Pearce v. Secretary of Health & Human Services

680 F. Supp. 1264, 1988 U.S. Dist. LEXIS 2078, 1988 WL 20849
CourtDistrict Court, C.D. Illinois
DecidedFebruary 19, 1988
DocketNo. 86-1091
StatusPublished
Cited by1 cases

This text of 680 F. Supp. 1264 (Pearce v. Secretary of Health & Human Services) is published on Counsel Stack Legal Research, covering District Court, C.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pearce v. Secretary of Health & Human Services, 680 F. Supp. 1264, 1988 U.S. Dist. LEXIS 2078, 1988 WL 20849 (C.D. Ill. 1988).

Opinion

ORDER

MIHM, District Judge.

The Defendant, Secretary of Health and Human Services (hereafter Secretary), seeks affirmation of this decision denying the Plaintiff, Guy Pearce (hereafter Pearce), benefits under the Social Security Act as amended. 42 U.S.C. § 401 et seq. [1265]*1265Pearce seeks summary reversal of the Secretary’s decision and that the case be remanded for further findings.

FACTS

Pearce filed an application for Disability Insurance Benefits on December 31, 1981 alleging disability beginning in March of 1978. (Tr. 145-148). Pearce’s insured status expired prior to the alleged onset date, and his claim for benefits was denied.

On January 19, 1983, Pearce filed a second application for Disability Insurance Benefits and Supplemental Security Income, again alleging disability beginning in March of 1978. (Tr. 160-163, 169-173).1 Both of these claims were denied. (Tr. 179).

On March 17, 1983, Pearce requested reconsideration, amending his application to reflect an alleged disability onset date of January 1985. (Tr. 175). Upon reconsideration, both claims were again denied. (Tr. 176-177).

Subsequently, Pearce requested an administrative hearing on both claims. (Tr. 178) On November 4, 1983, a hearing was held before an Administrative Law Judge (hereafter AU). (Tr. 44-77). The AU determined that Pearce did not suffer from a severe impairment, and was, therefore, not entitled to Supplemental Security Income. (Tr. 283). Regarding Pearce’s claim for Disability Insurance Benefits, the AU applied administrative res judicata pursuant to Pearce’s December 23, 1981 application and dismissed the claim. (Tr. 286-287).

On March 29, 1984, Pearce requested review of the hearing decision by the Appeals Council (Tr. 288), and submitted new evidence. (Tr. 298-301). Regarding Pearce’s Supplemental Security Income claim, the Appeals Council determined that the new evidence established that Pearce did, in fact, suffer from a severe impairment. (Tr. 303). However, the new evidence was found to not conform to the standards set forth by the Social Security regulations. (Tr. 303). For this reason, the Appeals Council specifically remanded the case to an AU and ordered the AU to obtain medical testing, which conformed to the regulations, and a medical assessment of Pearce’s ability to perform work related activities. (Tr. 304).

As to Pearce’s claim for Disability Insurance Benefits, the Appeals Council determined that Pearcé’s insured status date had been incorrectly computed, and therefore, reopened both the December 1981 and January 1983 applications. (Tr. 304). The Appeals Council noted that Pearce reported work activity from 1974 to 1978. (Tr. 304). Based on this work activity, the AU was directed to make a finding as to whether Pearce had engaged in gainful activity, and, if so, the testimony of a vocational expert (hereafter VE) was ordered to assess Pearce’s transferable skills. (Tr. 304).

Pursuant to the Appeals Council’s remand order, Pearce arrived at a consultative examination on September 28, 1984. (Tr. 309).2 In addition, two further hearings were held where testimony was heard from Pearce, Pearce’s friend, and a VE. (Tr. 78-126). Subsequently, the AU issued a decision finding that because Pearce had refused to meaningfully participate in the consultative examination, his claims for Disability Insurance Benefits and Supplemental Security Income were denied. (Tr. 34-35).

On April 26, 1985, Pearce requested review of the hearing decision (Tr. 26), and submitted additional evidence to the Appeals Council. (Tr. 16-21). The Appeals Council determined that the additional evidence did not follow the protocol established by the Social Security regulations or otherwise did not provide a basis to invalidate the AU’s decision. (Tr. 4). Thus, on January 22, 1986, the decision of the AU became the Secretary’s final decision. Subsequently, Pearce sought judicial review of the Secretary’s final decision.

[1266]*1266DISCUSSION

Both parties identify the issue before this Court to be “whether the final decision of the Secretary is supported by substantial evidence in the record.” Neither party discusses the weight, presence or absence, or interpretation of any of the medical evidence present in the record.

Pearce’s appeal arises from the provisions of the Act which allow an AU to deny benefits to a claimant, who is unwilling to cooperate in a consultative examination to which he is sent by the Secretary. This provision of the Act provides, in relevant part:

“If you do not appear at a consultative exam.
(a) General. If you are applying for benefits and do not have a good reason for failing or refusing to take part in a consultative examination or test which we arrange for you to get information we need to determine your disability or blindness, we may find that you are not disabled or blind. If you are already receiving benefits and do not have a good reason for failing or refusing to take part in a consultative examination or test which we arranged for you, we may determine that your disability or blindness has stopped because of your failure or refusal. Therefore, if you have any reason why you cannot go for the scheduled appointment, you should tell us about this as soon as possible before the examination date. If you have a good reason, we will schedule another examination.
(b) Examples of good reasons for failure to appear. Some examples of what we consider good reasons for not going to a scheduled examination include: (1) illness on the date of the scheduled examination or test; (2) not receiving timely notice of the scheduled examination or test, or receiving no notice at all; (3) being furnished incorrect or incomplete information; or being given incorrect information about the physician involved or the time or place of the examination or test; or (4) having had death or serious illness occur in your immediate family.
(c)Objections by your physician. If any of your treating physicians tell you that you should not take the examination or test, you should tell us at once. In many cases, we may be able to get the information we need in another way. Your physician may agree to another type of examination for the same purpose.” 20 C.F.R. §§ 404.1518; 416.918 (1985).

In the present case, the AU concluded that Pearce, without good reason, refused to meaningfully take part in a consultative examination, which was necessary to establish the severity of his pulmonary condition. (Tr. 95-96). Therefore, the AU denied his disability claim.

The record reflects that Pearce did establish that he suffers from a severe pulmonary impairment. However, as was explicitly pointed out to Pearce by the Appeals Council, the medical evidence in the record at that time did not conform to the criteria set forth by the Social Security regulations and “additional medical evidence was warranted in this case.” (Tr. 303). The additional medical evidence required was clearly identified by the Appeals Council:

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680 F. Supp. 1264, 1988 U.S. Dist. LEXIS 2078, 1988 WL 20849, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pearce-v-secretary-of-health-human-services-ilcd-1988.