Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ared-4_23-cv-00777/USCOURTS-ared-4_23-cv-00777-2/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:0405 Review of HHS Decision

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IN THE UNITED STATES DISTRICT COURT 

EASTERN DISTRICT OF ARKANSAS 

CENTRAL DIVISION 

CLARA C. GAITHER PLAINTIFF 

v. NO. 4:23-cv-00777-DPM-PSH 

MARTIN O’MALLEY, Commissioner DEFENDANT 

of the Social Security Administration 

FINDINGS AND RECOMMENDATION 

INSTRUCTIONS 

The following proposed Findings and Recommendation have been 

sent to United States District Judge D.P. Marshall Jr. You may file written 

objections to all or part of this Recommendation. If you do so, those 

objections must: (1) specifically explain the factual and/or legal basis for 

your objection, and (2) be received by the Clerk of this Court within 

fourteen (14) days of this Recommendation. By not objecting, you may 

waive the right to appeal questions of fact. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 1 of 24
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DISPOSITION 

In this case, plaintiff Clara C. Gaither (“Gaither”) challenges whether 

she actually applied for retirement benefits on September 1, 2020, and, 

alternatively, challenges the denial of her request for retroactive 

retirement benefits. She also challenges the cancellation of her dental 

coverage with Delta Dental. 

The undersigned previously issued a memorandum opinion and order, 

and entered judgment, in this case, believing Gaither to have consented 

to the jurisdiction of a United States Magistrate Judge. The undersigned 

now knows otherwise, as this case has been remanded by the Court of 

Appeals for “further action by an Article III judge.” See Docket Entry 31. 

The case has been referred to the undersigned to reconsider all of the 

issues. The undersigned has done so, giving particular attention to the 

assertions contained in Gaither’s notice of appeal. Having reviewed the 

entire record, the undersigned recommends that the decision of the 

Administrative Law Judge (“ALJ”) be affirmed, as it is supported by 

substantial evidence on the record as a whole and no legal error occurred.1

1 The questions in this case are whether the ALJ’s findings are supported by 

substantial evidence on the record as a whole and whether legal error occurred. See 

Sloan v. Saul, 933 F.3d 946 (8th Cir. 2019). 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 2 of 24
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The record reflects that in 2012, or when Gaither was fifty-five years 

old, she began receiving supplemental security income payments.2 The 

amount of the payments was approximately $800.00 a month. 

On September 1, 2020, Gaither had a telephone conversation with 

James Jones (“Jones”), a Social Security Administration Claims Specialist.3

Gaither understood the purpose of the conversation to be a “recertification,” or a review of her continued entitlement to supplement 

security income payments. See Docket Entry 16 at CM/ECF 33.4 Gaither did 

not understand the purpose of the conversation to be her entitlement to, 

or request for, retirement benefits, and she is adamant that she did not 

intend to apply for retirement benefits at that time. 

2 Gaither appears to have been awarded the payments in 2012, see Docket Entry 

16 at CM/ECF 47, but did not begin receiving them until 2013, see Docket Entry 16 at 

CM/ECF 32. 

3 Gaither identifies the specialist as “James Jones,” see Docket Entry 2 at CM/ECF 

4, although Gaither occasionally refers to him as “Mr. James,” see Docket Entry 16 at 

CM/ECF 25. The Commissioner of the Social Security Administration represents that the 

name of the specialist is actually “Mr. James.” See Docket Entry 22 at CM/ECF 4. 

Because the undersigned will quote liberally from Gaither’s pleadings and desires to 

maintain some consistency with her pleadings, the undersigned will refer to the Claims 

Specialist as “Jones.”

4 The Commissioner of the Social Security Administration represents that a “recertification” is a “non-medical determination under 20 C.F.R. 416.204(a).” See Docket 

Entry 22 at CM/ECF 4. 20 C.F.R. 416.204(a) provides, in part, that a “re-determination” 

is a “review of [the claimant’s] eligibility to make sure that [she is] still eligible and 

that [she is] receiving the right amount of [supplemental security income] benefits. ...”

