United States District Court, D. Idaho
MEMORANDUM DECISION AND ORDER
HONORABLE RONALD E. BUSH, CHIEF U.S. MAGISTRATE JUDGE.
Pending
is Petitioner Ronald Lindsey's Petition for Review (Dkts.
1, 15), [1]
appealing the Social Security Administration's final
decision to deny various claims for awards of additional
benefits.[2]
See generally Pet. for Review (Dkt. 15). Also
pending are two motions filed by Petitioner to obtain records
from the Office of Workers' Compensation Programs
(“OWCP”) (Dkt. 30) and the Social Security
Administration (“SSA”) (Dkt. 31). This action is
brought pursuant to 42 U.S.C. §§ 405(g). Having
carefully considered the record and otherwise being fully
advised, the Court enters the following Memorandum Decision
and Order:
I.
FACTUAL BACKGROUND AND ADMINISTRATIVE
PROCEEDINGS
This is
not a typical Social Security appeal. Rather than disputing a
finding of no disability, Petitioner here has been found
disabled and has been receiving Social Security Disability
Insurance benefits. Most of his challenges relate to
calculations of his benefit amounts.
Petitioner
was injured on the job in 1983 while working as a federal
employee. (AR 67- 68, 1362.) He subsequently received
periodic payments through OWCP from 1983 through 2013. (AR
1362, 1364, 1379-1380.) Petitioner claims he first filed for
Social Security Disability Insurance benefits in 1986, but
SSA records do not support this claim. Pet. for Review 9
(Dkt. 15); Addendum to Pet'r's Br. 7-8 (Dkt. 32-1);
AR 64 (2005 ALJ Decision) and AR 1361 (2015 ALJ Decision).
The
record does show that Petitioner filed a claim for disability
insurance benefits in 1990, which was denied initially and
then on reconsideration. (AR 64.) There is no evidence
Petitioner timely appealed this denial. (AR 64.)
Petitioner
next filed for disability insurance benefits in 2000. (AR
64.) That claim was denied on the basis of res
judicata[3]
because it was based on the same facts and law as his 1990
claim. (AR 64.) Again, Petitioner did not appeal the denial.
In
2002, Petitioner once more applied for disability insurance
benefits. (AR 64.) When that application was denied initially
and on reconsideration, also on the basis of res
judicata, Petitioner requested a hearing. (AR 64.) In
2004, Administrative Law Judge (“ALJ”) Henry M.
Tai vacated the denial of Petitioner's 2002 claim and
remanded for further consideration because SSA could not
locate the file from Petitioner's 1990 claim and
therefore ALJ Tai could not conclude that res
judicata precluded Petitioner's 2002 claim. (AR
1814-1816.) After the application was once more denied
initially and on reconsideration, Petitioner again requested
a hearing. (AR 32-34.) After the hearing, ALJ Tai issued a
fully favorable decision finding Petitioner had been disabled
since May 6, 1983. (AR 64-76.) ALJ Tai also found that
Petitioner's 2000 claim could be reopened and revised,
because Petitioner had filed his 2002 claim within the
four-year period allowed for reopening claims. (AR 74.)
However, ALJ Tai also found that Petitioner's 1990 claim,
and any earlier claims, could not be reopened because more
than four years had lapsed. (AR 74-75.) Ultimately, ALJ Tai
found that “[b]ased on the Title II applications filed
on October 16, 2002 and protectively filed on April 20, 2000,
the claimant is entitled to a period of disability beginning
May 6, 1983 and to disability insurance benefits under
Sections 216(i) and 223, respectively, of the Social Security
Act.” (AR 76.) Petitioner did not timely challenge ALJ
Tai's 2005 fully favorable decision. (AR 1362.)
Thereafter,
Petitioner received a Notice of Award indicating that his
disability insurance benefits were being reduced to take into
account his Workers' Compensation payments. (AR 81- 83.)
Petitioner appealed this and other aspects of the Notice of
Award, which ultimately resulted in ALJ Tai issuing an
unfavorable decision in 2007, finding that Petitioner's
disability insurance benefits had been properly calculated
and that there was no underpayment of benefits. (AR
1108-1115.) Petitioner appealed to the Appeals Council. (AR
1116-1118.) After a lengthy delay, in 2010 the Appeals
Council granted Petitioner's request for review, vacated
the 2007 ALJ decision, and remanded for a new hearing. (AR
1363.)
