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Wier v. Heckler

May 14, 1984

JANET WIER, ON BEHALF OF HER SON, JOHN P. WIER, A MINOR APPELLANT
v.
MARGARET M. HECKLER, SECRETARY OF HEALTH, EDUCATION AND WELFARE APPELLEE



On Appeal from the United States District Court for the Western District of Pennsylvania.

Hunter and Becker, Circuit Judges and Hoffman, District Judge.*fn*

Author: Becker

Opinion OF THE COURT

BECKER, Circuit Judge.

I. Preliminary Statement

This case involves a claim by John Wier, a seventeen-year old mentally impaired boy from Monroeville, Pennsylvania, for Supplemental Security Income benefits based on disability. John appeals from a summary judgment in favor of the defendant Secretary of Health and Human Services upholding the Secretary's denial of benefits. Although John was only eleven years old when his application for benefits was made by his mother, he will be well past eighteen, at which time he becomes subject to a new set of regulations,*fn1 when his case is finally adjudicated properly. Once again we find that the failure of an administrative law judge to mention and explain medical evidence adverse to his position has deprived the Secretary of the substantial evidence necessary to sustain his determination. See Cotter v. Harris, 642 F.2d 700 (3d Cir. 1981). We say "once again" because this is the fifth time since the beginning of the year that we have had to remand because of violation of Cotter. See Zelich v. Schweiker, 734 F.2d 9 (3d Cir. 1984) (remanding for failure to consider medical evidence of treating physician); Muro v. Heckler, 729 F.2d 1448 (3d Cir. 1984); McIntoch v. Schweiker, No. 83-5463 (3d Cir. Feb. 28, 1984); Sanders v. Schweiker, No. 83-5360 (3d Cir. Feb. 29, 1984); see also Stokes v. Schweiker, 729 F.2d 932 (3d Cir. 1984) (remanding case because of inadequate record); Sims v. Schweiker, 732 F.2d 147 (3d Cir. 1984) (remanding because of reliance on stale evidence); Wallace v. Schweiker, 729 F.2d 1450 (3d Cir. 1984) (remanding because of failure to consider impairments in combination); Speelman v. Schweiker, 727 F.2d 1101 (3d Cir. 1984) (remanding because of general failure to present substantial evidence).

Ordinarily we would proceed at once to recount the factual and procedural history of this case. However, the procedural problems described in detail below impel us to highlight at the outset a broader problem, one that we believe to be an essential part of the universe in which this all-too-typical case should be seen. The problem may be stated simply: the system of adjudication created by Congress for resolving eligibility for disability benefits is not working as it should. Depending on one's perspective, either the judicial system is placing impossible burdens on the administrative apparatus set in place by Congress to initially evaluate benefit claims or the officials in charge of the disability programs are, at least in many instances, ignoring the law. At all events, the resulting frictions and inefficiencies are burdening all concerned.

The following figures, compiled by the Administrative Office of the United States Courts and by the Clerk of the largest district court within this circuit, the District Court for the Eastern District of Pennsylvania, give some sense of the problem. To begin with, the number of suits filed by individuals denied disability benefits has exploded over the past several years. As recently as 1979, only 866 suits were filed requesting the federal district courts to review disability adjudications. See 1983 Annual Report of the Director of the Administrative Office of the United States Courts 140 (Table 28). This number edged upwards to 976 in 1980 and then jumped to 1,628 in 1981, to 2,378 in 1982, and to 3,595 in 1983. Thus, the past three years have seen over a 400 percent increase in the number of filings. Figures from the Eastern District of Pennsylvania reflect the national experience. In 1982, 165 disability suits were filed. In 1981, this number doubled to 329. Preliminary figures for 1984 show the high level of filings to be continuing.