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 3 of 24
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On the heels of the September 1, 2020, conversation, an Application 

Summary for Retirement Insurance Benefits (“Summary”) was prepared by 

the Social Security Administration. The Summary was sent to Gaither and 

contained several representations relevant to this case. First, the Summary 

confirmed that she had applied for “social security benefits” and was 

applying for “all insurance benefits for which [she is] eligible under Title II 

(federal old-age, survivors, and disability insurance) and Part A of Title 

XVIII (health insurance for the aged and disabled) of the Social Security Act 

...” See Docket Entry 16 at CM/ECF 102. Second, the Summary provided 

that Gaither wanted the benefits to begin “with the earliest possible month 

based on [her] earnings. See Docket Entry 16 at CM/ECF 103. Last, the 

Summary provided that she was to notify the Social Security Administration 

within ten days of receiving the Summary if she disagreed with any 

representation contained in it. 

In a letter dated September 15, 2020, the Mid-America Program 

Service Center (“Service Center”) notified Gaither that she is entitled to 

“monthly retirement benefits” beginning in September 2020, and the 

monthly benefit would be approximately $1,000. See Docket Entry 16 at 

CM/ECF 52. She was also notified that the benefits were the only benefits 

she could receive from the Social Security Administration at that time. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 4 of 24
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The Service Center subsequently notified Gaither of a slight increase 

in her monthly retirement benefit. In the notice, she was also informed 

that “[t]he State of Arkansas [would] no longer pay [her] Medicare Part B 

(medical insurance) premiums after October [of] 2020,” see Docket Entry 

16 at CM/ECF 60, and it would be necessary for her to pay the premiums 

beginning in November of 2020. 

Gaither asked the Service Center to reconsideration its decision. See 

Docket Entry 16 at CM/ECF 56-57, 59. The Service Center understood her 

request for reconsideration to involve the timing of her entitlement to 

retirement benefits and denied her request for the following reason: 

On September 2020, you applied for retirement benefits from 

Social Security and on about September 15, 2020, you were told 

that your entitlement had started with September 2020. On 

October 20, 2020, you asked for reconsideration because you 

believe that your entitlement to retirement benefits should 

have started earlier because you were not aware that you were 

eligible for retirement benefits at an earlier time. 

... 

Since you were under full retirement age at the time you filed 

your application, your initial month of entitlement to 

retirement benefits can be no earlier than September 2020, the 

month in which you filed your application. 

See Docket Entry 16 at CM/ECF 63. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 5 of 24
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Gaither then requested a hearing before an ALJ. She requested the 

hearing for the following reason: 

[The] Social Security Administration contacted me [in] 

September 2020 and informed me that as of 1-22-20, the only 

benefits I’m entitled to receive from social security are social 

security retirement benefits, yet declined to pay me the social 

security retirement benefits I’m entitled [to] beginning from 1-

22-20. 

See Docket Entry 16 at CM/ECF 67.5

 The ALJ subsequently conducted a hearing. See Docket Entry 16 at 

CM/ECF 29-40. The ALJ began the hearing by observing that the issue was 

“whether [Gaither is] entitled to an earlier onset of her retirement 

benefits.” See Docket Entry 16 at CM/ECF 29-30. The ALJ asked Gaither 

why she believed she had been wronged, and she testified as follows: 

A. ... I didn’t actually apply for the retirement benefits. 

It was someone at Social Security, the Social Security 

Administration that submit, submitted all the -- what it was 

necessary for me to transfer my benefits from Social Security 

Disability to Social Security Retirement and, but they -- when 

they did that, they started it in October of 2020, rather than 

starting it when I was eligible for it in January 22, 2019. 

