Charles P. Cieutat v. Otis R. Bowen, M.D., Secretary of Health and Human Services, DefendantCharles P. Cieutat v. Otis R. Bowen, M.D., Secretary of Health and Human Services, Defendant
Plaintiff-appellant Charles Cieutat (Cieu-tat) appeals the district court’s summary judgment in favor of defendant-appellee Secretary of Health and Human Services (Secretary) dismissing Cieutat’s suit, which sought to set aside the Secretary’s denial of his claim for Social Security disability insurance benefits and supplemental security income (SSI) benefits under
Facts and Proceedings Below
At the time of the Secretary’s decision, Cieutat was twenty-six years old and had a ninth grade education. He had worked for periods of varying duration as a stock clerk, framing carpenter, welder’s helper, truck driver, and oilfield worker. In addition to the application for benefits that is the subject of this appeal, Cieutat previously had applied on two occasions for Social Security benefits, but both of the earlier applications were denied without appeal. Cieutat filed the present application on October 6, 1982, claiming that he was unable to work due to a back impairment. The Social Security Administration (SSA) denied this application initially and upon reconsideration. On July 19, 1983, Cieutat received a de novo hearing before an AU. Cieutat appeared in person and was represented by counsel. Cieutat’s wife and his mother also appeared before the AU.
At the July 1983 hearing before the AU, Cieutat alleged the onset of his disability was in September 1977, when at age nineteen he fell at work and injured his back. He testified that he had been in pain since the 1977 injury, that he could sit comfortably only for ten minutes at a time, and that walking exacerbated the pain. Cieutat said that at first the pain was sporadic, but that since 1979 or 1980 it had worsened in intensity and had become constant. He stated that he could not bend to pick up objects on the floor and that he had difficulty opening doors. He said he took medication and
Subsequent to the AU’s decision, the SSA received a Work Activity Report, dated January 23, 1984, and submitted on behalf of Cieutat. The Report stated that Cieutat had worked for six months in 1981 as a “truck driver/electrician” for ATI, Inc. The same month, the SSA received an employer report prepared by ATI, Inc., which verified that for the six-month period between July and December 1981 Cieutat earned approximately $1,000 per month, along with a memorandum from the Office of Disability Operations calling Cieutat’s work activity to the SSA’s attention.
Based on the receipt of these documents, on November 30,1984, the Appeals Council on its own initiative reopened the AU’s decision. On March 27, 1985, the Appeals Council issued a revised decision finding that Cieutat was not disabled within the meaning of the Social Security Act. Specifically, the Appeals Council determined that Cieutat had a severe back impairment, and that he had suffered from drug abuse, which had been successfully treated, and from a brief depressive condition, but that he did not have an impairment or combination of impairments listed in, or medically equal to one listed in, Appendix 1 of the regulations. 1 The Appeals Council also found that Cieutat’s testimony regarding his extreme pain was inconsistent with the medical evidence and with his level of activity; that Cieutat could not perform his past relevant work, but that he had the residual functional capacity, which was not significantly affected by nonexertional limitations, for at least sedentary work; and that considering his residual functional capacity, age, education, and work experience, Cieu-tat was not disabled and, therefore, not entitled to disability insurance or SSI benefits.
After the Appeals Council’s decision, Cieutat requested judicial review by timely filing a complaint in the United States District Court for the Middle District of Louisiana. Upon submission of cross-motions for summary judgment, the magistrate issued Findings and Conclusions recommending that Cieutat’s motion be granted. The dis
Discussion
A. Authority to Reopen
Acting under the authority of the SSA regulations,
see
In addressing this argument, we first note that our review of an agency’s regulations is circumscribed.
See
Cieutat contends, however, that the Secretary’s interpretation of section 404.988 to permit him to reopen and revise the AU’s decision in this case is inconsistent with language of the SSA regulations. In cases involving such challenges, longstanding precedent obligates us to give great deference to the agency’s interpretation of its own regulations.
