Stieberger v. BowenStieberger v. Bowen
Burt Neuborne, American Civil Liberties Union Foundation, New York City (Frederick A.O. Schwarz, Jr., Corp. Counsel, Alice Morey, Alexandra S. Bowie, New York City, Ralph Byrd, M.F.Y. Legal Services Inc., New York City, John E. Kirklin, Nancy Morawetz, Legal Aid Soc., New York City, on brief), for plaintiffs-appellees.
Before MESKILL, NEWMAN and KEARSE, Circuit Judges.
JON O. NEWMAN, Circuit Judge:
This appeal from the issuance of a preliminary injunction against the Secretary of Health and Human Services potentially raises far-reaching issues concerning the proper role of agencies and courts in the implementation of statutes. The issues arise in the context of adjudicating claims for disability benefits. The District Court for the Southern District of New York (Leonard B. Sand, Judge) ruled that the Secretary has violated and will violate the rights of a class of present and future claimants for disability benefits by failing to apply the law of this Circuit concerning the so-called “treating physician rule,” the standard for assessing the significance of the medical testimony presented by a claimant‘s treating physician. The Court issued an injunction barring the Secretary from denying or terminating benefits under policies inconsistent with decisions of this Circuit and granting other relief to implement this prohibition. Stieberger v. Heckler, 615 F.Supp. 1315 (S.D.N.Y.1985). After the District Court‘s decision, another panel of this Court ordered a substantial but less far-reaching remedy on behalf of a class of disability claimants who had complained of the Secretary‘s failure to observe the treating physician rule. Schisler v. Heckler, 787 F.2d 76 (2d Cir.1986). For reasons that follow, we conclude that the Schisler remedy has removed, at least for now, the justification for the preliminary injunction issued in this case, and we therefore vacate the injunction.
Background
Clarification of the issues requires a detailed examination of the proceedings in the District Court. The amended complaint was brought by the plaintiff, Theresa Stieberger, on behalf of herself and a class alleged to consist of all New York residents who have had disability benefits denied or terminated since October 1, 1981, by administrative law judges and who have not had benefits granted or restored in administrative appeals. The City of New York is also a plaintiff.1 A class was certified, and later redefined by an order entered December 20, 1985, to include “All New York residents whose claims for benefits or continuation of benefits have been or will be denied or terminated since October 1, 1981, based on a determination that they do not have a disability that prevents them from engaging in substantial gainful activity.” The defendants are the Secretary and other Health and Human Services officials, collectively referred to as “the Secretary.”
The District Court ruled that jurisdiction under section 205(g) of the Social Security Act,
In considering plaintiffs’ motion for a preliminary injunction, the District Court initially determined that those future class members whose claims have not yet been resolved in the administrative process face irreparable injury if their claims are denied pursuant to policies they contend are unlawful. Judge Sand therefore proceeded to consider whether a likelihood of success on the merits had been established.
On the issue of non-acquiescence, the District Court initially noted that the treating physician rule has been clearly articulated in the decisions of this Circuit. See, e.g., Bluvband v. Heckler, 730 F.2d 886, 892-93 (2d Cir.1984); Carroll v. Secretary of Health and Human Services, 705 F.2d 638, 642 (2d Cir.1983); Hankerson v. Harris, 636 F.2d 893, 896 (2d Cir.1980). In Schisler we summarized the rule as follows:
The rule, which has been the law of this circuit for at least five years, provides that a treating physician‘s opinion on the subject of medical disability, i.e., diagnosis and nature and degree of impairment, is: (i) binding on the fact-finder unless contradicted by substantial evidence; and (ii) entitled to some extra weight because the treating physician is usually more familiar with a claimant‘s medical condition than are other physicians, although resolution of genuine conflicts between the opinion of the treating physician, with its extra weight, and any substantial evidence to the contrary remains the responsibility of the fact-finder.
787 F.2d at 81 (citations omitted). We also noted in Schisler that an additional element of the rule is “‘that there is no requirement that the [treating] physician‘s medical testimony be supported by objective clinical or laboratory findings.‘” Id. at 82 n. 2 (quoting Bluvband v. Heckler, supra, 730 F.2d at 893).