Q. Okay. So, what happened? 

5 It is likely that her reason for requesting a hearing contains a typographical error. 

The phrase “yet declined to pay me the social security retirement benefits I’m entitled 

[to] beginning from 1-22-20,” see Docket Entry 16 at CM/ECF 67, might be better 

understood to mean beginning from 1-22-19, i.e., her sixty-second birthday. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 6 of 24
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A. -- there was a – 

Q. Just let me explain too. What typically happens is 

when you’re getting disability benefits at age 65, they start 

drawing the, the benefits from the retirement fund instead of 

the disability trust fund. So, there, there should be no 

reduction in benefits. It’s just transferred to a different pot of 

money because of your age. 

A. I did it, I did it -- I was 62. 

Q. Okay. So, you were sixty-two, two years old when this 

transfer was done? 

A. Well, that’s when I was told that I was eligible for it, 

to get done, but that I, that I didn’t initiate the application for 

it to get done when I was eligible for this age 62 because I was 

have doctor’s appointments and I didn’t want to disrupt my -- I 

had a feeling that it was gonna have effect on my insurance if I 

did that, so I didn’t do that just ‘cause I had appointments 

coming up. And, of course, someone this gentlemen by the 

name of Mr. James, at Social Security. He called me on the 

phone, and I thought he was doing just a re-certification. I was 

actually in Ohio on a family emergency trip when I was 

answering all the questions because he was doing -- he actually 

transferred my benefits from Social Security Disability to Social 

Security Retirement, supplemental retirement, I think it was. 

And then sure enough, when I went to the, Dr. Shepherd, I seen 

his dental work on one of my cousins I had, and when I got there 

my dental -- because that was changed he wouldn’t, he 

wouldn’t accept the dental that -- I no longer had the type of 

insurance that he accepted once they did that change and I, I 

filed a complaint for unfair treatment. Because they was gonna 

take the initiative upon themselves to transfer my benefits 

from Social Security Disability to Social Security Retirement 

supplement -- why wasn’t it, why wasn’t it done when I was 

actually eligible for it? And that’s why I filed the unfair 

treatment. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 7 of 24
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Q. What did you have before, Medicaid or Medicare? 

A. I had Medicaid and Medicare, but I had -- Medicaid was 

allowing me to have this Delta Dental. And then once it was 

transferred over to the Social Security Supplemental 

Retirement they would no longer -- that discontinued my Delta 

Dental so that I didn’t have the option to go to Dr. -- I actually 

went to Dr. Shepherd, and they had ran it and found it out the 

coverage that I no longer had Delta Dental so I could -- they 

could not see me because they did not accept my, my insurance 

then. 

Q. Do you have any dental coverage right now? 

A. I’ve got dental coverage, yes. 

Q. It’s just not Delta Dental. 

A. It’s not Delta Dental and the -- it’s, it’s very hard, it’s 

been very hard to find a good dentist down from -- in Arkansas 

and once I started dental work I -- my [INAUDIBLE] I, and I found 

out that he accepted my dental which I had to travel from Little 

Rock to Pine Bluff to get them and then that, that was one of 

my -- that’s one of my biggest complaints right there. That is 

the number one complaint. 

Q. Yeah, you have two of them it looks like. One is that 

you should have got transferred earlier to the retirement fund 

and then the second is once you were retired, re-transferred 

that you shouldn’t have not lost your dental. Correct? 

A. Yes, that’s right. Well, that’s the way it goes -- once 

he transferred me -- 

Q. -- I, I understand. I’m just trying to clarify that you 

have really two issues before me. You’re complaining about two 

things, correct? 

A. Yes, sir. That is, that is correct, sir. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 8 of 24
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Q. All right. So, basically, they, they moved you over to 

the retirement fund in September of 2020. You’re saying it 

should have happened earlier -- 

 

A. -- yes -- 

Q. -- in January 2019. How did you come up with January 

2019? Is that when you were 62? 

A. That’s when, that’s when -- I said -- yeah, yeah. That 

was when I became eligible to be transferred over to that. 

Q. Okay, but how were you harmed by them doing it in 

2020 as opposed to 2019? Did – you didn’t have a reduction in 

benefits. So, other than losing your dental insurance were you 

harmed in any other way? 

