Miller v. Bowen

789 F.2d 678
Court of Appeals for the Ninth Circuit·Decided May 5, 1986·No. No. 85-2344·Published·Cited by 4 cases

Opinion

BOOCHEVER, Circuit Judge:

In this case we must determine whether there was substantial evidence to support the decision of the Secretary of Health and Human Services (Secretary) that Mr. Miller’s death, caused by a cerebral infarction, was not accidental under the provisions of the Social Security Act. We conclude that the Secretary’s decision is not supported by substantial evidence.

Mr. Miller died approximately one month after he underwent surgery to replace his heart’s mitral valve and to repair an aortic valve prosthesis that had been implanted four years earlier. Mr. Miller had been recovering normally from the surgery, and physicians described his long-term prognosis as very good. His death occurred suddenly from a cerebral infarction, the cause of which is in dispute. Van Lee Miller filed an application under the Social Security Act for widow’s insurance benefits. The Social Security Administration (SSA) determined that the marriage between Mr. and Mrs. Miller did not meet the duration requirement for benefits. Upon reconsideration the SSA upheld that decision and found further that the death of the insured was not accidental within the meaning of an exception to the duration requirement. Mrs. Miller was thus denied benefits. The administrative law judge considered the case de novo and determined that Mrs. Miller was entitled to widow’s insurance benefits because Mr. Miller’s death was accidental.

The Office of Hearings and Appeals reopened the administrative law judge’s decision and after consideration of additional evidence and argument concluded that Mr. and Mrs. Miller did not meet the nine-month duration of marriage requirement, or the exception thereto, and consequently Mrs. Miller was not entitled to widow’s [680] insurance benefits. That decision is the final decision of the Secretary of Health and Human Services.

Mrs. Miller brought this action under section 205(g) of the Social Security Act, 42 U.S.C. § 405(g) (1982), in district court for reconsideration. The district court granted the Secretary's motion for summary judgment and dismissed Mrs. Miller’s complaint. She now appeals and we reverse, remanding for entry of summary judgment for Mrs. Miller on her cross motion.

■ I. ANALYSIS

Section 202(e) of the Act, 42 U.S.C. § 402(e) (1982 & Supp. I 1983), provides for the payment of monthly benefits to the widow of an individual who died fully insured. The term “widow” is defined by section 416(c)(5) as “the surviving wife of an individual, but only if ... she was married to him for a period of not less than nine months immediately prior to the day on which he died.” 42 U.S.C. § 416(c)(5) (1982). The nine month requirement is deemed satisfied where the insured’s death is accidental. 42 U.S.C. § 416(k)(l)(A). The death of an individual is accidental “if he receives bodily injuries solely through violent, external, and accidental means and, as a direct result of the bodily injuries and independently of all other causes, loses his life not later than three months after the day on which he receives such bodily injuries.” 42 U.S.C. § 416(k).

Mrs. Miller was married to her husband for only ten days prior to his death. The sole issue presented by the parties on this appeal is whether death was the result of bodily injuries received solely through external and accidental means, independent of all other causes. The Secretary determined that the evidence failed to establish such cause of death. Our review is limited to whether substantial evidence exists to support the Secretary’s decision. 42 U.S.C. § 405(g); Richardson v. Perales, 402 U.S. 389, 401-02, 91 S.Ct. 1420, 1427, 28 L.Ed.2d 842 (1971); Bilby v. Schweiker, 762 F.2d 716, 718 (9th Cir.1985). Substantial evidence means such relevant evidence as a reasonable mind would accept as adequate to support a conclusion. Key v. Heckler, 754 F.2d 1545,1549 (9th Cir.1985). We find no such evidence.

At issue is whether Mr. Miller’s death fits within the requirements of 42 U.S.C. § 416(k) as being caused by bodily injury through violent, external, and accidental means. The Secretary found that the infarction which caused Mr. Miller’s death was a “bodily injury”; and further acknowledged that Mr. Miller’s death might be interpreted as “violent.” The Secretary determined, however, that the evidence failed to establish that Mr. Miller’s death resulted from external and accidental means. Thus, specifically at issue is whether the infarction resulting in Mr. Miller’s death was caused by an internal or external source of infection and whether that infection was accidental.

A. External Cause of Death

With reference to whether Mr. Miller’s death was internally or externally caused, the Secretary concluded that Mr. Miller’s death resulted from his general cardiac condition and was therefore internally caused. The Secretary, although acknowledging that Mr. Miller had bacteria in his blood, determined that the insured died because an embolus, formed from atheros-clerotic plaque, entered the blood stream, lodged at the brain stem, and resulted in an infarction. The Secretary explained that Mr. Miller “was known to have coronary artery disease and it is well known that atherosclerosis is a generalized disorder. The more probable cause of the cerebral infarction is ischemia from atheromatous occlusion as atherosclerosis was severe in the abdominal aorta and present in the kidneys to a lesser extent.” The Secretary provides no medical evidence, however, ei[681] ther that Mr. Miller had atherosclerosis or that plaque from atherosclerosis dislodged and caused the infarction.

Furthermore, all evidence as to the cause of the infarction is to the contrary. The autopsy report contradicts the Secretary’s conclusion by stating that there was no evidence of “mural thrombi ... in the heart and the aortotomy site and prosthetic valves were free of thrombus.” No embo-lus or venous thrombosis were present in the pulmonary vessels nor was there evidence of fibrosis infarction or embolus in the kidneys.

Within a reasonable degree of medical certainty, Dr. Joe Ehrlich observed that the embolus that is believed to have caused Mr. Miller’s death originated from a bacterial infection related to the aortic valve replacement. The infection was “more likely ... introduced during the surgical procedure.” Mr. Miller’s doctor, Dr. Denton Cooley, could “only assume that the blood clot came from the heart valve.”

Free access — add to your briefcase to read the full text and ask questions with AI

Miller v. Bowen, 789 F.2d 678 (9th Cir. 1986).

789 F.2d 678 (Miller v. Bowen) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

McLaughlin v. Cooke
774 P.2d 1171 (Washington Supreme Court, 1989)
Sandra Turner, Debra Scruggs, and Jerrylean Baker, on Behalf of Themselves and All Others Similarly Situated v. Linda McMahon Individually and in Her Official Capacity as the Director of the Department of Social Services of the State of California Department of Social Services of the State of California Jesse Huff, Individually and in His Official Capacity as Director of the Department of Finance of the State of California and the Department of Finance of the State of California Defendants/third-Party v. Otis R. Bowen, Secretary of Health and Human Services, Third-Party Sandra Turner Debra Scruggs Jerrylean Baker, on Behalf of Themselves and All Others Similarly Situated v. Otis R. Bowen, Secretary of Health and Human Services, Third-Party-Defendant-Appellant, and Linda McMahon Individually and in Her Official Capacity as the Director of the Department of Social Services of the State of California, Defendant-Third-Party-Plaintiff. Sandra Turner Debra Scruggs Jerrylean Baker, on Behalf of Themselves and All Others Similarly Situated v. Otis R. Bowen, Secretary of Health and Human Services, Third-Party and Linda McMahon Individually and in Her Official Capacity as the Director of the Department of Social Services of the State of California Jesse Huff, Individually and in His Official Capacity as Director of the Department of Finance of the State of California Department of Finance of the State of California, Defendant-Third-Party-Plaintiff-Appellant
830 F.2d 1003 (Third Circuit, 1987)
Miller v. Bowen
789 F.2d 678 (Ninth Circuit, 1986)