefits. Plaintiff alleged a disability onset date of November 30, 2008. Disability Determination Services denied Plaintiff's applications on initial review and on reconsideration. Plaintiff requested and received a hearing before an administrative law judge (ALJ).

         Following the hearing, the ALJ determined Plaintiff's DIB claim was barred by the doctrine of res judicata. (ALJ Decision, ECF No. 9-2.) The ALJ reasoned that Plaintiff had not sought review of, nor appealed from, the prior administrative determination, and Plaintiff's insured status under Title II expired before the effective date of the prior administrative determination. (ALJ Decision, R. 18 - 19, ECF No. 9-2.) According to the ALJ, the record did not support a determination that Plaintiff lacked the mental capacity to preserve the prior claim, and Plaintiff did not establish the regulatory conditions for reopening the matter.[1] (ALJ Decision at 19.) The ALJ, therefore, dismissed the claim.

         In assessing the SSI claim, the ALJ determined that Plaintiff has a cardiac impairment that medically equals listing 4.04(B) and (C), and found Plaintiff disabled on that basis. (Id. ¶¶ 3 - 4, R. 21 - 24.) The ALJ awarded complete relief on the current SSI claim. Under the decision, Plaintiff would receive benefits commencing in May 2013. The ALJ did not address the reopening of the prior SSI claim.

         Plaintiff sought review before the Appeals Council. Upon its review, the Appeals Council “found no reason to review the [ALJ's] dismissal, ” and summarily affirmed the dismissal of the DIB claim. (R. 10.) On review of the SSI claim, the Appeals Council expanded the scope of Plaintiff's SSI claim.[2] Specifically, the Appeals Council determined that the medical expert testimony supported a finding that Plaintiff's cardiac impairment equaled a listing as of November 15, 2012. The Appeals Council thus reopened Plaintiff's prior Title XVI application to permit Plaintiff to recover SSI benefits for the period between December 2012 and May 2013. (R. 5 - 6.)[3]

         Standard of Review

         A court must affirm the administrative decision provided the ALJ applied the correct legal standards and provided the decision is supported by substantial evidence. This is so even if the record contains evidence capable of supporting an alternative outcome. Manso-Pizarro v. Sec'y of HHS, 76 F.3d 15, 16 (1st Cir. 1996) (per curiam); Rodriguez Pagan v. Sec'y of HHS, 819 F.2d 1, 3 (1st Cir. 1987). Substantial evidence is evidence that a reasonable mind might accept as adequate to support a finding. Richardson v. Perales, 402 U.S. 389, 401 (1971); Rodriguez v. Sec'y of HHS, 647 F.2d 218, 222 (1st Cir. 1981). “The ALJ's findings of fact are conclusive when supported by substantial evidence, but they are not conclusive when derived by ignoring evidence, misapplying the law, or judging matters entrusted to experts.” Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999).


         Plaintiff argues that the Appeals Council's decision to reopen his prior SSI application must be deemed to have also reopened his prior DIB application. In other words, Plaintiff contends that the Appeals Council could not reopen the SSI application, while simultaneously ruling that the DIB application was barred by res judicata, particularly because the standard for reopening (“good cause”) is the same for the DIB and the SSI claims. (Statement of Errors at 3, ECF No. 13.) In addition, Plaintiff argues the ALJ erred when he applied the doctrine of res judicata to the DIB claim because he did not provide notice to Plaintiff that he was considering application of the res judicata doctrine, because a mere administrative denial of a claim (without a hearing) is not a final determination on the merits, and because the ALJ did not have a factual record from which he could make all of the findings required for application of the res judicata doctrine.[4] (Id. at 5.) Plaintiff further maintains that because the Appeals Council found good cause to reopen the SSI claim, Defendant is collaterally estopped from finding a lack of good cause to reopen the DIB claim. (Id. at 14 - 15.)

         Defendant in part argues that the discretionary decision not to reopen the prior DIB claim is unreviewable. (Defendant's Opposition at 4, ECF No. 15.) In addition, Defendant contends the decision of the Appeals Council regarding the onset of disability was informed by the entire record and, therefore, there is no cause to remand the reopened SSI claim to determine whether an earlier onset date could be assessed at step 5 based on a residual functional capacity finding as Plaintiff argues. (Id. at 15.)

         A. Reviewability of the Failure to Reopen ...

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