The District Court then considered whether the Secretary was complying with the rule. The Court cited Social Security Ruling (SSR) 82-48c (1982), which provides that other things being equal, the fact that a physician treated a claimant will increase the weight accorded to that physician‘s opinion, but noted that this SSR does not mention that the treating physician‘s opinion is binding unless contradicted by substantial evidence. The Court also cited regulations suggesting that a treating physician‘s opinion must be supported by clinical or laboratory findings. See
Based on these materials, Judge Sand concluded that “the preliminary showing here is virtually as strong a showing of de facto non-acquiescence as can be made.” Id. at 1349. The District Court then considered and rejected the defendants’ contention that Congress had ratified the Secretary‘s approach to assessing the opinion of the treating physician by enacting section 9(b)(1) of the Social Security Disability Benefits Reform Act of 1984 (the “Reform Act“), Pub.L. No. 98-460, 98 Stat. 1794, 1805 (codified at
Turning to Circular 185, which is set out in full as Appendix C to the District Court‘s opinion, 615 F.Supp. at 1403-05, Judge Sand recognized that the new policy represents some curtailment of the virtually unbridled non-acquiescence policy of the past. Under the new policy, SSA proposes to issue a series of SSRs “identifying circuit court decisions which are at variance with established SSA policy,” id. at 1403. The Circular sets forth a special procedure to be used by ALJs and by the Appeals Council when considering claims within the purview of one of these “variance-noting” SSRs. The ALJ has three options. If he is prepared to rule in favor of the claimant, he simply issues his decision in the normal course. If he believes that an unfavorable decision is required under both SSA policy and the prevailing law of the relevant court of appeals, he issues a decision rejecting the claim but is obliged to assess the claim under both standards. If he believes that an unfavorable decision is required under SSA policy but that a favorable decision is required under the relevant law of the circuit, he recommends a favorable decision, accompanied by assessment of the claim under both standards.
The Circular then sets forth a procedure to be followed by the Appeals Council. It too has three options. It may remand to the ALJ for further development of the record in light of the relevant circuit law. It may rule in favor of the claimant if satisfied that such a result is required under relevant circuit law and that a ruling against the claimant would be reversed if the claimant sought judicial review.3 Or, if the Appeals Council concludes that circuit law favors the claimant but that such law should be relitigated, it recommends to the SSA Special Policy Review Committee a decision unfavorable to the claimant. If the Review Committee agrees that the circuit law should be relitigated, the agency consults with the Department of Justice. If relitigation is determined to be appropriate, the unfavorable decision is issued; otherwise, circuit law is followed, and a favorable decision is issued.
Judge Sand concluded that the new non-acquiescence policy, like its predecessor, was unlawful, even though it obviously represented some effort by SSA to promote adherence to circuit law while reserving the right to identify test cases appropriate for relitigation of circuit law with which the agency disagrees. A major defect identified by the District Court was the limitation of the new procedure to the ALJ and Appeals Council levels of administrative decision-making. The policy is totally inapplicable to state agencies that make the initial decisions on disability claims. These agencies, in making decisions at the first level of consideration and at the second level of reconsideration, remain bound to follow SSA policy, without being alerted to supervening circuit law to the contrary. SSA reports that in fiscal 1984 nearly 600,000 claimants denied benefits at the state agency level did not pursue further administrative remedies at the ALJ level. 615 F.Supp. at 1371. Judge Sand also found the new policy defective even as applied to agency action at the ALJ and Appeals Council levels of review. He noted the cumbersome nature of the procedure, which obliges a claimant to persevere throughout the multi-layered administrative process before being afforded an opportunity to gain the benefit of favorable circuit law. He also noted the absence of interim benefits for claimants in whose favor an ALJ would have ruled under relevant circuit law. Finally, he found deficient the standards for selecting test cases appropriate for relitigation of circuit law.
In assessing public interest concerns, the District Court first determined that Congress had taken no action that could be interpreted as endorsing the Secretary‘s nonacquiescence policy. On the contrary, the Conference Report on the Reform Act made clear that deletion of the differing House and Senate versions of language curtailing non-acquiescence was not to be interpreted as indicating approval of SSA‘s policy. The Conference Report expressed the view that the legal and constitutional issues posed by non-acquiescence “can only be settled by the Supreme Court,” a view that manifestly contemplates adjudication in the lower courts. See H.R.Rep. No. 1039, 98th Cong., 2d Sess. 38, reprinted in 1984 U.S.Code Cong. & Ad.News 3080, 3096. The District Court then assessed the consequences to the class of withholding injunctive relief and the consequences to the defendants of granting it and concluded that the nature of the relief to be awarded was necessary for the plaintiffs and not unduly burdensome for the defendants. The Court therefore issued the preliminary injunction challenged on this appeal.