A. I mean I would have had more benefits if, if they had 

did it, or, if, if, it is a reduction of benefits. But I didn’t, wasn’t 

allowed to get the benefits that I was entitled to if I was 

entitled to get them in January of 2019. 

Q. Okay. How much were you getting in per month before 

they change you over to the retirement fund? What was your 

monthly benefit amount? 

A. Geez, I think it was like eight hundred and something 

dollars. I, I would have to look it up, but it was, it was, it was, 

it was in the eight hundred -- I’m thinking like eight hundred 

and eighty something dollars. 

Q. Okay. So, you were getting $880.00 -- 

A. -- [INAUDIBLE] -- 

Q. -- prior to the transfer. 

A. Right. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 9 of 24
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Q. And then after the transfer you started getting 

$1.014.00 a month? 

A. I think so. Then the $1,014 went up to one thousand, 

yeah, $1,014.00. 

Q. Okay. So, you didn’t, you didn’t have a reduction in 

benefits, you actually had an increase in benefits of about two 

hundred bucks per month. 

A. Yeah, yeah, right. [INAUDIBLE]. 

Q. Okay. So, you’re – what you’re saying is if they had 

done it when you first turned 62, January of ’19, you would 

have had three more years of -- or however more years -- it’s 

not really three years. 

A. No. 

Q. Let’s see, one nineteen to twenty -- all right. So, about 

a year and eight months. Or about -- 

A. -- [INAUDIBLE] -- 

Q. Is that what you’re saying? 

A. That is correct, sir. 

Q. Okay. All right. Okay. So, you were $1,014.00 back in, 

effective in September of ’20. What, what are you getting right 

now? What do you get every month now? 

A. $1,088.00 a month. 

Q. Okay and do you have Medicare? 

A. I do have Medicare and Medicaid? 

Q. Okay. So, you still have both. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 10 of 24
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A. Yes. 

Q. Okay, and did you see if they could put you back on 

Delta or did they say you couldn’t get that anymore? 

A. They said I couldn’t get that anymore. 

See Docket Entry 16 at CM/ECF 32-37. 

 The ALJ thereafter issued a written decision in which he addressed 

two issues: first, “whether [Gaither] is entitled to the difference in her 

monthly benefits that she did not begin to receive until October 2020,” and 

second, “whether [she] is entitled to receive Medicare coverage for her 

dental coverage when the provider converts benefits.” See Docket Entry 

16 at CM/ECF 45. With respect to the first issue, the ALJ found that Gaither 

turned sixty-two on January 22, 2019, and could have applied for reduced 

retirement benefits at that time. Gaither, though, did not apply at that 

time. It was not until September 1, 2020, that she was deemed to have 

applied for retirement benefits. The ALJ found that Gaither is not entitled 

to retroactive retirement benefits for the twenty month period between 

January 22, 2019, and September 1, 2020. He so found because she was 

not deemed to have filed for benefits until September 1, 2020, and she was 

not mis-informed about her right to file an earlier application. With respect 

to the second issue, the ALJ found the following: 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 11 of 24
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As for [Gaither’s] right to Medicare coverage, there is nothing 

in the Social Security Act that requires a provider to continue 

coverage if the Medicare state program chooses to convert 

coverage. [Gaither] is not entitled to continued coverage under 

her former Medicare Part B provider. 

See Docket Entry 16 at CM/ECF 48. 

 Gaither appealed to the Appeals Council. She maintained that she did 

not intend to apply for retirement benefits on September 1, 2020. Gaither 

also sought a recording of her conversation with Jones to prove that Gaither 

did not intend to apply for such benefits. The Appeals Council found no 

reason to reverse the ALJ’s decision and denied Gaither’s appeal. 