Ford Motor Credit Co. v. Milhollin,
Accordingly, we must determine whether the Secretary’s interpretation of section 404.988 as sustaining the jurisdiction of the Appeals Council to reopen Cieutat’s case is plainly inconsistent with the language of the regulations. 5 In pertinent part, section 404.988 provides:
“A determination, revised determination, decision, or revised decision may be reopened—
“(a) Within 12 months of the date of the notice of the initial determination, for any reason;
“(b) Within four years of the date of the notice of the initial determination if we find good cause, as defined in § 404.-989, to reopen the case; or
“(c) At any time if — [certain here immaterial specified conditions are met].” 6
Assuming for the moment that the Appeals Council properly determined that good cause existed, nothing in the language of section 404.988 appears on its face inconsistent with the Secretary’s reading of the regulation to permit the Appeals Council to reopen Cieutat’s case. Cieutat does not contend otherwise. Cieutat argues, however, that such an interpretation is inconsistent with the Secretary’s regulations pertaining to the administrative “review” process,
see
The regulatory framework relating to the SSA Disability Benefits Program,
see
Title II of the Act,
Cieutat argues that the Secretary’s reading of section 404.988 to allow the Appeals Council to “reopen” a decision for twelve months for any reason, and for four years with good cause, renders meaningless section 404.969, which specifically limits the Appeals Council’s ability to review on its own motion an AU’s decision to sixty days from the date of the decision. According to Cieutat, reading section 404.-988 this way would mean that the sixty-day limitations period of section 404.969 would have no effect, because its limit could always be overridden by the one- and four-
The Secretary counters, persuasively we think, that this argument fails to recognize that the time limits in these two sections are not measured symmetrically.
9
The sixty-day time period during which the Appeals Council may review a case on its own motion begins running from the date of the AU’s hearing decision.
See id.
§ 404.-969.
10
In contrast, the one- and four-year periods during which the Appeals Council may reopen a case commence on the date the claimant is sent notice of the
initial determination
on his application for benefits. As the Secretary explains, given the time it takes to process a claim through the four levels of the administrative process, it is quite possible that the twelve-month period during which a case may be reopened without a showing of good cause will expire
before
the sixty-day review period has run.
11
Thus, although it will often be the case, as here, that the sixty-day review period expires before the twelve-month reopening (without cause) period, this will not always be so. Hence, since there are situations where the Appeals Council would be free to review an ALJ’s decision, but where
Other circuits that have faced this issue have reached irreconcilable conclusions about how the regulations should be interpreted. The Fourth and Eighth Circuits have adopted the interpretation of section 404.988 urged by the Secretary.
See Zimmermann v. Heckler,
The Eleventh Circuit has read section 404.988 differently.
See Butterworth v. Bowen,
Most recently, the First Circuit has adopted yet another interpretation of section 404.988.
See McCuin v. Secretary of Health and Human Services,
In determining which of the available interpretations to adopt in this case, we are mindful of the deference we must give to the Secretary’s interpretation of his agency’s own regulations. In light of the fact that we do not consider that the interpretation urged by the Secretary deprives the sixty-day limitations period of section 404.-969 of all its force, we cannot say that the Secretary’s reading of section 404.988 as allowing the Appeals Council to reopen the AU’s decision in Cieutat’s case is plainly inconsistent with the language of the regulations.
13
We therefore decline to invali
We must now consider whether the Appeals Council had good cause to reopen. According to the regulations, good cause exists if new and material evidence is furnished, a clerical error was made, or the evidence considered in making the determination shows on its face that an error was made.
Cieutat argues that this evidence was available to the AU and, therefore, was not new. He is correct that there was admitted into evidence before the AU a vocational work report dated October 17, 1982, listing a job at ATI, Inc. Significantly, however, this report does not state the length of time Cieutat had worked. Moreover, where the report asks for a description of each job held, Cieutat wrote: “Jobs not explained — Did not work on long enough.” Additionally, although Cieutat testified at the hearing that he had worked briefly as a security guard, he did not mention that he had worked for six months in 1981 for ATI, Inc. as a truck driver/electrician. In fact, he testified that he had not held any job successfully since 1977.
14
The Secretary argues, and we agree, that taken as a whole, the evidence before the AU suggested that Cieutat engaged in no work
The evidence in question is also “material.” Interpreting a similarly worded requirement in the statutory provision that allows a district court to order additional evidence to be taken by the Secretary,
see
B. Trial Work Period
Cieutat argues that even if the Appeals Council had the authority to reopen the AU’s decision, his 1981 work qualifies as “trial work” under
Even if the trial work exception in
C. Supplemental Security Income Benefits
SSI benefits, authorized by Title XVI of the Act,
Cieutat correctly asserts that the district court erred in basing its affirmance of the Appeals Council’s denial of benefits in part on the termination of his insured status in December 1978. Nonetheless, this error is immaterial to our decision. Unlike the district court, the Appeals Council properly applied the Title II eligibility requirements only to Cieutat’s claim for disability insurance benefits. It also properly applied the statutory provisions and regulations governing the determination of disability for purposes of SSI benefits in reaching its decision denying SSI benefits.
See infra.
Thus, the Appeals Council did not make the error made by the district court. Where, as here, appeal is taken from a district court’s summary judgment in favor of the Secretary, this Court has held that our review is to be made independently of the determinations of the district court, and without regard to whether the
For the reasons stated in the following' unpublished portion of our opinion, we conclude that substantial evidence supports the Secretary’s determination that Cieutat was not disabled.
