Caseflicks

Court of Appeals for the Eleventh Circuit • 1983

Jack Bloodsworth v. Margaret M. Heckler, Secretary of Health and Human Services

703 F.2d 1233 | 1983 U.S. App. LEXIS 28592 | 1 Soc. Serv. Rev. 352

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Takeaway

In short, this case confirms that an Appeals Council's untimeliness dismissal is judicially reviewable and that an ALJ cannot deny disability benefits by disregarding well-supported treating-physician evidence and corroborated disabling pain without substantial evidence.

Background

Jack Bloodsworth, a minimally literate man in his mid-fifties with a fourth-grade education, sought disability insurance benefits and supplemental security income. He had worked as a Florida drawbridge tender, a job requiring operation of controls with both hands and feet, roughly four hours of standing and four hours of sitting each day. He had also worked as a park attendant and welder.

Bloodsworth had a long history of serious back problems, including surgeries for lumbar disc disease and a ruptured disc. Medical evidence documented scoliosis, degenerative osteoarthritis, disc disease, limited spinal motion, and severe pain. He testified that constant pain disrupted his sleep and required him to lie down several times a day. His treating physicians concluded that his conditions prevented him from performing his bridge-tender job.

The Social Security Administration denied his applications initially, on reconsideration, and after an ALJ hearing. Bloodsworth missed the sixty-day deadline to request Appeals Council review by about two weeks. The Appeals Council dismissed his request as untimely and found no good cause for an extension. The district court held that it had jurisdiction to review that action and remanded. On remand, the Appeals Council again deemed the request untimely but, pursuant to the court's order, considered the merits and denied review. The district court affirmed the denial of benefits, and Bloodsworth appealed.

Issues

Issue #1

Whether a federal district court has jurisdiction under 42 U.S.C. § 405(g) to review an Appeals Council dismissal of a request for review as untimely.

Holding

Yes. An Appeals Council dismissal of an untimely request for review is a final decision made after a hearing for purposes of § 405(g).

Reasoning

The court followed Langford v. Flemming, which had held that an agency decision declining to extend the time for Appeals Council review is final and judicially reviewable. The Secretary's argument that the dismissal was not final because it did not reach the merits, and was not made after a hearing because no separate hearing occurred on timeliness, ignored the role of Appeals Council review in the Social Security administrative process.

The court distinguished Califano v. Sanders, which barred review of a refusal to reopen an already final benefits decision. Reopening is an extraordinary, regulation-created opportunity for a second consideration of a claim; Appeals Council review, by contrast, is an ordinary stage of the prescribed administrative-review process available to a dissatisfied party.

The Secretary's own regulations treated an Appeals Council action—whether it decided the merits or dismissed a request for review—as binding and as triggering the claimant's right to file in federal district court. The Appeals Council's dismissal finalized the ALJ decision that had been made after a hearing, satisfying § 405(g).

The contrary interpretation would leave a claimant in procedural limbo. An ALJ decision would not become judicially reviewable unless the Appeals Council reviewed it on the merits, but an Appeals Council dismissal would preclude such review. The court therefore concluded that Salfi, not Sanders, governed this situation.

Issue #2

Whether substantial evidence supported the Secretary's finding that Bloodsworth could return to his past work as a drawbridge tender.

Holding

No. The ALJ lacked good cause to reject the treating physicians' opinions, and the record did not substantially support the conclusion that Bloodsworth could perform his former work.

Reasoning

Although judicial review under § 405(g) is limited, the court must examine the record as a whole to determine whether the agency's decision rests on substantial evidence. A claimant initially must show inability to perform past work by considering objective medical findings, physicians' diagnoses, subjective evidence of pain, and the claimant's age, education, and work history, both separately and together.

The opinions of treating physicians generally receive substantial or considerable weight unless the ALJ shows good cause to discount them. Dr. Batson, Bloodsworth's treating orthopedist, and Dr. Prevatt, his treating internist, substantially agreed that Bloodsworth had degenerative spinal conditions, marked motion limits, severe pain, and an inability to perform the physical demands of bridge-tender work. Their assessments were also supported by imaging, other medical opinions, and the Florida Retirement Division's finding that Bloodsworth was totally disabled.

The ALJ wrongly stated that Dr. Prevatt had not confirmed Dr. Batson's conclusions. Dr. Prevatt expressly reported painful and limited movement, pain from prolonged standing, sitting, bending, and lifting, and disability from Bloodsworth's bridge-tender position. Thus, the ALJ's stated basis for rejecting the treating evidence was unsupported by the record.

The ALJ instead relied on consulting rheumatologist Dr. Flatt, but her conclusion that Bloodsworth was not disabled was weakened by her misunderstanding that his former job was wholly sedentary and involved only pushing buttons. In fact, the job required substantial standing and use of both arms and legs. Moreover, her own examination findings documented permanent arthritis, severe pain, restricted back rotation, and painful movement.

The ALJ also could not reject the claim of disabling pain merely by finding Bloodsworth not credible. Pain was not supported only by Bloodsworth's and his wife's testimony; every examining physician, including Dr. Flatt, reported clinical evidence of significant pain. The ALJ may not arbitrarily reject uncontroverted medical testimony, and the extensive corroborating evidence made the credibility finding insufficient to support the denial.

Issue #3

Whether the evidence required an automatic disability finding under Listing 1.05(C) for vertebrogenic disorders.

Holding

No. The record did not establish abnormalities severe enough to satisfy the listing without consideration of vocational factors.

Reasoning

Listing 1.05(C) required a qualifying vertebrogenic disorder with persistent pain, muscle spasm, significant spinal-motion limitation, and specified radicular motor, sensory, and reflex losses. Bloodsworth had previously undergone surgery for a herniated nucleus pulposus and produced substantial evidence of pain and limitation.

But the court concluded that the later x-rays and myelograms did not reveal abnormalities of the severity required by the listing. His earlier surgery appeared sufficiently successful to permit him to return to work until 1978, and the evidence did not establish that the precise listing criteria were met.

Because Bloodsworth had nevertheless proved that he could not return to his past work, the burden shifted to the Secretary to show that jobs existed in the national economy that he could perform. The case was remanded for that vocational determination.