 Gaither thereafter began this case by filing a pro se complaint 

pursuant to 42 U.S.C. 405(g). In the complaint, she alleged the following: 

September 2020, I received a call from Social Security 

Administration Representative, Mr. James Jones. Unknowingly, 

at the time, Mr. Jones was initiating the process to start my 

Social Security Supplement Retirement benefits. [The] Social 

Security Administration [has] continuously decline[d] to pay my 

full retirement benefits beginning from the time of eligibility, 

January 22, 2019. 

See Docket Entry 2 at CM/ECF 4. She asked that she be awarded $5,072.00 

in retroactive social security benefits and punitive damages in an equal 

amount. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 12 of 24
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The Commissioner of the Social Security Administration 

(“Commissioner”) filed the transcript, or record, of the administrative 

proceedings. Gaither was directed to file a brief in which she explained 

why the ALJ’s decision is not supported by substantial evidence on the 

record as a whole. 

Gaither then filed a brief outlining her position in this case. In the 

brief, she represented, in part, the following: 

This case [arose] when ... Jones contacted the Plaintiff 

... on ... September 1, 2020, asking the Plaintiff to verify 

personal information in her Social Security Disability File. 

The Defendant[’s] nine page Court Transcript, exhibit 

B1D, ... falsely claims that the Plaintiff ... applied for her Social 

Security Disability to be transferred to Social Security Early 

Retirement. 

... 

The Plaintiff’s exhibit A1 ... documents ... the fax and 

successful fax transmission sent to the [A]ppeals Council ... [on] 

October 25, 2022, [and] demonstrates the Plaintiff’s effort to 

obtain the substantial evidence of the recorded call ... Jones 

placed to the Plaintiff on/about September 1, 2020. 

... Jones and the Plaintiff[’s] ... recorded conversation is 

substantial evidence in this matter. 

There’s no indication that the ALJ’s unfavorable decision 

was based on taking the substantial evidence of the recorded 

conversations of ... Jones and the Plaintiff ... into account. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 13 of 24
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Defendant’s Court Transcript Index, page 23, under the 

ISSUES segment states that the Plaintiff applied for retirement 

benefits, is absolutely not a fact and is not true. All the facts 

regarding this case/complaint cannot be reviewed, if all the 

facts, including the recorded conversations, aren’t presented. 

There is no paper trail of Plaintiff completing, signing and 

submitting an application applying for Early Social Security 

Retirement to replace her Social Security Disability benefits, at 

the time. 

The defendant Social Security Administration is/was in 

possession of the substantial evidence. The ... conversations of 

... Jones and [t]he Plaintiff ... recorded for September 1, 2020, 

... and October 24, 2022, ... [were] not found in the 

Defendant[’s] Transcript filed in this case. 

See Docket Entry 18 at CM/ECF 1-2. 

 The Commissioner, in response, construed Gaither’s brief to allege 

“two seemingly inconsistent positions.” See Docket Entry 22 at CM/ECF 8. 

First, the Commissioner understood Gaither to allege that she did not 

intend to file an application for retirement benefits on September 1, 2020. 

Second, the Commissioner understood Gaither to also allege that she 

should be awarded retroactive retirement benefits for the twenty month 

period between January 22, 2019, and September 1, 2020. The 

Commissioner alleged that under either construction, Gaither is not 

entitled to relief. With respect to Gaither’s claim for continued Medicare 

dental coverage, the Commissioner noted the following in a footnote: 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 14 of 24
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... Gaither presented a concern to the ALJ about the 

effects of her entitlement to retirement insurance benefits on 

her dental insurance soon after that entitlement. ..., but does 

not renew that concern before this Court. She has waived any 

such claim. In any event, even assuming there was a connection 

between ... Gaither’s entitled to retirement insurance benefits 

and the loss of Delta Dental insurance, it is unclear how any 

injury-in-fact would be redressable by a judgment against the 

Commissioner. Nothing the Commissioner could do would allow 

... Gaither to receive treatment from her preferred dentist in 

2020 and 2021. Beyond that, Medicare beneficiaries are allowed 

to enroll in a new plan each year during open enrollment. ... 