Conclusion
The Appeals Council had the power to reopen the ALJ’s decision regarding Cieu-tat’s claims for benefits. It applied the proper legal standard in treating Cieutat’s 1981 work as substantial gainful activity rather than as a trial work period and in determining his eligibility for disability insurance and SSI benefits. In addition, substantial evidence supports the Appeals Council’s determination that Cieutat is not disabled within the meaning of the Social Security Act. Accordingly, we affirm the district court's decision upholding the Secretary's denial of benefits.
AFFIRMED.
Notes
Of the numerous issues raised by the defendants on appeal, only some have precedential value. Local Rule 47.5 provides: "The publication of opinions that have no precedential value and merely decide particular cases on the basis of well-settled principals of law imposes needless expense on the public and burdens the legal profession.” Pursuant to that rule the Court has determined that the nonprecedential portions of this opinion should not be published.
The places at which the published opinion omits parts of the unpublished opinion are indicated by asterisks.
. The SSA regulations set forth a five-step sequential process in evaluating disability claims.
See
. The Administrative Procedure Act directs that a court shall "hold unlawful and set aside agency action, findings, and conclusions found to be — (A) arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law."
. The Act grants the Secretary “full power and authority to make rules and regulations and to establish procedures, not inconsistent with the provisions of [the disability benefits program of the Act], which are necessary or appropriate to carry out such provisions" and directs him to adopt "rules and regulations to regulate and provide for the nature and extent of the proofs and evidence and the method of taking and furnishing the same” in disability cases.
.As stated by the Supreme Court, in construing administrative regulations, "a court must necessarily look to the administrative construction of the regulation if the meaning of the words used is in doubt.... [T]he ultimate criterion is the administrative interpretation, which becomes of controlling weight unless it is plainly erroneous or inconsistent with the regulation."
Udall,
. Sections 404.987-404.996 govern the reopening of a determination or decision regarding
disability
benefits; whereas the reopening of determinations or decisions regarding
SSI
benefits is governed by
. The full text of clause (c) of
"(c) At any time if—
"(1) It was obtained by fraud or similar fault;
"(2) Another person files a claim on the same earnings record and allowance of the claim adversely affects your claim;
"(3) A person previously determined to be dead, and on whose earnings record your entitlement is based, is later found to be alive;
"(4) Your claim was denied because you did not prove that the insured person died, and the death is later established—
"(i) By reason of an unexplained absence from his or her residence for a period of 7 years; or
"(ii) By location or identification of his or her body;
"(5) The Railroad Retirement Board has awarded duplicate benefits on the same earnings record;
"(6) It either—
“(i) Denies the person on whose earnings record your claim is based gratuitous wage credits for military or naval service because another Federal agency (other than the Veterans Administration) has erroneously certified that it has awarded benefits based on the service; or
“(ii) Credits the earnings record of the person on which your claim is based with gratuitous wage credits and another Federal agency (other than the Veterans Administration) certifies that it has awarded a benefit based on the period of service for which the wage credits were granted;
“(7) It finds that the claimant did not have insured status, but earnings for the appropriate period of time were later credited to his or her earnings record;
"(8) It is wholly or partially unfavorable to a party, but only to correct clerical error or an error that appears on the face of the evidence that was considered when the determination or decision was made;
“(9) It finds that you are entitled to monthly benefits or to a lump sum death payment based on the earnings of a deceased person, and it is later established that:
“(i) You were convicted of a felony or an act in the nature of a felony for intentionally causing that person’s death; or
"(ii) If you were subject to the juvenile justice system, you were found by a court of competent jurisdiction to have intentionally caused that person’s death by committing an act which, if committed by an adult, would have been considered a felony or an act in the nature of a felony;
"(10) It either—
“(i) Denies the person on whose earnings record your claim is based deemed wages for internment during World War II because of an erroneous finding that a benefit based upon the internment has been determined by an agency of the United States to be payable under another Federal law or under a system established by that agency; or
“(ii) Awards the person on whose earnings record your claim is based deemed wages for internment during World War II and a benefit based upon the internment is determined by an agency of the United States to be payable under another Federal law or under a system established by that agency; or
"(11) It is incorrect because—
"(i) You were convicted of a crime that affected your right to receive benefits or your entitlement to a period of disability; or
“(ii) Your conviction of a crime that affected your right to receive benefits or your entitlement to a period of disability is overturned.”