After a
hearing, ALJ Robert J. Labrum issued an unfavorable decision
in 2011. (AR 18- 24.) The Appeals Council subsequently denied
Petitioner's request for review of ALJ Labrum's
decision. (AR 14, 10-12.) Thereafter, Petitioner petitioned
for review in the United States District Court for the
District of Idaho, United States Magistrate Judge Candy W.
Dale presiding. (See AR 1397-1400; see also
Case No. 4:13-cv-0439-CWD.) After noting that the Respondent
agreed with Petitioner that ALJ Labrum failed to explain
adequately the reasons for his decision, the district court
granted the petition for review, vacating ALJ Labrum's
decision and remanding to the ALJ to develop the factual
record further and issue a new decision after analyzing four
listed issues. (AR 1401-1408.) The district court also held
that there was no legal basis for Petitioner to receive an
award of punitive damages against the SSA. (AR 1405.)
On
remand, ALJ Michele M. Kelley held a hearing on April 9, 2015
and then issued an unfavorable decision on May 22, 2015. (AR
1361-1382.) Petitioner once again sought review by the
Appeals Council, which was once again denied. Thereafter,
Petitioner petitioned for review to this Court. (Dkts. 1,
16.)
The
Court has worked diligently to understand the particular
claims Petitioner now brings. In his Petition for Review,
Petitioner sets out five numbered claims. First, he appears
to contest the starting date of his benefits, the application
of an offset due to his workers' compensation payments,
and the treatment of cost-of-living increases. Second, he
contends that the calculation to determine his disability
insurance award should be based on his 1983 earnings, which
were less overall than the 1982 earnings on which SSA relied,
but which were higher per month for the months in 1983 he
worked before he became disabled. Third, he contends he has
been improperly deprived of Medicare benefits to which he is
entitled. Fourth, he contends he has been improperly deprived
of family benefits related to his wife and child. Fifth,
Petitioner seeks payment of benefits withheld.
In
addition to the five numbered issues identified in the
Petition for Review, Petitioner elsewhere raises other
claims. In particular, he seeks punitive damages against the
SSA, Addendum to Pet'r's Br. 15 (Dkt. 32-1), and he
claims he is owed $990, 000 in back pay from the SSA.
Pet'r's Br. 8 (Dkt. 32). He also asserts that his
original SSA claim was in 1986 and that ALJ Kelley's
decision includes typos. Addendum to Pet'r's Br. 7-8,
1 (Dkt. 32-1). Each of these arguments will also be
addressed.
II.
STANDARD OF REVIEW
To be
upheld, the Commissioner's decision must be supported by
substantial evidence and based on proper legal standards. 42
U.S.C. § 405(g); Trevizo v. Berryhill, 817 F.3d
664, 674 (9th Cir. 2017). Findings as to any question of
fact, if supported by substantial evidence, are conclusive.
42 U.S.C. § 405(g). In other words, if there is
substantial evidence to support the ALJ's factual
decisions, they must be upheld, even when there is
conflicting evidence. See Treichler v. Comm'r of
Social Sec. Admin., 775 F.3d 1090, 1098 (9th Cir. 2014).
“Substantial
evidence” is defined as “such relevant evidence
as a reasonable mind might accept as adequate to support a
conclusion.” Richardson v. Perales, 402 U.S.
389, 401 (1971); Ludwig v. Astrue, 681 F.3d 1047,
1051 (9th Cir. 2012). The standard requires more than a
scintilla but less than a preponderance (Trevizo,
817 F.3d at 674), and “does not mean a large or
considerable amount of evidence.” Pierce v.
Underwood, 487 U.S. 552, 565 (1988).
With
respect to questions of fact, the role of the Court is to
review the record as a whole to determine whether it contains
evidence that would allow a reasonable mind to accept the
conclusions of the ALJ. Richardson, 402 U.S. at 401;
see also Ludwig, 681 F.3d at 1051. The ALJ is
responsible for determining credibility, resolving conflicts
in medical testimony, and resolving ambiguities.
Treichler, 775 F.3d at 1098. Where the evidence is
susceptible to more than one rational interpretation, the
reviewing court must uphold the ALJ's findings if they
are supported by inferences reasonably drawn from the record.
Ludwig, 681 F.3d at 1051. In such cases, the
reviewing court may not substitute its judgment or
interpretation of the record for that of the ALJ. Batson
v. Comm'r of Social Sec., 359 F.3d 1190, 1196 (9th
Cir. 2004).
