Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alsd-2_14-cv-00303/USCOURTS-alsd-2_14-cv-00303-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

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IN THE UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF ALABAMA

NORTHERN DIVISION

RICHARD EVANS, :

 :

Plaintiff, :

 :

vs. :

 : CIVIL ACTION 14-0303-M

CAROLYN W. COLVIN, :

Social Security Commissioner, :

 :

Defendant. :

MEMORANDUM OPINION AND ORDER

In this action under 42 U.S.C. § 405(g), Plaintiff seeks 

judicial review of an adverse social security ruling which 

denied a claim for disability insurance benefits (Docs. 1, 12). 

The parties filed written consent and this action has been 

referred to the undersigned Magistrate Judge to conduct all 

proceedings and order the entry of judgment in accordance with 

28 U.S.C. § 636(c) and Fed.R.Civ.P. 73 (see Doc. 20). Oral 

argument was waived in this action (Doc. 19). After considering 

the administrative record and the memoranda of the parties, it 

is ORDERED that the decision of the Commissioner be REVERSED and 

that this action be REMANDED for further proceedings not 

inconsistent with the Orders of the Court.

This Court is not free to reweigh the evidence or 

substitute its judgment for that of the Secretary of Health and 

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Human Services, Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th

Cir. 1983), which must be supported by substantial evidence. 

Richardson v. Perales, 402 U.S. 389, 401 (1971). The 

substantial evidence test requires “that the decision under 

review be supported by evidence sufficient to justify a 

reasoning mind in accepting it; it is more than a scintilla, but 

less than a preponderance.” Brady v. Heckler, 724 F.2d 914, 918 

(11th Cir. 1984), quoting Jones v. Schweiker, 551 F.Supp. 205 (D. 

Md. 1982).

At the time of the administrative hearing, Plaintiff was 

thirty years old, had received a certificate that he had 

attended high school (Tr. 37), and had previous work experience 

as a tire changer, oil changer, and furniture mover (Tr. 45). 

In claiming benefits, Evans alleges disability due to mild 

mental retardation and cervical and lumbar degenerative disc 

disease (Doc. 11). It should be noted that Evans “has already 

been found eligible for Supplemental Security Income benefits 

(“SSI”), pursuant to Title XVI of the Act (Tr. 97-98)” (Doc. 15, 

n.3). 

The Plaintiff applied for disability benefits on January 

27, 2010, alleging an onset date of October 30, 2009 (Tr. 207-

08). An Administrative Law Judge (hereinafter ALJ) denied

benefits (Tr. 81-91); however, the Appeals Council remanded the 

action back for two determinations: (1) whether Evans’s

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earnings from 2004 through 2009 were substantial gainful 

activity (hereinafter SGA); and (2) if yes, were the 

Supplemental Security Income (hereinafter SSI) payments Evans 

had received inappropriately paid (Tr. 97-98).

On remand, the ALJ determined that Evans had engaged in SGA 

since October 30, 2009, his alleged disability onset date, as 

the work performed “involved significant physical or mental 

activities, and [] the claimant did this work in anticipation of 

pay or profit” (Tr. 12). The ALJ then held that this finding 

precluded using the doctrine of collateral estoppel. The ALJ 

further held that Evans did not meet the requirements of any 

Listing and could not return to his past relevant work but could 

perform medium exertion jobs (Tr. 10-25). Plaintiff requested 

review of the hearing decision (Tr. 190-93) by the Appeals 

Council, but it was denied (Tr. 1-5). The relevant evidence of

record follows.

Plaintiff claims that the opinion of the ALJ is not 

supported by substantial evidence. Specifically, Evans alleges 

that: (1) The ALJ failed to apply the doctrine of collateral 

estoppel in reaching his determination; and (2) Plaintiff is

mentally retarded, meeting the requirements of Listing 12.05C 

(Doc. 12). Defendant has responded to—and denies—these claims 

(Doc. 15).

The Court notes that Plaintiff, in his brief, has made the 

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following argument regarding his first claim. As it has gone, 

essentially, unanswered by Respondent (Doc. 15, pp. 10-11), the 

Court will set it out herein in its entirety:

1. The ALJ erred in failing to properly 

apply the doctrine of collateral estoppel, 

which requires him to adopt the findings of 

the Title XVI claim in connection with the 

Title II claim.

Mr. Evans applied for SSI benefits in 

1993, which were approved under the 

childhood SSI rules. In 1998, his claim was 

reviewed and deemed ceased under the adult 

SSI rules. On February 18, 1999, ALJ Calvin 

Washington issued a Fully Favorable Decision 

finding his disability had not ceased and he 

continued to be disabled based on the severe 

impairment of mild mental retardation. None 

of the SSI determinations are included in 

the record before the Court.

Mr. Evans filed the current application 

on January 27, 2010. (Tr. 207-08). At the 

hearing [before] the ALJ on June 15, 2011, 

the ALJ took testimony regarding the SSI 

claim, confirming Mr. Evans had collected 

SSI while he was in school, the SSI was 

stopped while he worked, and the SSI 

benefits resumed after he stopped working.

(Tr. 56). At the hearing on September 25, 

2012, Mr. Evans testified he had repaid an 

overpayment on his SSI record and his SSI 

benefits had been reinstated to the full 

amount. (Tr. 34-35). 

When remanding the claim after the 

ALJ’s first denial, the Appeals Council 

raised the likelihood that collateral 

estopped would apply to this case, based on 

the prior SSI decision.

The Hearing, Appeals and Litigation Law 

Manual (HALLEX) and the Social Security 

Regulations address the doctrine of 

collateral estoppel. “When an [ALJ] has for 

decision an issue which has already been 

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decided in a previous determination or 

decision in a claim involving the same 

claimant, but arising under a different 

title of the Social Security Act, the ALJ 

will not consider the issue again. In this 

situation, the ALJ will apply the doctrine 

of collateral estoppel and accept the 

factual finding made in the previous 

determination or decision, and a statement 

that such finding is binding in the current 

claim.” (HALLEX I-2-2-30, citing 20 C.F.R. 