The terms of the injunction are contained in paragraph 6 of the District Court‘s order, set forth as Appendix A to the Court‘s opinion. 615 F.Supp. at 1399-1401. First, the Secretary and all his agents and employees are enjoined from denying or terminating disability benefits pursuant to policies that are inconsistent with decisions of the Second Circuit. Second, the defendants are directed to rescind, with respect to New York residents, all policies, including Interim Circular No. 185, that state a general policy of non-acquiescence or state a policy of nonacquiescence in any decision of the Second Circuit. Third, the defendants are directed to inform all agents and employees who adjudicate disability claims of all decisions of the Second Circuit that reverse decisions of the Secretary denying or terminating disability benefits and to furnish a copy of the court ruling with instructions that the ruling is to be followed. Fourth, the defendants are directed to inform all agents and employees who adjudicate disability claims that the Second Circuit‘s decision in Bluvband v. Heckler, supra, is to be followed and to furnish a copy of that decision and a copy of the District Court‘s phrasing of the requirements of the treating physician rule. The injunction thus imposes obligations in three categories: adjudication of claims, rescission of non-acquiescence policies, and distribution of information.
Discussion
In challenging the District Court‘s preliminary injunction, the Secretary advances several contentions. Objection is raised to the basic approach of the injunction to the extent that it places adjudicators of disability claims at risk of contempt in the event the District Court concludes that they have denied benefits pursuant to policies inconsistent with Second Circuit case law. In addition, the Secretary contends that the injunction is not warranted because the accusation of non-acquiescence in the treating physician rule as announced in this Circuit is incorrect. Finally, the invalidation of the Secretary‘s general approach to non-acquiescence, as set forth in Interim Circular No. 185, is challenged as premature.
[Contempt proceedings] are not appropriate where an official simply misapplies a correct legal standard to the facts of a particular case. This Court‘s order does not require ALJs to grant benefits in cases involving a treating physician‘s opinion of disability; it orders the defendants to instruct ALJs to decide cases in accordance with Second Circuit precedents on this and other issues which arise in disability determinations. As long as the provisions of this Order are fully complied with, we see no reason why unfavorable determinations will not be reviewable in accordance with the normal substantial evidence standard.
Thus, the District Court did not contemplate that an ALJ or any other adjudicator of a particular disability claim would risk contempt. Nevertheless, the terms of the Court‘s injunction understandably raise apprehensions among the defendants, and very likely among their employees and agents, that the risk of contempt will be present in the adjudication process. It is true that the injunction does not require benefits to be granted in any particular case. But the injunction does more with respect to the adjudication process than oblige the defendants to issue instructions to adjudicators. It specifically provides in paragraph 6a that all agents and employees of the defendants, which appears to mean members of the Appeals Council, all ALJs, and all state officials acting as agents of the Secretary in the initial processing of claims, are enjoined from denying or terminating benefits “pursuant to policies, procedures, rulings or regulations which are inconsistent with decisions of” the Second Circuit. 615 F.Supp. at 1400. Adjudicators will not be comforted by the District Court‘s assurance that they do not face contempt proceedings if they are found only to have misapplied a correct legal standard to the facts of a particular case. As the treating physician rule cases of this Court and the district courts demonstrate, courts frequently cannot tell whether the adjudicator has ignored the treating physician rule and implicitly applied some more restrictive policy of the Secretary‘s, or have “simply” misapplied the correct legal standard. ALJs and other adjudicators could clarify matters considerably if they would indicate in their opinions that they recognize the binding authority of the treating physician rule and that they are endeavoring to apply it to the facts of the cases before them. Courts could then readily distinguish between disregard of the rule and its mere misapplication. Unfortunately, we have already seen too many cases where ALJs make no mention of the treating physician rule and give no adequate indication that they are applying it. If such cases were to recur with the injunction in effect, there would be the distinct possibility that an adjudicator would face contempt for non-compliance with the injunction, even though his denial of benefits might have resulted only from misapplication of the correct standard. Even if actual contempt proceedings would be rare, confined to adjudicators whose disregard of relevant law was established by a pattern of non-complying decisions, all adjudicators would apprehend some risk that even their good-faith efforts to apply the correct standard would be retrospectively found to be a denial of benefits pursuant to policies inconsistent with relevant law.
