Opinion ID: 3012180
Heading Depth: 2
Heading Rank: 3

Heading: F.R. 404.988(a).

Text: The second way Kaszer suggests we can find that her initial determination has been reopened is via 20 C.F.R. 404.988(b). That section allows a determination to be reopened within four years of the date of the notice for good cause. Good cause is defined in 20 C.F.R. 404.989 and includes New and material evidence is furnished. Kaszer’s second application was filed within four years of the date of the notice of the initial determination, and she alleges the good cause requirement has been met in that she submitted new material information that was not part of the December 1, 1993 application. There is some ambiguity in our caselaw over whether we must find there was good cause to reopen an application before we can find a de facto reopening occurred. The agency may reopen a prior application only for good cause, yet we have no jurisdiction to review an agency decision not to reopen. See Califano v. Sanders, 430 U.S. 99 (1977); Coup, 834 F.2d at 317. In a typical case where we find that a de facto reopening has occurred, the agency made no mention of the prior application, so it made no decision on whether or not to reopen it. We then look at the whole record and conclude that, even though the agency did not discuss the prior application, it essentially reconsidered the prior application in its consideration of the new application. The unanswered question is, do we have to find that the agency would have been able to reopen the application if it wanted to? That is, do we have to find that the agency had good cause to reopen the application even though the agency ignored the reopening issue? One of our cases suggests that the answer to that question is yes. In Purter v. Heckler, 771 F.2d 682 (3d Cir. 1985), a case where we found the Secretary had de facto reopened the claimant’s prior applications, one of our findings was that we find that there was ’good cause’ for reopening his earlier claims. Id. at 695. In stating our holding, we said, Since the Secretary reconsidered Purter’s claims on the merits and because there was good cause for reopening the earlier claims, we find that there was a de facto reopening of Purter’s prior claims. Id. at 696. This language makes it sound like we need to find two things to find a de facto reopening: (1) reconsideration of the claims on the merits, and (2) good cause for reopening. There is no further discussion in Purter about whether a finding of good cause was a necessary condition for us to find a de facto reopening, but our language seems to imply it. In contrast, our decision in Coup v. Heckler indicates that a finding of good cause is not necessary. There we said, A reopening, and thus a waiver of any claim of administrative res judicata, will be found where the administrative process does not address an earlier decision, but instead reviews the entire record in the new proceeding and reaches a decision on the merits... Kane v. Heckler, 776 F.2d 1130, 1132 (3d Cir. 1985). See also Purter v. Heckler, 771 F.2d 682 (3d Cir. 1985). It is not our role to determine whether the Secretary had good cause for reopening, for in that respect his decision is not judicially reviewable. Rather, we look at the administrative record to determine whether an explicit or a de facto reopening has occurred. Coup, 834 F.2d at 317 (emphasis added). This language implies that we do not have to find good cause as a condition of finding a de facto reopening. We think the language in Coup is clearer and more directly on point than our language in Purter, and we will follow Coup for purposes of this appeal. We do not have to find that the Secretary had good cause before we can consider whether the Secretary de facto reopened Kaszer’s prior application. 4. The final question is whether a reopening of Kaszer’s first application occurred at the administrative level. In conducting our analysis, we will examine the record to determine whether or not a reopening has occurred. A reopening, and thus a wavier of any claim of administrative res judicata, will be found where the administrative process does not address an earlier decision, but instead reviews the entire record in the new proceeding and reaches a decision on the merits . . . Coup, 834 F.2d at 317 (quoting Kane v. Heckler, 776 F.2d 1130, 1132 (3d Cir. 1985)). Even if a prior determination was not explicitly reopened, we may find that a de facto reopening has occurred. Id. There is an initial question here of whether we have jurisdiction to find a de facto reopening. The ALJ’s opinion notes that Kaszer had previously filed applications for SSI and SSDI in 1993 and that they were both denied. But the ALJ found that [i]t is not necessary to consider the question of whether the unfavorable decision made with respect to the prior claim should be reopened and revised. If the ALJ had explicitly decided