Therefore, it is unclear how ... Gaither’s current Medicare plan 

enrollment is fairly traceable to any alleged injury-in-fact. 

See Docket Entry 22 at CM/ECF 12, n.3 (emphasis in original). 

 The undersigned’s review function is “extremely limited.” See Simuel 

v. Apfel, 21 F.Supp.2d 941, 942 (E.D. Ark. 1998). It is limited to reviewing 

the administrative record to determine if the ALJ’s decision is supported 

by substantial evidence on the record as a whole and whether legal error 

occurred. The undersigned does not try the case de novo, does not 

substitute its judgment for that of the administrative finder of fact, and, 

save some compelling reason for considering additional evidence, does not 

consider additional evidence. See Id. See also Nelson v. Sullivan, 966 F.2d 

363 (8th Cir. 1992) (if Appeals Council does not consider additional 

evidence, reviewing court may remand case to Appeal Council if additional 

evidence is new and material). 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 15 of 24
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The undersigned has reviewed the parties’ pleadings and exhibits. 

The undersigned has also reviewed the administrative record in this case, 

the Commissioner’s summation of the admittedly complex and involved 

regulations governing the case, and Gaither’s notice of appeal. On the basis 

of that review, the undersigned finds that substantial evidence on the 

record as a whole supports the ALJ’s findings, and no legal error occurred. 

The undersigned so finds for the reasons that follow. 

Gaither first maintains that she did not intend to apply for retirement 

benefits on September 1, 2020, the date on which she was deemed to have 

applied for them. In an attempt to support the assertion, Gaither asked 

the Appeals Council, and has now asked the undersigned, to obtain a 

recording of her conversation with Jones. 

Throughout the administrative process, Gaither maintained that she 

is entitled to retroactive retirement benefits for the period from January 

22, 2019, to September 1, 2020. She did so in asking the Service Center to 

reconsider its decision to award her retirement benefits effective 

September 1, 2020; in requesting a hearing before the ALJ; and in the 

hearing before the ALJ. In fact, during the hearing, Gaither agreed that 

the two issues for the ALJ’s consideration were as follows: “[o]ne is that 

[Gaither] should have got[ten] transferred earlier to the retirement fund 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 16 of 24
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and then the second is once [she was] retired, re-transferred that [she] 

shouldn’t have not lost [her] dental.” See Docket Entry 16 at CM/ECF 35. 

It was not until Gaither asked the Appeals Council to review the ALJ’s 

decision that Gaither, for the first time, alleged she did not intend to apply 

for retirement benefits on September 1, 2020. Given those facts, the 

undersigned is hesitant to consider an issue Gaither did not fully and fairly 

raise in the administrative process and the ALJ did not specifically address 

in his decision. 

Notwithstanding the foregoing, and because the Commissioner 

addressed the assertion that Gaither did not intend to apply for retirement 

benefits on September 1, 2020, the undersigned will address the assertion. 

The undersigned begins by noting Gaither’s requests for a recording of her 

conversation with Jones. Gaither maintains that a recording will show that 

she did not intend to apply for retirement benefits at that time, and legal 

error occurred when the recording was not obtained. 

The undersigned has no idea if a recording of Gaither’s conversation 

with Jones exists, and, if a recording does exist, how it might be obtained. 

In the absence of such a recording, the undersigned simply assumes that a 

recording would show Gaither did not intend to apply for retirement 

benefits on September 1, 2020. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 17 of 24
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Assuming Gaither did not intend to apply for retirement benefits on 

September 1, 2020, the Social Security Administration could nevertheless 

reasonably conclude that she did, in fact, apply for such benefits. The 

undersigned so finds for three reasons. 