With
respect to questions of law, the ALJ's decision must be
based on proper legal standards and will be reversed for
legal error. Zavalin v. Colvin, 778 F.3d 842, 845
(9th Cir. 2015); Treichler, 775 F.3d at 1098.
Considerable weight must be given to the ALJ's
construction of the Social Security Act. See Vernoff v.
Astrue, 568 F.3d 1102, 1105 (9th Cir. 2009). However,
reviewing federal courts “will not rubber-stamp an
administrative decision that is inconsistent with the
statutory mandate or that frustrates the congressional
purpose underlying the statute.” Smith v.
Heckler, 820 F.2d 1093, 1094 (9th Cir. 1987).
III.
DISCUSSION
A.
Petitioner's Motions to Obtain Additional Records Are
Denied.
Petitioner
filed two motions to obtain records he believes are relevant
to his case. First, he filed a Motion for Workers Comp
Records or an Index of Workers Comp Records (Dkt. 30),
“to obtain Federal Workers' Compensation records
pertaining to [his] work injury that occurred May 6, 1983 to
the present day.” His stated purpose behind the motion
is “to establish failure for due process and the Social
Security negligence for not processing my claim and Social
Security negligence for not assisting me with my
claim.” Id.
Separately,
he also filed a Motion for Social Security Records and the
Triennial Redetermination Ratio Considered Starting 1983 to
Present (Dkt. 31). His stated purpose is “to obtain all
of Social Security records, respectfully the dates from 1986
to 1992 and 2000 to the present to establish failure for due
process and the Social Security negligence in processing my
claim and not assisting me with my claim.” Id.
Respondent
opposes both motions (at Dkts. 34, 35), arguing that this
Court, in its appellate role, “simply cannot look
beyond the record.” Resp't's Resp. to
Pet'r's Mot. for Workers' Compensation Records or
an Index of Workers' Compensation Records 1-2 (Dkt. 34)
(quoting Roberts v. Shalala, 66 F.3d 179, 183 n.3
(9th Cir. 1995)). Respondent also points out that the issue
of agency negligence is not before the Court, quoting Judge
Dale's citation to 42 U.S.C. § 405(g) in
Petitioner's prior case. Id. at 2. Additionally,
Respondent characterizes this as a “closed-record,
administrative case” where “[t]he record is
complete.” Id. Finally, Respondent observes
that the certified administrative record already includes
some 175 pages of records ALJ Kelley subpoenaed from OWCP.
Id. at 3; see also AR 912-1087.
Respondent
offers parallel arguments in its opposition to
Petitioner's other motion. See Resp't's
Resp. to Pet'r's Mot. for Social Security Records and
the Triennial Redetermination Ratio (Dkt. 35).
The
motions must be denied, both because this is a closed-record
appeal and because the issues to which the motions relate are
not properly before this Court. This reasoning is further
explained in the next several paragraphs.
Social
Security appeals such as this one involve “a certified
copy of the transcript of the record including the evidence
upon which the findings and decision complained of are
based.” 42 U.S.C. § 405(g). The
“decision” referred to is the ALJ decision. The
“record” consists of all the evidence that was
before the ALJ. Unlike most civil cases filed in United
States District Court, Social Security appeals at the
District Court do not give the parties an opportunity to
subpoena records or present evidence. Nor is this Court
authorized to consider new evidence on appeal. It is the
obligation of a claimant such as the Petitioner to gather and
introduce evidence while, or before, the claim is in front of
an ALJ.
The
purpose of a Petition for Review is not for the District
Court to judge a petitioner's claims as if they were
newly brought. Rather, it is to review the ALJ's decision
for correctness - which is why the filing initiating a case
here is a Petition for Review. To prevail on appeal,
a Petitioner must show that the ALJ erred in some legally
significant way. Merely showing that the ALJ could have
decided differently is not enough. Nor is it enough to show
that Petitioner's claims have merit or that Petitioner is
in some way “right.” Instead, it is the
Petitioner's burden to show, on the same record the ALJ
considered, that the ALJ's decision is materially wrong.
In order to preserve the District Court's ability to
undertake this analysis, it is essential that the Court
consider precisely the same record the ALJ considered. For
this reason, Petitioner's motions to obtain information
to supplement the administrative record on appeal must be
denied.
Additionally,
Petitioner's motions seek to acquire new information that
Petitioner believes will support his claims that the SSA
acted negligently or violated his due process rights. But
Respondent is correct that those issues are not properly
before the Court. This case arises under 42 U.S.C. §
405(g), which allows only for judicial review of final
decisions of the SSA. The only matters to consider in this
case are those matters that were before ALJ Kelley when she
issued her decision. Those did not include whether the SSA
was negligent or had violated Petitioner's constitutional
rights, so those issues are not properly before this Court.