not to reopen Kaszer’s first application, and Kaszer argued on appeal that the ALJ’s decision was wrong, then we would not have jurisdiction because we cannot review the propriety of the ALJ’s decision. Califano v. Sanders, 430 U.S. 99 (1977); Coup, 834 F.2d at 317. But Kaszer is not contesting the propriety of the ALJ’s reopening decision on appeal. Instead, she is arguing that the ALJ actually reopened her prior application, despite any statements by the ALJ to the contrary. We do have jurisdiction to consider this claim because if the ALJ did in fact reopen the prior application and reach a decision on merits, then she made precisely the sort of agency decision which we may review pursuant to 205(h) of the Social Security Act, 42 U.S.C. 405(h). This finding of jurisdiction is supported by our decision in Coup v. Heckler where we said: A decision of the Secretary declining to reopen a claim is not judicially reviewable. Califano v. Sanders, 430 U.S. 99, 97 S.Ct. 980, 51 L.Ed.2d 192 (1977). This court has held, however, that we will examine the record to determine whether or not a reopening has occurred. Coup, 834 F.2d at 317. The key word here is however. We recognized in Coup that we cannot review the propriety of the Secretary’s decision not to reopen a claim, but in the next sentence we said however meaning notwithstanding that fact we still have jurisdiction to consider whether a reopening has actually occurred. Thus, we may consider whether the ALJ de facto reopened Kaszer’s first application. We are aware that in a series of unpublished and per curiam opinions, the Court of Appeals for the Tenth Circuit has said that an express refusal to reopen normally precludes a claim of de facto reopening by the administrative law judge and is also not reviewable by this court, Cook v. Chater, No. 95-7095, 85 F.3d 640 (table), 1996 WL 223711 (10th Cir. May 3, 1996), at  n.2, but we do not find these opinions persuasive. See also Gilbert v. Chater, No. 96-1405, 110 F.3d 73 (table), 1997 WL 158139 (10th Cir. Apr. 2, 1997); Brown v. Sullivan, 912 F.2d 1194, 1196 (10th Cir. 1990) (per curiam). All of these cases rely upon a footnote in Taylor v. Heckler, 738 F.2d 1112, 1115 n.6 (10th Cir. 1984), as well as the Supreme Court’s decision in Califano v. Sanders, 430 U.S. 99, 107-08 (1977), for support. The footnote in Taylor says, When the Social Security Administration refuses to reopen a claim for benefits, that decision is unreviewable. Taylor, 738 F.2d at 1115 n.6 (emphasis supplied). This is merely a restatement of the Supreme Court’s holding in Califano that when the agency refuses to reopen a claim, federal courts do not have jurisdiction to consider the propriety of that decision. It is an entirely different thing to say, as does Cook, that an explicit refusal to reopen precludes a federal court from possibly finding that a de facto reopening has occurred. Neither Califano nor Taylor supports this latter proposition, and we think the statements to the contrary in the unpublished opinions cited above are incorrect. Finally we get to the question of whether or not a de facto reopening actually occurred in this case. In one formulation of our test for a de facto reopening, we said: A reopening, and thus a waiver of any claim of administrative res judicata, will be found where the administrative process does not address an earlier decision, but instead reviews the entire record in the new proceeding and reaches a decision on the merits . . . Coup, 834 F.2d at 317 (quoting Kane v. Heckler, 776 F.2d 1130, 1132 (3d Cir. 1985)). The first question, then, is whether the ALJ addressed the earlier decision. It is true that the ALJ mentioned the earlier decision, but we are not convinced that mere mentioning is what we had in mind in Coup. The ALJ said: It is not necessary to consider the question of whether the unfavorable decision made with respect to the prior claim should be reopened and revised. [Tr. 13]. The ALJ did not say that she was using the prior adjudication for its res judicata effects or that she was only considering the second application for the time period following the first decision. We think that Coup requires that the ALJ address the earlier decision vis-a-vis res judicata. The agency must address whether the prior adjudication will be used for its preclusive effect or whether it will be reopened. No such expression was made here, so we move on to the second part of the Coup test to see if the ALJ review[ed] the entire record in the new proceeding and reache[d] a decision on the merits. In the section of her opinion entitled Evaluation of the Evidence, the ALJ went through Kaszer’s medical evaluations and other evidence and concluded that she was not entitled to benefits. Some of the evidence she considered was relevant to Kaszer’s first application which was filed in December 1993. For example, she found: The objective medical evidence