First, on the heels of Gaither’s conversation with Jones, Gaither was 

sent a Summary reflecting the Social Security Administration’s 

understanding of their conversation. In the Summary, Gaither was deemed 

to have applied for “all insurance benefits for which [she is] eligible under 

Title II (federal old-age, survivors, and disability insurance) and Part A of 

Title XVIII (health insurance for the aged and disabled) of the Social 

Security Act ...” See Docket Entry 16 at CM/ECF 102. She was also deemed 

to want the benefits to begin with the earliest possible month based on her 

earnings. She was cautioned that she was to notify the Social Security 

Administration within ten days of receiving the Summary if she disagreed 

with any representation contained in it. Sadly, Gaither did not notify the 

Social Security Administration at any time, let alone within ten days of 

receiving the Summary, that the Summary was not correct, and she did not 

intend to apply for retirement benefits at that time. Her failure to do so, 

and her failure to raise the assertion until the last stage of the 

administrative process, brought her to this point. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 18 of 24
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Second, the Service Center sent Gaither a letter in which she was 

notified that she is entitled to “monthly retirement benefits” beginning in 

September of 2020, and the benefits were the only benefits she could 

receive at that time. See Docket Entry 16 at CM/ECF 52. She was notified 

of her appeal rights, which she exercised. In her appeal, though, she never 

alleged that she did not intend to apply for retirement benefits on 

September 1, 2020. She instead alleged that she is entitled to retirement 

benefits effective January 22, 2019, i.e., her sixty-second birthday. 

Third, when Gaither appeared before the ALJ, the ALJ began the 

hearing by framing the issue before him as being whether Gaither is 

entitled to an earlier onset of her retirement benefits. As the hearing 

progressed, the ALJ learned of a second issue, i.e., whether Gaither is 

entitled to continued Medicare dental coverage. He addressed both issues 

in his decision. As a part of addressing the first issue, he accepted as given 

that Gaither applied for retirement benefits effective September 1, 2020. 

Gaither at no point disabused the ALJ of his view of the issues. 

Gaither notes that there is “no paper trail of [her] completing, 

signing and submitting an application” for retirement benefits. See Docket 

Entry 18 at CM/ECF 2. Although Gaither is correct in that she did not 

actually complete, sign, and submit an application, she was deemed to 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 19 of 24
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have done so during her conversation with Jones. As to whether a mere 

telephone conversation can set an application in motion, and as to whether 

Gaither’s conversation with Jones did so in this instance, the undersigned 

adopts the following excerpt from the Commissioner’s brief: 

... the agency documents an applicant’s intent to file an 

application (and the applicant’s affirmation that the provided 

information is correct) by having the interviewer make 

notations in agency records after orally confirming this 

information with the applicant. [Citation omitted]. The 

application information was included in a mailing addressed to 

... Gaither (Tr. 99-105). That document confirms that ... 

Gaither was applying for all Title II benefits for which she was 

eligible, including old-age insurance benefits, and that she 

wanted her benefits to begin as soon as possible. ... 

See Docket Entry 22 at CM/ECF 10. 

 The Commissioner makes note of a matter that bears repeating here, 

a representation the undersigned adopts. The representation is as follows: 

The Commissioner notes that a conclusion that ... Gaither 

had never applied for retirement ... benefits would not lead to 

the outcome she appears to seek. If she did not apply for 

retirement ... benefits in September 2020 and wished for that 

application to be deleted, ... Gaither would not have been 

eligible for Title II benefits at any time. As a result, the 

retirement ... benefits payments she has received over the last 

several years would become overpayments. ... 

See Docket Entry 22 at CM/ECF 11. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 20 of 24
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 Gaither alternatively maintains that she is entitled to retroactive 

retirement benefits. Specifically, she maintains that she is entitled to 

retirement benefits for the twenty month period between January 22, 

2019, i.e., her sixty-second birthday, and September 1, 2020, i.e., the date 

she was deemed to have filed her application for retirement benefits. 