The problem is not so much the increase in filings and the consequent burden imposed on already-taxed federal judicial resources. Rather, what troubles us more is the fact that the Secretary so often appears to have wrongfully withheld benefits or to have processed a claim so that it is impossible to tell whether he correctly denied benefits. In the Eastern District of Pennsylvania, for example, over the past two and one quarter years, the Secretary has prevailed at the district court level only 31 percent of the time. This figure is extraordinarily low, not only because there is no other genre of cases with which we are familiar that is reversed or remanded by the federal courts at such a rate,*fn2 but also because the Secretary does not even have to show that she is "right" but only that there is "substantial evidence" to support her position. Approximately 45 percent of the cases are remanded to the Secretary for further proceedings.The claimant wins outright or subject to further proceedings in 22 percent of the cases initially filed.*fn3

In terms of appellate cases, although we do not have exact figures either nationally or on a local level, it appears as though, even after the apparently rigorous district court screening, the courts of appeals reverse district court judgments in favor of the Secretary approximately one quarter of the time. See 1983 Annual Report of the Director of the Administrative Office of the United States Courts 224 (Table B-1A). This figure is apparently on the rise, for since the beginning of the year, the reversal rate by the Third Circuit has been about fifty percent. These figures showing the resolution of cases presented to the district court probably overestimate the number of times that the Secretary has substantial evidence to support her position, for our figures of course cannot take into account the number of claimants who cannot ask for judicial review of the Secretary's determination or take an appeal from an adverse district court judgment because their financial resources have been exhausted by the lengthy and expensive process of seeking benefits. Neither are statistics available to measure the delays between initial application and final disposition, but our judicial perspective tell us that they are often considerable.

It is not our province to say whether the delays and injustices reflected in these statistics are the consequence of judicial persnicketiness, of an executive branch attempting to reduce governmental expenditures, or of other factors. It does seem clear, however, that the system is not working to anyone's advantage and cries out for Congressional attention.*fn4 We now turn to the case before us, which, in our opinion, provides a more human illustration of the problems reflected in the statistics and which also presents important questions concerning analysis of children's impairments in combination and the power of the administrative law judge to make unexplained credibility determinations.

II. PROCEDURAL HISTORY

John Wier applied through his mother Janet for SSI disability benefits on August 10, 1978. Administrative levels of the Social Security Administration denied his claim. John requested a hearing, which was held nine months after benefits had been requested. The Administrative Law Judge (ALJ) decided two months later that John was not disabled under the applicable statutes and regulations. On August 31, 1979, a year after John first requested benefits, the Appeals Council of the Social Security Administration denied review.

John then petitioned the United States District Court for the Western District of Pennsylvania to review the determination of the Secretary that he was not entitled to SSI benefits.The court referred cross motions for summary judgment to a magistrate for a recommendation. After an initial examination of the evidence before the Secretary, the magistrate recommended that the Secretary's decision be affirmed. The magistrate issued this recommendation, however, without benefit of briefing from the appellant, whose counsel at the time had been delinquent in his submissions. On April 24, 1980, upon receipt of briefs from appellant's attorney, and reports detailing the results of additional psychological evaluations, the magistrate revised his opinion. In his Supplemental Report and Recommendation he wrote:

Both additional reports contain evaluations of the plaintiff which indicate that although his I.Q. exceeds the maximum requirement [sic] for a finding of disability. . . . [T]here appears to be overriding considerations which indicate that the plaintiff is functioning considerably below the low level upon which one would expect him to function as a result of his test scores. Thus there may be a severe overlay or interacting of factors which when combined with his limited intelligence would warrant a finding of disability.

The magistrate thus recommended a remand for consideration of this new evidence submitted by appellant. The district court followed the magistrate's recommendation and on May 15, 1980, remanded the case to the Social Security Administration.

Given the rather simple directive of the magistrate, and given the obvious need for haste if John was to be benefitted by disability payments while still a child, one might think the Social Security Administration would have resolved the remanded matter in several weeks or months. Alas. It took the Administration's Appeals Council two months to determine that, in light of the district court's disposition, further fact finding was needed.After another four months, in Decemb3er 1980, a hearing was held before an administrative law judge to examine the new evidence, which consisted of testimony from several witnesses and three medical reports. In January 1981, the administrative law judge issued a recommended decision. Five months later, in May 1981, the Appeals Council discovered that the testimony offered at the hearing held in December 1980, had not been properly recorded. The Appeals Council thus remanded the case back to the administrative law judge for proceedings "consistent with the Order of the District ...


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