Whether and to what extent adherence to the standards of relevant circuit law may be enforced by placing administrative adjudicators under an injunction is a serious issue, requiring the most careful effort to maintain both the integrity of the administrative process and the paramount commands of law. We are not prepared to say that an injunction containing a provision like paragraph 6a is beyond the equitable power of a district court, though its use would require a very strong justification and its terms would have to make clear the distinction between refusal to apply relevant law and misapplication of relevant law to particular facts. We also have substantial doubts whether such a remedy would ever be appropriate in a preliminary injunction, where the standard on the merits is only a probability of success. Such a remedy, posing at least some risks to the orderly functioning of the administrative process no matter how carefully crafted, should normally be issued only after the merits of the lawsuit have been fully litigated.
The Secretary mounts a strong challenge to the injunction‘s invalidation of Interim Circular No. 185. As explained above, that policy, designed to identify test cases for relitigation of circuit law, contemplates implementation through a series of SSRs. At the time the preliminary injunction was ordered, no implementing SSRs had been issued. Thus, there is some merit to the claim that the validity of the Interim Circular is not yet ripe for decision. On the other hand, the limitation of the Circular to decision-making at the ALJ and Appeals Council levels renders it vulnerable to the criticism of the District Court that it tolerates a considerable degree of non-acquiescence at the state agency levels of adjudication. Moreover, the Secretary has not advanced any substantial argument against those provisions of the injunction that endeavor to preclude non-acquiescence by means other than the Interim Circular. For example, we have been given no reason why the District Court was not entirely correct in ordering the rescission of any policies or rulings of the defendants that “state specific non-acquiescence in any decision of the United States Court of Appeals for the Second Circuit.” 615 F.Supp. at 1400.
As we indicated at the outset, the context in which all of the Secretary‘s objections to the injunction arise has been significantly altered by our decision in Schisler v. Heckler, supra, rendered on April 2, 1986, several months after Judge Sand issued the injunction. A cross-appeal taken by the plaintiffs in that litigation had requested us to direct the District Court for the Western District of New York, from which that appeal arose, to issue an injunction requiring the Secretary to apply the treating physician rule in adjudicating the disability claims of members of the large class of New York residents in that case.4 We disagreed with the Secretary‘s contention that we lacked the authority to impose substantive requirements on the adjudication of disability claims, id. at 82, but nevertheless determined that a more limited remedy than that requested by the plaintiffs was appropriate. In the course of that appeal, counsel for the Civil Division of the Department of Justice, representing the Secretary, had assured us that the policy of the Secretary with respect to the treating physician rule “‘is clear‘” and “‘is the same as the second circuit rule.‘” Schisler v. Heckler, supra, 787 F.2d at 83. We accepted that representation “at face value.” Id. at 84. We expressed serious concern, however, over the Secretary‘s failure, acknowledged by counsel during the argument, to inform adjudicators of the content of the treating physician rule. Accordingly, we directed the District Court on remand to order SSA to “state in relevant publications to be determined by the district court that adjudicators at all levels, state and federal, are to apply the treating physician rule of this circuit.” Id. at 84.
Our decision to vacate the preliminary injunction does not, however, preclude the possibility that some form of injunctive relief may be warranted when the merits of the plaintiffs’ claims have been adjudicated. Though the conduct of the litigation remains within the discretion of the District Court, it might be appropriate to move expeditiously with resolution of any claims affecting the benefits of the named plaintiffs, leaving for later consideration the need for and content of any class relief with respect to the treating physician rule and issues of nonacquiescence. We assume that the District Court will, with the assistance of counsel, be kept informed of the progress of formulating and implementing the Schisler injunction. Any indication that the Secretary is not proceeding expeditiously to issue adequate instructions about the treating physician rule to all adjudicators will provide substantial basis for the formulation of appropriate injunctive relief at the conclusion of the pending litigation before Judge Sand. Indeed, there may well be room for cooperation between Judges Elfvin and Sand toward the end that the legitimate needs of members of both the classes they have certified will be met. Furthermore, the ensuing course of the litigation before Judge Sand will afford the Secretary an opportunity to inform the District Court whether SSA continues to keep in effect policies or rulings that disregard applicable law of this Circuit with respect to residents of the Circuit. The existence of any such policies and the Secretary‘s position with respect to them may be given due consideration in the determination of the content of any final injunction that may be issued in this case. Finally, the parties will have an opportunity to bring to the District Court‘s attention any SSRs that may have been issued pursuant to Interim Circular No. 185 so that the need for any relief with respect to the Circular may be assessed in light of its implementation. Whether or not any permanent injunction should be issued will depend on what the record discloses when finally concluded.
For all of the foregoing reasons, the preliminary injunction is vacated.