 The ALJ found that Gaither is not entitled to retroactive retirement 

benefits because she was “under the full retirement age” at the time she 

was deemed to have filed an application for retirement benefits, see 

Docket Entry 16 at CM/ECF 47, and she was not mis-informed about her 

right to file an earlier application. Substantial evidence on the record as a 

whole supports the ALJ finding for the following reason set forth by the 

Commissioner, a reason the undersigned adopts in full: 

... some of ... Gaither’s statements suggest a belief that 

she should be receiving retirement insurance benefits effective 

with the first month for which she was potentially eligible for 

it had she filed an application, rather than the month in which 

her application was actually filed. See, e.g., Tr. 32-33 

(testimony), 53-56 (reconsideration paperwork). She explained 

to the ALJ that she would have been entitled to more money 

for January 2019 through mid-2020 if she started receiving 

retirement insurance benefits when she turned 62. See Tr. 33 

(“I mean I would have had more benefits if, if they had did it, 

or, if, if, it is a reduction of benefits. But I didn’t, wasn’t 

allowed to get the benefits that I was entitled to if I was 

entitled to get them in January of 2019.”). 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 21 of 24
22 

However, an individual must file an application for Title 

II benefits to be eligible to receive those benefits. [Citation 

omitted]. Congress has provided by statute that a claimant who 

is younger than full retirement age — and thus will be subject 

to a reduction in their retirement insurance benefits monthly 

amount due to filing early — cannot receive retirement 

insurance benefits “for any month prior to the month in which 

he or she files an application for benefits . . . .” [Citations 

omitted]. Because ... Gaither’s full retirement age was 66 1⁄2, 

[citations omitted], this provision applied to her and she could 

not receive retirement insurance benefits ... for any month 

prior to the month of her application. ... 

... Gaither would need to identify a Title II application or 

protective filing that allowed her application to be deemed 

filed on an earlier date. As the ALJ noted, ... Gaither was 55 

when she applied for and received SSI benefits ... Thus, she was 

not even potentially eligible for retirement insurance benefits 

... at the time of this application, and it cannot be used to 

establish a filing date for a retirement insurance benefits 

application. She does not allege the existence of any 

redetermination that occurred between the date on which she 

attained age 62 in January 2019 and her September 2020 

redetermination. Therefore, there was no Title II application 

filed prior to September 2020 on which benefits could be paid. 

The statute precludes payment of benefits for any month prior 

to September 2020 on the application filed that month. ... 

See Docket Entry 22 at CM/ECF 8-9. 

 Gaither last challenges the cancellation of her dental coverage with 

Delta Dental. Although she currently has dental insurance, she no longer 

has dental insurance provided by Delta Dental, and her dentist of choice 

does not accept the coverage provided by her new carrier. 

Case 4:23-cv-00777-DPM Document 35 Filed 09/23/24 Page 22 of 24
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 The ALJ found that there is nothing in the Social Security Act 

requiring a provider to continue coverage if the Medicare state program 

chooses to convert coverage, and Gaither is not entitled to “continued 

coverage under her former Medicare Part B provider.” See Docket 16 at 

CM/ECF 48. Substantial evidence on the record as a whole supports the ALJ 

finding for at least two reason. 

First, Gaither has failed to show some connection between her 

entitlement to retirement benefits and the loss of her Delta Dental 

insurance coverage. The undersigned certainly knows of no connection. 

Second, assuming there is some connection, the Commissioner is 

correct that Gaither’s loss of her Delta Dental insurance coverage would 

not be “redressable by a judgment against the Commissioner.” See Docket 

Entry 22 at CM/ECF 12 n.3. In fact, the undersigned knows of no scenario 

in which the Commissioner could be ordered to place Gaither back on Delta 

Dental’s insured rolls. 

 For the foregoing reasons, the ALJ’s decision is supported by 

substantial evidence on the record as a whole and no legal error occurred. 

It is recommended that the ALJ’s decision be affirmed. Gaither’s complaint 

should be dismissed, and all requested relief should be denied. Judgment 

should be entered for the Commissioner. 

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DATED this 23rd day of September, 2024. 

 __________________________________ 

 UNITED STATES MAGISTRATE JUDGE 

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