Accordingly, Petitioner's motions to obtain information
that could support such claims must be denied on this
additional ground.
Finally,
ALJ Kelley considered and rejected Petitioner's request
to subpoena records from OWCP, concluding that the
“records are not relevant to any of the issues before
her.” (AR 1381.) Petitioner's motion regarding OWCP
records must be denied even if the Court assumes for the sake
of argument that that motion could be regarded as challenging
the ALJ's conclusion the records were irrelevant. The
motion asks this Court for assistance getting the records,
but does not mention ALJ Kelley's decision. Certainly,
Petitioner's motion does not argue that ALJ Kelley
somehow erred in rejecting Petitioner's request for the
records. Accordingly, Petitioner has not shown error in that
aspect of ALJ Kelley's decision.
In
deciding to deny Petitioner's motions, the Court has
considered that it “may at any time order additional
evidence to be taken before the Commissioner of Social
Security, but only upon a showing that there is new evidence
which is material and that there is good cause for the
failure to incorporate such evidence into the record in a
prior proceeding.” 42 U.S.C. § 405(g). This
“new evidence” provision in the law does not
allow a court to consider new evidence itself, but it does
allow the case to be remanded for further consideration by
the SSA in appropriate circumstances. But, by the plain terms
of the law, this only applies when the new evidence is
“material” and when Petitioner's failure to
incorporate it into the record sooner is justified.
Id.
Here,
neither requirement is met. The records Petitioner seeks are
not material to any claims properly brought before the Court.
Nor has good cause been shown as to why the evidence sought
by Petitioner was not previously incorporated into the
record. Thus, there is no basis for remanding so SSA can
reconsider its decision based on new evidence. As discussed
above, Petitioner's motions to obtain additional records
are denied.
B.
Petitioner's Petition for Review Is Granted and the Case
Is Remanded.
Petitioner
numbered five issues in his Petition for Review. Pet. for
Review at 1, 1, 4, 5, 8 (Dkt. 15). He also raised additional
issues in his Brief. Addendum to Pet'r's Br. 15 (Dkt.
32-1); Pet'r's Br. 8 (Dkt. 32). Although Respondent
frames some of these issues differently, Resp't's Br.
2 (Dkt. 36), the Court will closely follow Petitioner's
framing of the issues to give Petitioner the clearest
possible understanding of its decision.
1.
Petitioner's Benefits Starting Date and Workers'
Compensation Offset Are Correct.
In its
entirety, the first issue Petitioner raises states:
Social Security Administration (SSA) Attorney [sic] Law Judge
(ALJ) Chief Judge Henry M. Tai
The Social Security starting date payout is April 20, 1999.
My Social Security entitlement of benefits starts May 6,
1983. That means the tally of 1983- 1999 is unpayable but the
tally 1999 stands and is to be paid out from 1999 with all
the ongoing cost of living increases of my Social Security
payout without the Workers Comp offset.
Pet. for Review 1 (Dkt. 15).
In his
2005 decision, ALJ Tai found that Petitioner was disabled as
of May 6, 1983. (AR 76.) He also found that Petitioner had
protectively filed an application for disability insurance
benefits on April 20, 2000. (AR 75.) An eligible person may
receive disability insurance benefit payments for up to 12
months prior to the date they filed, so long as they would
have been entitled to the benefit had they filed sooner. 42
U.S.C. § 423(b), (a)(1); 20 C.F.R. § 404.621(a)(1).
Here, Petitioner was found entitled to benefits as of April
20, 1999 - one year before the date of his April 20, 2000
protective filing that established his disability based on
ALJ Tai's 2005 decision. Id.; AR 75.
By the
same law, Petitioner was not entitled to benefits prior to
April 20, 1999 because he did not prove he was disabled based
on an earlier filing. Even though Petitioner may have filed
in 1986, and did file in 1990, Petitioner did not adequately
prove to the SSA that he was disabled until 2005. As ALJ Tai
and ALJ Kelley both noted in their decisions, prior filings
may only be opened for good cause for a period of four years
from the SSA's initial determination. AR 74- 75; AR 1376;
20 CFR § 404.988(b). There is simply no way Petitioner
could be entitled to benefits any earlier than April of
1999.[4]
Petitioner
seems to acknowledge that he is not entitled to disability
insurance benefits prior to April 20, 1999 by stating
“the tally of 1983-1999 is unpayable.” Pet. for
Review 1 (Dkt. 15). But if he is somehow claiming he is
entitled to disability insurance benefits prior to April 20,
1999, his Petition for Review is denied to that extent. He
has not shown that ALJ Kelley (whose decision it is that is
before this Court for review) erred in finding that April
1999 was the first month he was entitled to disability
insurance benefits. (AR 1376-1377.)
