Thomas v. Heckler

598 F. Supp. 492, 1984 U.S. Dist. LEXIS 24322
CourtDistrict Court, M.D. Alabama
DecidedAugust 15, 1984
DocketCiv. A. 83-T-826-N
StatusPublished
Cited by8 cases

This text of 598 F. Supp. 492 (Thomas v. Heckler) is published on Counsel Stack Legal Research, covering District Court, M.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Thomas v. Heckler, 598 F. Supp. 492, 1984 U.S. Dist. LEXIS 24322 (M.D. Ala. 1984).

Opinion

MEMORANDUM OPINION

MYRON H. THOMPSON, District Judge.

Plaintiffs Nellie P. Thomas, Mamie Johnson and Robert L. Benford, who are Alabama citizens, have brought this class action lawsuit challenging the refusal of defendant Secretary of Health and Human Services to follow the settled law of the Eleventh Circuit in terminating the payment of benefits under Title II of the Social Security Act, 42 U.S.C.A. §§ 401-433, and Title XVI of the Act, 42 U.S.C.A. §§ 1381-1385. The State of Alabama and its Attorney General have also been allowed to intervene as plaintiffs.

Pointing to Simpson v. Schweiker, 691 F.2d 966 (11th Cir.1982), the plaintiffs claim that the Secretary may not terminate benefits without producing evidence that a recipient’s medical condition has substantially improved since the initial finding of disability. The Secretary, on the other hand, contends that she is not bound by Simpson and that she may terminate benefits at any time upon a new finding, based on current evidence, that a prior recipient is not disabled, notwithstanding the complete absence of evidence that the recipient’s medical condition has improved.

This lawsuit is now before the court on the plaintiffs’ (1) request for a class-wide preliminary injunction and (2) request for certification of a plaintiff class. For reasons which follow, both requests are due to be granted.

I. BACKGROUND

Titles II and XVI of the Social Security Act provide benefits to persons determined to be “disabled” and entitled to benefits under the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. Under both Titles, disability is defined as “inability to engage in any substantial gainful activity by rea *494 son of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve (12) months.” 42 U.S.C.A. §§ 423(d)(1)(A), 1382c(a)(3)(A).

A recipient is entitled to disability benefits only so long as the disability continues to exist. 42 U.S.C.A. §§ 423(a)(1), 1383(a)(5). The procedure for review of continued eligibility for benefits is essentially similar to the procedure followed in the initial application for benefits. A recipient of benefits is contacted by the Disability Determination Division of the Alabama Department of Education, the state agency working under contract with the Secretary to make disability determinations. The recipient is told that his or her case is being reviewed to determine whether he or she is still disabled. If the state agency determines that the recipient is no longer disabled the recipient is so informed, and the Secretary terminates benefits shortly thereafter. A recipient dissatisfied with the initial determination is afforded an administrative review procedure, which includes an opportunity for reconsideration by the state agency, a hearing before a Social Security administrative law judge and a review by the Social Security Appeals Council at the discretion of the council. A recipient still dissatisfied may seek review in the federal courts. 42 U.S.C.A. § 405(g). Also, under certain circumstances, persons whose benefits have been terminated may continue to receive them until a determination adverse to their claim is made by the administrative law judge. 42 U.S.C.A. § 423(g)(1).

In 1980, Congress mandated that disability benefits eligibility be reviewed at least once every three years. 42 U.S.C.A. § 421(h)(1). This mandate for continuing disability review was implemented in Alabama in early 1981, causing an approximately five-fold increase in the number of cases reviewed by the state agency. Prior to this time, eligibility review had been conducted on an irregular basis under a “medical diary” procedure which targeted certain cases in which disabilities might be expected to cease.

In the late 1970’s or early 1980’s, the Secretary altered the standard for periodic review of disability cases. Under the former standard, benefits were continued unless there was evidence that the medical condition for which the recipient had originally been awarded benefits had significantly improved. In other words, the review standard focused on whether there had been a medical improvement. Under the new standard, current medical evidence generated in the twelve months preceding the review is examined to determine whether the recipient has a present condition considered disabling. In other words, the previous finding of disability is given no effect and the recipient’s condition is evaluated as if he or she were presenting an initial application for disability benefits. No effort is made to determine whether the condition upon which the original finding of disability was based has improved. See 20 C.F.R. §§ 404.1579, 404.1586, 404.1594, 416.994; 45 Fed.Reg. 55,568 (1980).

In 1982, the Eleventh Circuit Court of Appeals in Simpson v. Schweiker, 691 F.2d 966 (11th Cir.1982), expressly rejected the Secretary’s use of the current evidence standard, concluding instead that there must be some evidence of medical improvement before a recipient’s benefits may be terminated. The appellate court stated that “[i]f ... the evidence in a continuation case is substantially the same as the evidence had been in the initial disability benefits request case, benefits must be continued. Otherwise, termination of benefits will often depend not on a finding of changed condition, but simply on the whim of a changed [Administrative Law Judge].” 691 F.2d at 969.

The Secretary refused to comply with Simpson except when directed to do so in a specific case. She continued to limit her administrative review of continuing disability cases to current medical evidence, with no effort at comparing that evidence with the evidence that supports the initial finding of disability.

*495 The Secretary’s change in standards and her refusal to comply with Simpson were more than semantic. The application of the standard has led to the termination of disability benefits in a flood of cases in Alabama.

Among the many who had their benefits terminated under the current evidence standard are plaintiffs Nellie P. Thomas, Mamie Johnson, and Robert L. Benford. Thomas was initially found disabled due to a back impairment and received Title II benefits. Johnson was initially found disabled due to coronary and disc disease and received Title II and Title XVI benefits. And Benford was initially found disabled due to mental impairments and received Title II benefits. In each case, the administrative law judge who determined whether the plaintiff was entitled to continued disability benefits focused entirely on the plaintiff’s present condition. No comparison was made with the evidence which supported the original determination of disability, nor was there a finding that the plaintiff’s condition had improved.

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229 B.R. 821 (N.D. Alabama, 1999)
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788 F.2d 698 (Eleventh Circuit, 1986)
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602 F. Supp. 925 (M.D. Alabama, 1984)

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Bluebook (online)
598 F. Supp. 492, 1984 U.S. Dist. LEXIS 24322, Counsel Stack Legal Research, https://law.counselstack.com/opinion/thomas-v-heckler-almd-1984.