Fleming v. Sullivan

806 F. Supp. 13, 1992 U.S. Dist. LEXIS 20514, 1992 WL 322671
CourtDistrict Court, E.D. New York
DecidedAugust 24, 1992
Docket91 CV 33
StatusPublished
Cited by9 cases

This text of 806 F. Supp. 13 (Fleming v. Sullivan) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fleming v. Sullivan, 806 F. Supp. 13, 1992 U.S. Dist. LEXIS 20514, 1992 WL 322671 (E.D.N.Y. 1992).

Opinion

MEMORANDUM AND ORDER

NICKERSON, District Judge:

Plaintiff Edward Fleming seeks review of the decision of the Secretary of Health and Human Services (the Secretary) that plaintiff’s disability and entitlement to disability insurance benefits ended in May 1980. The Secretary moves for a remand, and plaintiff cross-moves for a judgment on the pleadings.

I.

Plaintiff filed his original application for Social Security disability benefits in 1978 or *14 1979. On April 30, 1979 the Secretary determined that he had been disabled since 1977 and awarded him benefits. Because the Secretary’s decision awarding benefits and some of the medical records upon which that decision was based cannot be located, the exact date on which plaintiff established his disability is unclear. Also unclear is the basis of the Secretary’s decision.

Shortly after the original favorable decision the Secretary initiated an investigation into plaintiff’s continuing disability. At the Secretary’s request plaintiff was examined by a consulting orthopedic surgeon on May 1, 1980. (Tr. 229-230). On July 21, 1980 the Secretary terminated plaintiff’s benefits as of the date of the consultative examination. The Secretary is also unable to produce much of the documentation relating to this decision.

At some point in 1987 the Secretary restored plaintiff’s benefits on the basis of Schisler v. Heckler, 787 F.2d 76 (2d Cir.1986), a class action in which the court held the “treating-physician rule” applicable.

The Secretary then attempted to make a new determination whether plaintiff's benefits had been properly terminated in May 1980 because of a “medical improvement.” The Secretary decided that the benefits were properly terminated, and reaffirmed that decision upon reconsideration in January 1988. The Secretary assessed a $39,-162.60 overpayment against plaintiff for benefits erroneously paid since 1980.

After a hearing, an administrative law judge affirmed the Secretary’s decision, finding that plaintiff “currently” had lum-bosacral strain with a possible herniated disc, alcoholism, and chronic/obstructive pulmonary asthma, but also that plaintiff’s condition had improved since 1977 so that he could perform a variety of light or sedentary jobs. On this basis the administrative law judge found a medical improvement. He also affirmed the decision to deny plaintiff a statutory waiver of the overpayment.

On September 18, 1989 the Appeals Council reversed the administrative law judge’s decision and remanded for a new hearing. The Appeals Council noted that the record did not contain “the favorable determination [awarding benefits] and most of the evidence upon which it was based.” Because of this omission the Appeals Council found it impossible to make any “meaningful evaluation of medical improvement ... upon the current record.” (Tr. 30-31). The Appeals Council directed the administrative law judge “to enlarge the record to include the initial favorable decision and the evidence upon which that determination was based.” (Tr. 31). It also instructed him to determine whether plaintiff’s alcoholism was diagnosed on or before May 1, 1980. Finally, it rejected the administrative law judge’s finding that plaintiff was capable of a full range of sedentary and light work and directed the administrative law judge to obtain the opinion of a vocational expert.

The second hearing was held on December 12, 1989 before a different administrative law judge. At the beginning of the hearing the administrative law judge learned that the favorable decision was unavailable from the files. Plaintiff’s attorney advised him that the Appeals Council had ordered him to obtain the decision. But the administrative law judge never did obtain that decision or the transcript of the evidence. He said that he would have to decide whether plaintiff “was disabled as of 1980.” (Tr. 108).

On April 2, 1990 the administrative law judge affirmed the May 1980 termination of plaintiff’s benefits. Though he still did not have the Secretary’s initial favorable decision or the information upon which it was based, the administrative law judge concluded that there had been improvement in plaintiff’s medical condition since May 1, 1980, that he was able to perform a full range of light work, and that he was not limited by alcoholism. The Appeals Council denied review, and this action followed.

II.

To terminate a recipient’s Social Security disability benefits the Secretary must have substantial evidence of a “medical improvement” relevant to the recipient’s ability to *15 work and that the recipient does not currently meet the statutory standard of disability. 42 U.S.C. § 423(f)(1); 20 C.F.R. § 404.1594. “Medical improvement” means “any decrease in the medical severity of [the] impairment(s) which was present at the time of the most recent favorable medical decision that [the recipient was] disabled or continued to be disabled.” 20 C.F.R. § 404.1594(b)(1). A determination that there has been a decrease in medical severity “must be based on changes (improvement) in the symptoms, signs and/or laboratory findings associated with [the] impairment.” Id. The Secretary does not allege that any of the “exceptions to medical improvement” apply. See 20 C.F.R. 404.1594(d)-(e).

Both administrative law judges focused on the wrong time period to establish plaintiffs alleged medical improvement. The first held that there had been medical improvement in plaintiffs condition “since 1977”, the date of plaintiffs back injury. The second held that there had been medical improvement “since May 1, 1980”, the date as of which plaintiffs benefits were terminated. But the relevant inquiry is whether plaintiffs condition improved from the date of the most recent decision in his favor (the comparison point). 20 C.F.R. § 404.1579(b)(7). The administrative law judge should have compared plaintiffs condition on April 30, 1979, the date of the Secretary’s favorable decision, and May 1, 1980, the date on which the Secretary found that plaintiffs disability had ceased.

In any event the Secretary failed to meet his burden because he presented insufficient evidence of plaintiffs medical condition as of April 1979, the comparison point. Without that information there was no way to evaluate whether plaintiffs condition had improved between that date and May 1, 1980. The Secretary’s regulations state that “[i]f relevant parts of the prior own record are not reconstructed either because it is determined not to attempt reconstruction or because such efforts fail, medical improvement cannot be found.” 20 C.F.R. § 404.1594(c)(3)(v).

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Cite This Page — Counsel Stack

Bluebook (online)
806 F. Supp. 13, 1992 U.S. Dist. LEXIS 20514, 1992 WL 322671, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fleming-v-sullivan-nyed-1992.