It is
not quite accurate for Petitioner to assert that his
“Social Security entitlement of benefits starts May 6,
1983.” Pet. for Review 1 (Dkt. 15). He was disabled as
of that date, but not yet entitled to disability insurance
benefits. Under 42 U.S.C. § 423(a)(1), he was not
entitled to benefits until he met all of the
eligibility requirements - including filing an application
establishing that he is under a disability. That did not
happen until he applied for disability insurance benefits on
April 20, 2000. This is consistent with ALJ Tai's 2005
decision, which stated that Petitioner “is entitled to
a period of disability beginning May 6, 1983 and to
disability insurance benefits under Sections 216(i) and
223.” (AR 76.) ALJ Tai noted that Petitioner's
disability began in 1983 but that his
entitlement to benefits would begin as provided by
statute. ALJ Kelley affirmed, and this Court now affirms,
that Petitioner's disability insurance benefits
properly began in April 1999.
The
remaining portion of Petitioner's first issue states that
he “is to be paid out from 1999 with all the ongoing
cost of living increases of my Social Security payout without
the workers comp offset.” Pet. for Review 1 (Dkt. 15).
The record reflects that Petitioner's benefits
calculations have included cost of living increases. (AR
125-126; see also AR 1453.) Petitioner's filings
do not indicate why he believes he is not receiving cost of
living adjustments to his disability insurance benefits to
which he is entitled. In the absence of argument or
explanation on the issue of cost of living adjustments, and
in the presence of record evidence indicating they have been
included, the Court finds no reason to overturn ALJ
Kelley's decision on that basis.
Nor
does Petitioner offer argument or explanation why he thinks
his disability insurance benefits should not have been
reduced while he was receiving workers' compensation
payments. ALJ Kelley quoted section 224(a) of the Social
Security Act, 42 U.S.C. § 424a, which provides that
disability insurance benefits awards must be reduced when the
recipient also receives disability-related periodic benefits
for workers' compensation. (AR 1378.) ALJ Kelley's
decision is detailed and thorough, describing the history and
purpose of this reduction as well as the mechanics of how it
is applied in practice. (AR 1378-1379.) The decision then
discusses how the law applies in Petitioner's case,
giving dates and dollar amounts as appropriate. (AR 1379-
1380.) Except for Petitioner's claim that his benefits
calculations should have been based in part on his 1983
earnings, an issue which is handled later in this Memorandum
Decision and Order, Petitioner does not challenge any aspect
of ALJ Kelley's findings regarding the application of the
workers' compensation offset. Accordingly, the Court will
not overturn ALJ Kelley's finding that the offset
applies.
2.
Petitioner's Benefits Were Properly Calculated
Excluding His 1983 Earnings.
Petitioner's
cornerstone contention is that his benefits calculations
should have included his earnings from 1983. Pet. for Review
1-4 (Dkt. 15); Addendum to Pet'r's Br. 2-4 (Dkt.
32-1). More specifically, the issue is whether SSA properly
calculated Petitioner's “average current
earnings” for purposes of offsetting his workers'
compensation payments. 42 U.S.C. § 424a(a)(5).
As
discussed above, section 224 of the Social Security Act, 42
U.S.C. § 424a, requires reduction of a person's
disability insurance benefits when they also receive periodic
workers' compensation payments. The statute provides the
method for calculating the reduction. As applicable here,
[5]
Petitioner's disability insurance benefits are reduced
(even, potentially, to zero) by the dollar amount calculated
when subtracting 80% of Petitioner's “average
current earnings” from the sum of his disability
insurance benefit amount and his workers' compensation
amount. 42 U.S.C. § 424a(a)(2)-(5). Seen another way, an
individual's “average current earnings”
establish a cap on the monthly benefits an individual can
receive. The higher the “average current earnings,
” the higher the cap will be. Thus, the amount of the
reduction turns on how Petitioner's “average
current earnings” under § 424a(a)(5) are
determined.
The
statute answers that question:
For
purposes of clause (5), an individual's average current
...