establishes that the claimant was diagnosed with insulin dependent diabetes mellitus in June 1993. She had been controlling her diabetic condition with oral medical prior to June 1993 (Exhibit 23). [Tr. 15]. Similarly, she found: Ms. Kaszer complained of being severely depressed in October 1993, but was unwilling to begin anti-depression treatment (Exhibit 31, page 23). Among the exhibits listed in the administrative record as Exhibits in Connection with Current Application are Exhibit 23: Hospital Records for admission on June 4, 1993 through discharge on June 10, 1993, from Medical Center of Beaver County. Exhibit 24: Medical Reports dated August 10, 1993, by Dr. Gary Harvanich, M.D. Exhibit 26: Emergency Room Records dated September 7, 1993 and November 24, 1995, from The Medical Center of Beaver County. Exhibit 27: Medical Reports dated July 26, 1994 and June 7, 1996, by Dr. George R. Zambelli, Jr., M.D., for services provided November 30, 1992 to December 13, 1995. Exhibit 31: Medical Records covering the period December 1, 1992 to November 8, 1996, from The Family Practic [sic] Center. [Tr. 2]. We assume the ALJ utilized these exhibits in reaching her decision because she says she made her conclusions [a]fter careful consideration of all the evidence. [Tr. 13]. It is apparent that the ALJ considered evidence that was relevant to Kaszer’s first application and based its decision on all of the evidence. The second application was filed on September 6, 1995, so benefits could only be awarded back to September 6, 1994. Yet the ALJ considered evidence of Kaszer’s condition back in 1992 and 1993, a period for which Kaszer would not be entitled benefits under her second application. This is consistent with reconsidering Kaszer’s first application, which was filed on December 1, 1993 and could award benefits back to December 1, 1992. The ALJ did not narrow the time period under consideration by using the decision on Kaszer’s first application for its res judicata effects. Instead, the ALJ review[ed] the entire record in the new proceeding and reach[ed] a decision on the merits, which is what we said in Coup would constitute a de facto reopening. 834 F.2d at 317. We are aware that some courts of appeals have held that a review of [a claimant’s] medical history does not amount to the reconsideration ’on the merits’ necessary to constitute a de facto reopening of the earlier application because such a review is often necessary to determine whether the claimant was disabled within the twelve months prior to filing the second application. Rohrich v. Bowen, 796 F.2d 1030, 1031 (8th Cir. 1986); Frustaglia v. Sec’y of Health & Human Servs., 829 F.2d 192, 193 (1st Cir. 1987) (per curiam); Moore v. Chater, No. 95-35764, 97 F.3d 1460 (table), 1996 WL 498916 (9th Cir. Aug. 8, 1996) (unpublished); Boone v. Apfel, No. 98-7176, 189 F.3d 477 (table), 1999 WL 668253 (10th Cir. Aug. 26, 1999) (unpublished). We, too, have indicated in dicta that where the agency explicitly considered such earlier evidence [of a claimant’s medical history] solely for the purpose of determining whether the claimant was disabled within the twelve months preceding the most recent application we will not on that basis alone find a de facto reopening. Coup, 834 F.2d at 318. There is, admittedly, a fine line between considering a claimant’s medical history solely for the purpose of establishing whether the claimant was disabled and actually reconsidering that evidence. The Commissioner argues that the agency made a proper inquiry into the additional evidence without reopening Kaszer’s prior application. That same argument was advanced in Young v. Bowen, 858 F.2d 951, 955-56 (4th Cir. 1988), but there the court found that despite the protestations on appeal that the medical evidence was reviewed simply to determine whether there was good cause to reopen appellant’s previous applications, a careful reading of the decision reveals an implicit analysis of the nature of Young’s disability in 1979 and 1980. Since the Secretary has attempted to support his decision in some part by weighing the full range of medical evidence, we are thus free to determine whether that decision is supported by substantial evidence. Id. Similarly, the ALJ here analyzed Kaszer’s medical history and supported her decision by careful consideration of all the evidence, [Tr. 13], such that her actions were sufficient to reopen Kaszer’s first application de facto. See also Crady v. Sec’y of Health & Human Servs., 835 F.2d 617, 620 (6th Cir. 1987) (finding a reopening where [t]he ALJ made an extensive analysis of the claimant’s medical condition . . . [for] a period as to which no benefits could have been awarded absent a reopening); Lewis v. Apfel, 236 F.3d 503 (9th Cir. 2001) (Res judicata does not apply when an ALJ later considers ’on the merits’ whether the claimant was disabled during an already-adjudicated period.).