§ 404.950(f)).

The SSA’s Program Operations Manual 

System (POMS) indicates collateral estoppel 

applies as long as the rules for determining 

disability have not changed; and there is no 

reason to question the correctness of the 

prior determination. (POMS DI 27515.001).

In fact, the ALJ did not apply the 

doctrine of collateral estoppel, even though 

the Appeals Council suggested it might apply 

to this case. He reviewed the earnings 

records to determine Mr. Evans had engaged 

in substantial gainful activity (SGA) during 

the years 2004 through 2009. He then 

concluded, “The undersigned finds that based 

on the fact that the claimant has engaged in 

substantial gainful activity, the doctrine 

of collateral estoppels does not apply.” 

(Tr. 14). The ALJ provided no basis for his 

opinion that engaging in SGA precluded the 

application of collateral estoppel. The 

regulations likewise do not address SGA in 

relation to collateral estoppel.

The final SSI decision in this case is 

the 1999 determination that Mr. Evans 

continued to be disabled. Fifteen years 

have passed since that determination. The 

social security regulations allow a SSI 

application to be reopened more than four 

years later only for fraud or similar fault. 

POMS DI 27505.001(A)(4)(c). There is no 

allegation or evidence of fraud in this 

case.

During the fifteen years since the 

final SSI determination, Mr. Evans engaged 

in work activity that resulted in an 

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overpayment of his SSI benefits, and his SSI 

benefits were reinstated when he stopped 

working. (Tr. 34, 56). Clearly he remains 

eligible for SSI benefits. As the 

disability rules for SSI and social security 

disability are the same, medical eligibility 

for one Title should result in medical 

eligibility for the other Title. This is 

the purpose of collateral estoppel. 

“Collateral estoppel, like the related 

doctrine of res judicata, has the dual 

purpose of protecting litigants from the 

burden of relitigating an identical issue 

with the same party or his privy and of 

promoting judicial economy by preventing 

needless litigation.” Parklane Hosiery Co., 

Inc. v. Shore, 439 U.S. 322[, 326] (1979).

The only possible reason an ALJ would 

be allowed to consider the same issue would 

be if there are reasons to believe the prior 

decision was incorrect. However, the ALJ 

made no such assertion. He completely 

ignored the prior determinations and thereby 

neglected to justify his failure to apply 

collateral estoppel.

Case law supports the doctrine, finding 

that work activity can interrupt periods of 

eligibility without ending eligibility. A 

claimant whose impairment meets a listing is 

disabled regardless of the fact that he or 

she worked in the past with the impairments 

or could return to his or her past work. 

Ambers v. Heckler, 736 F.2d 1467, 1469-70 

(11th Cir. 1984). In Ambers, the court found 

that a mentally retarded claimant who was 

gainfully employed in the past is disabled 

upon the cessation of employment. Id. at 

1469; see also Powell ex rel. Powell v. 

Heckler, 773 F.2d 1572, 1576-77 (11th Cir. 

1985) (finding that a claimant with a longstanding mental illness was eligible for 

disability benefits for those periods from 

1978 to 1982 during which his income was 

below that sufficient to constitute 

substantial gainful activity.).

In Vaughn v. Astrue, 494 F.Supp.2d 1269 

(N.D. Ala. 2007), the court faulted the 

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ALJ’s decision which apparently relied on 

the claimant’s ability to perform her past 

jobs even though she satisfied the 

requirements of Listing 12.05C. Id. at 

1274. The court concluded that the ALJ 

misapplied the law because once the claimant 

is “found to suffer from a Listed 

impairment, vocational factors are 

irrelevant.” Id.

The ALJ erred in failing to apply the 

doctrine of collateral estoppel in this 

matter. He should have developed the 

evidence by obtaining the prior SSI

determination to determine which issues were 

not to be re-adjudicated. He then should 

have limited his determination to other 

issues. This case is due to be remanded for 

proper application of collateral estoppel.

(Doc. 12, pp. 2-4). In Response, the Government asserts that 

the ALJ did implicitly what he was instructed to do explicitly, 

viz., find that the earlier determination of mental retardation 

under Listing 12.05C was wrong (Doc. 15, pp. 10-11). 

The Court finds the Government’s response an acknowledgment 

that the ALJ has not done the job he was instructed to do. The 

law presented by Plaintiff shows that his mental retardation was 

established in the granting of SSI benefits. The Title II and 

Title XVI Listing requirements are the same and have not 

changed. The ALJ must either uphold the original finding and 

proceed with those findings or show cause why they are to be set 

aside and advance from that point. The ALJ, in this most recent 

determination, has done neither. 

The Court would further note that Plaintiff’s second 

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argument, that he meets the requirements of Listing 12.05C, 

needs revisiting as well, should resolution of the first issue 

not satisfy the question of disability. The ALJ’s reliance on 

the results of an outdated test with less than full data 

presented represents, in this Court’s mind, something less than 

substantial evidence.

Based on review of the entire record, the Court finds that 

the Commissioner's decision is not supported by substantial evidence. Therefore, it is ORDERED that the action be REVERSED and 

REMANDED to the Social Security Administration for further 

administrative proceedings consistent with this opinion, to 

include, at a minimum, a supplemental hearing for the gathering 

of evidence regarding Plaintiff’s past SSI finding of 

disability. Judgment will be entered by separate Order.

DONE this 12th day of March, 2015.

s/BERT W. MILLING, JR. 

UNITED STATES MAGISTRATE JUDGE

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