Jack E. COUP, Appellant, v. Margaret HECKLER, Secretary of Health and Human Services

834 F.2d 313, 1987 U.S. App. LEXIS 15404, 1987 WL 4358
CourtCourt of Appeals for the Third Circuit
DecidedNovember 23, 1987
Docket87-3252
StatusPublished
Cited by76 cases

This text of 834 F.2d 313 (Jack E. COUP, Appellant, v. Margaret HECKLER, Secretary of Health and Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Jack E. COUP, Appellant, v. Margaret HECKLER, Secretary of Health and Human Services, 834 F.2d 313, 1987 U.S. App. LEXIS 15404, 1987 WL 4358 (3d Cir. 1987).

Opinions

OPINION OF THE COURT

GIBBONS, Chief Judge:

Jack E. Coup, an applicant for Social Security Act disability benefits, and his attorney, appeal from orders of the district court: 1) approving the determination of the Secretary of Health and Human Services that he should be awarded disability benefits from January, 1983 rather than from January, 1980; 2) denying Coup’s application for' an award of fees from the government under the Equal Access to Justice Act; and 3) fixing the amount of the fee to be paid by Coup to his attorney at $1,470. Coup contends that the Secretary reopened a 1980 application, and thus that disability payments should run from the January 1980 onset date of his disability. He also contends that there should be a fee award against the government because its position was not substantially justified. Finally Coup, or more precisely his attorney, contends that the district court erred in limiting the attorney’s recovery from Coup to $1,470. We will reverse the district court’s order fixing January 1983 as the date from which disability payments should be paid as well as the order denying Coup’s claim under the Equal Access to Justice Act. We will vacate the order limiting the amount of the attorneys fee to be paid to Coup’s attorney, and remand for a reconsideration in light of (a) the amount of the fee awarded under the Equal Access to Justice Act, and (b) this opinion.

I.

The Date from Which Payments Are Due

In early 1980 Mr. Coup, a school teacher, applied for Social Security disability benefits, alleging a disability as of January 18, 1980. His application was denied in June of 1980 and he did not pursue it through the administrative process. In June of 1982 Coup filed a new application, again alleging an onset date in January, 1980. Coup’s 1982 application was denied, after reconsideration, in November, 1982, and he did not appeal that denial. In January of 1984 Coup filed his last application for benefits, once again alleging disability as of January, 1980. After a hearing in which evidence was submitted and considered respecting his condition back to January of 1980, the Administrative Law Judge concluded that Coup was not disabled, since he could return to work as a teacher. Coup appealed that ruling to the Appeals Council of the Social Security Administration, submitting to that body evidence of a further injury since the hearing before the Administrative Law Judge. The Appeals Council considered both the new evidence and that before the Administrative Law Judge, but denied Coup’s request for review. Thus [317]*317the Administrative Law Judge’s order became the final order of the Secretary.

Coup then commenced a civil action, pursuant to 42 U.S.C. § 405(g), for review in the district court of the decision denying benefits. The district court denied the Secretary’s motion for summary judgment, and granted Coup’s motion. The court concluded that the agency record was fully developed and, on the basis of that record, that Coup is entitled to disability benefits. The judgment, dated March 4,1986, provided that the Secretary’s decision is reversed, and that Coup “is found eligible for disability insurance benefits in accordance with the January 19, 1980 stated date of onset.” The Secretary did not appeal from this final judgment.

Despite the plain language of the judgment, the Social Security Administration, while awarding retroactive benefits, did so only to January 1, 1983 rather than to January 18, 1980. Coup then moved in the district court, under the same docket number as his original complaint, for an order directing that, in accordance with the court’s judgment, benefits be paid from January 18, 1980.

The Secretary opposed Coup’s motion on the ground that limitation of retroactive benefits to January 1983 was consistent with section 223(b) of the Social Security Act, 42 U.S.C. § 423(b), and the implementing regulation, 20 C.F.R. § 404.621(a)(l)(i). That statute and regulation limit the payment of retroactive benefits to a 12-month period prior to the date of the application. It was the Secretary’s position, accepted by the district court despite its prior final judgment, that the relevant application date was in January of 1984.

We disagree. Section 223(b) does provide that an applicant for benefits for any month “shall be entitled to such benefit for such month if such application is filed before the end of the 12th month immediately succeeding such month.” 42 U.S.C. § 423(b). Coup contends, however, that in adjudicating his 1984 application the Secretary reopened his 1980 and 1982 applications. The Secretary has discretion to reopen prior applications within four years of notice of the initial determination for “good cause.” 20 C.F.R. §§ 404.987, 404.988(b) (1987). Good cause includes the furnishing of “new and material evidence.” 20 C.F.R. § 404.989(a)(1). Beyond four years, a claim may be reopened on narrower grounds. 20 C.F.R. § 404.988(c). The initial adverse determination on Coup’s 1980 application was made in June of 1980; his January 1984 application was within four years of that date. Thus the 1980 application could properly be reopened upon the furnishing of new and material evidence.

A decision of the Secretary declining to reopen a claim is not judicially reviewable. Califano v. Sanders, 430 U.S. 99, 97 S.Ct. 980, 51 L.Ed.2d 192 (1977). This court has held, however, that we will examine the record to determine whether or not a reopening has occurred. A reopening, and thus a waiver of any claim of administrative res judicata, will be found “where the administrative process does not address an earlier decision, but instead reviews the entire record in the new proceeding and reaches a decision on the merits ...” Kane v. Heckler, 776 F.2d 1130, 1132 (3d Cir.1985). See also Purter v. Heckler, 771 F.2d 682 (3d Cir.1985). It is not our role to determine whether the Secretary had good cause for reopening, for in that respect his decision is not judicially reviewable. Rather, we look at the administrative record to determine whether an explicit or a de facto reopening has occurred. See Cleaton v. Secretary, Dept. of Health and Human Services, 815 F.2d 295 (4th Cir. 1987); Jelinek v. Heckler, 764 F.2d 507 (8th Cir.1985); Taylor v. Heckler, 738 F.2d 1112 (10th Cir.1984); McGowen v. Harris, 666 F.2d 60 (4th Cir.1981).

Plainly there was a de facto reopening here.

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Bluebook (online)
834 F.2d 313, 1987 U.S. App. LEXIS 15404, 1987 WL 4358, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jack-e-coup-appellant-v-margaret-heckler-secretary-of-health-and-human-ca3-1987.