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Domozik v. Cohen

decided: June 30, 1969.

LEO J. DOMOZIK, APPELLANT,
v.
WILBUR J. COHEN, SECRETARY OF HEALTH, EDUCATION AND WELFARE, UNITED STATES OF AMERICA



Seitz, Aldisert and Stahl, Circuit Judges.

Author: Per Curiam

Opinion OF THE COURT

This is an appeal from a grant of summary judgment by the district court, Appellant's Appendix 1(a), in favor of the Secretary of Health, Education and Welfare, appellee, which had the effect of upholding the denial of appellant's claim for disability benefits.

Appellant's application for establishing a period of disability and for disability insurance benefits under the Social Security Act was filed on January 4, 1964, claiming June 10, 1961, as the date of onset of disability. After the Social Security Administration of the Department of Health, Education and Welfare rejected the application in 1966, a hearing was held before a Hearing Examiner who disallowed the claim on April 14, 1967 (TR. 4-10).*fn1 The Appeals Council declined review of the Examiner's decision in September 1967 (TR. 1), and appellant then filed this suit in the court below in accordance with § 205(g) of the Social Security Act, 42 U.S.C. § 405(g).

In order to be eligible for disability benefits, a claimant must meet the twin requirements of

(1) disability within the meaning of the Act, and

(2) the requisite coverage preceding the onset of disability. §§ 216(i), 223, 42 U.S.C. §§ 416(i), 423.*fn2

The latter requirement is twenty calendar quarters of coverage, i.e., five years, during the ten-year period ending with the quarter in which the claimant becomes disabled.

Appellant did not have the required period of coverage with respect to the claimed June 10, 1961, date of onset of disability. According to appellee the last time appellant met the coverage requirement was December 31, 1959. (TR. 5, 66.)*fn3

Of prime significance to the decision in this case is the fact that in two prior applications appellant had made for disability benefits,*fn4 in which he had claimed 1958 and 1955 dates of disability, it had been determined that his condition was not disabling at any time from 1955 to December 31, 1959. (TR. 66.) These prior applications were rejected by the Chief of the Evaluation and Authorization Branch of the Social Security Administration in a letter dated November 23, 1964, which stated, in pertinent part:

After studying all the facts in your case and the medical evidence, and considering your statements, age, education, and experience, we find that your condition was not disabling within the meaning of the law on December 9, 1955, (the date you state you became unable to work), or on any later date through December 31, 1959. This is the last day on which you still met the earnings requirement.

If you believe that this determination is not correct, you may request that your case be reexamined. If you want this reconsideration you must request it not later than 6 months from the date of this notice. You may make any such request through your local social security district office. If additional evidence is available you should submit it with your request. Please read the enclosed pamphlet for more information about your right to question the decision made on your claim. (TR. 66.)

Appellant did not seek any administrative reconsideration of the 1964 denial of his application, either with respect to the absence of disability or the terminal date of his period of coverage,*fn5 within the six-month period. Nor has appellant ever sought to reopen the 1963 and 1964 applications within the four-year period allowed by the Secretary's regulations, 20 C.F.R. §§ 404.956-404.958, where error or other good cause is shown.

In view of appellant's failure to pursue his administrative remedies following the denial of the earlier applications, the Government contends he may not now relitigate the prior ...


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