. Following decision at this stage, the claimant may take his case to federal court. Section 205(g) of the Social Security Act,
. Section 404.969 states:
"Anytime within 60 days after the date of a hearing decision or dismissal, the Appeals Council itself may decide to review the action that was taken. If the Appeals Council does review the hearing decision or dismissal, notice of the action will be mailed to all parties at their last known address.”
. Moreover, the Secretary maintains, Cieutat’s argument fails to recognize the separateness of, and distinct purposes served by, the reviewing and reopening provisions. Their separateness, he argues, is illustrated not only by the different bases from which the periods run, but also by the fact that the two sets of provisions are placed under distinct subheadings within the SSA regulations; that review procedures are available only to the Appeals Council, whereas a case presumably may be reopened by any component within the SSA that otherwise has jurisdiction; and that while only an ALJ’s hearing decision may be reviewed, a determination or decision made at any level of the administrative process may be reopened. The Secretary contends further that the consistency of his interpretation with a reading of the regulations in their entirety becomes clearer by an understanding of the distinct purposes served by the two sets of provisions. The Secretary maintains that the review procedures seek to create a means for establishing administrative finality while also providing a basis for routine reviews of decisions within the SSA during the period of appeal before the Secretary’s decision becomes subject to judicial review. By contrast, the purpose of the reopening provisions, according to the Secretary, is to afford the SSA a means of administrative reconsideration, in extraordinary circumstances, after an otherwise final determination or decision has been reached at any level of the administrative process.
See Bloodsworth
v.
Heckler,
. This conclusion follows from the definition of decision provided in the SSA regulations. Section 404.901 explains that for purposes of Subpart J, “[d]ecision means the decision made by an administrative law judge or the Appeals Council.” By contrast, the same section defines a determination as "the initial determination or the reconsidered determination.” Thus, since section 404.969 permits own-motion review by the Appeals Council within sixty days of "a hearing decision or dismissal," the time period for review necessary commences on the date of the ALJ’s hearing decision, and not on the date of the state agency’s or the SSA’s initial or reconsidered determination.
.For example, suppose a claimant received an initial determination denying him benefits from a state agency on January 1, 1987. This determination triggers the limitations periods on the SSA’s ability to reopen the case sua sponte, so that the Appeals Council (or, presumably, the ALJ) may reopen without cause through January 1, 1988, and with cause through January 1, 1991. In the meantime, since the claimant was denied benefits, he will probably seek reconsideration. Assuming he waits until the end of the sixty-day period that he has to do so, and that reconsideration occurs within thirty days after that, the claimant may be expected to receive notice of the agency’s decision upon reconsideration on about April 1, 1987. The claimant then has another sixty days within which to request a hearing before an ALJ. Assuming he makes such a request sixty days after receiving notice of the state agency’s decision upon reconsideration, the SSA would get the request on about June 1, 1987. If the hearing before the ALJ is held six months later, and the ALJ issues his decision only a month after the hearing, the ALJ’s hearing decision could be expected to be released by January 1, 1988. From that date, the Appeals Council has sixty days, until approximately March 1, 1988, to review the case on its own motion. Thus, under this hypothetical scenario, the Appeals Council could reopen without cause only through January 1, 1988, but could initiate review through March 1, 1988.
. The First Circuit in
McCuin
rested its interpretation in large part upon the plaintiffs due process challenge to a reading of
. While we cannot say that the
Butterworth
analysis is unreasonable, or that we would not adopt it as an original proposition, that is not the question.
Marcello,
The Secretary’s unpublished internal operating manual (Program Operations Manual System) restricts the authority to reopen to "the component (and job position(s)) which made the determination that has become final and that is being reopened or the component (and job position(s)) which has the authority to review and, if necessary, revise the determination.” Id. § 04010.030. While Butterworth construes this to mean that the component having review authority must reopen within the time that it could review, that is not the only reasonable interpretation. The Secretary’s interpretation, that the component having review authority means the component which would have had authority to review if timely appeal had been taken and that “the determination” as used in that connection refers back to the earlier phrase, "the determination that has become final and that is being reopened” (emphasis added), is also reasonable. Hence we defer to the Secretary’s interpretation of his own internal operating manual.
. Cieutat gave inaudible or nonresponsive answers to several questions by the AU and by his attorney concerning his post-injury work history; however, he did clearly respond negatively when his attorney asked whether he had been able successfully to hold any type of job since the 1977 injury.
. Citing the Supreme Court’s opinion in
Califano
v.
Sanders,
. The Fourth Circuit has determined that former
. Cieutat contends that by virtue of two applications which he filed prior to his present application, he satisfies
.For a claimant to be eligible for disability benefits, in addition to being disabled he must meet the Act’s special insured status earnings requirement.
See