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MCADAMS v. SECRETARY OF HHS

December 11, 1989

JOSEPH McADAMS, Petitioner,
v.
SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent



The opinion of the court was delivered by: COHEN

 Plaintiff, Joseph T. McAdams, brings this action under section 205(g) of the Social Security Act (the "Act"), 42 U.S.C. § 405(g), seeking review of the Secretary of Health and Human Services' ("Secretary") final determination establishing the onset date of plaintiff's disability for purposes of awarding disability insurance benefits.

 Plaintiff initially filed an application for a period of disability and disability insurance benefits under sections 216(i) and 223 of the Act, 42 U.S.C. §§ 416(i) and 423, on June 21, 1984, asserting therein a disability due to "recurring emboli -- blood clots," with an alleged onset date of February 11, 1984. Administrative Record at 54 (hereinafter "Record"). The application was denied initially and upon request for reconsideration. Thereafter, plaintiff timely requested an administrative hearing on his application. A hearing was held on February 5, 1985, and on March 6, the Administrative Law Judge ("ALJ") affirmed denial of benefits, holding plaintiff was not disabled. This decision of the ALJ was in turn affirmed by the Appeals Council on June 10, 1985, thereby becoming a final decision of the Secretary.

 Plaintiff commenced this civil action on July 11, 1985, challenging the Secretary's determination. The parties' initial foray into this forum culminated in a Consent Order entered January 6, 1986, which remanded the matter to the Secretary for reconsideration in light of plaintiff's additional mental impairments. On April 9, 1986, the Appeals Council vacated its earlier denial of plaintiff's request for review and remanded the case to an ALJ for consideration of plaintiff's impairments in light of revised rules for determining disability due to mental disorders, and to consider the transferability of plaintiff's acquired work skills. Record at 371-72. A supplemental hearing for these purposes was held before an ALJ on August 8, 1986.

 Meanwhile, on June 26, 1985, plaintiff had filed a second, duplicative application for disability insurance benefits, again alleging disability due to "blood clots in system." Record at 407. This second application was ultimately granted June 3, 1986, on the basis of combined mental and physical impairments but with an "unfavorable onset," Record at 497; for procedural reasons plaintiff's entitlement to benefits pursuant to the second application was limited to a July 1, 1985 onset date. Hence, plaintiff's initial application remained viable with respect to the period from February 1984 to July 1985.

 On September 25, 1986, the ALJ issued a recommended decision, regarding the initial application, awarding plaintiff disability benefits, with an onset date of February 14, 1984. Record at 313. Upon notice and an opportunity to be heard, the Appeals Council issued a decision on June 11, 1987, modifying the ALJ's recommended determination by establishing a later onset date of December 20, 1984. Record at 285. This modified determination became the final decision of the Secretary.

 By Consent Order filed March 24, 1988, this civil action was reopened for a review of these supplemental administrative proceedings.

 Plaintiff is a fifty-five year old male with a tenth grade education. He was previously employed for some seventeen years in the textile industry. In 1969 plaintiff left the textile field and became a liquor store clerk in the Pennsylvania State Store system, a position he occupied until 1981. During this period, plaintiff also operated a variety store business in Philadelphia, which he later turned over to his son. From 1981 until 1984, plaintiff worked as a casino cashier in Atlantic City. He last engaged in substantial gainful employment on February 11, 1984.

 Plaintiff first developed significant medical problems in October of 1983, at which time he spent ten days in Temple University Hospital, suffering from vague pleuritic chest pain. While no definite diagnosis was made despite extensive testing, his condition was believed to represent a pleurodynia secondary to Coxsackie viral infection. Plaintiff also presented abnormal liver function, but this was believed secondary to his lung infection. Record at 103.

 On February 14, 1984, plaintiff was again hospitalized, this time at Einstein Medical Center, for work-up of his recurrent pneumonic symptoms. He was discharged on February 24, with a diagnosis of right lower lobe pneumonia with effusions and reactive adenopathy. Record at 129.

 Just two weeks later, on March 9, plaintiff was readmitted to Einstein for further evaluation. He remained hospitalized there for over a month. A week into this hospitalization, pulmonary angiography revealed that plaintiff suffered from massive bilateral pulmonary emboli. An immediate attempt was made to dissolve the clots with the use of an anticoagulant, Streptokinase. Following administration of Streptokinase, plaintiff was observed to experience a "transient period of unresponsiveness." Record at 145. Streptokinase proved ineffective in dissolving the clots and plaintiff's doctors performed a partial embolectomy, removing large clots from both right and left pulmonary arteries. Additional clots remained visible angiographically, however, and a Greenfield filter was inserted below plaintiff's renal veins. At this time plaintiff was transferred to the hospital's intensive care unit where he remained for the next week. Record at 145. The following day plaintiff was noted to have a left hemiparesis. A CT scan of plaintiff's brain revealed an "acute hemorrhagic infarct in the distribution of the right middle cerebral artery." Record at 179. On his discharge April 12, 1984, plaintiff's condition was characterized with a four prong diagnosis:

 
(1) status post massive bilateral pulmonary emboli;
 
(2) right intracerebral hemorrhage with resolving left hemiparesis;
 
(3) deep vein thrombosis of the right lower extremity; and
 
(4) depression.

 Record at 146.

 Nine days after this discharge, plaintiff was readmitted to Einstein yet again, this time experiencing left leg pain and edema. Following an eighteen day hospitalization plaintiff was discharged on May 9, 1984, with another similar compound diagnosis:

 
(1) deep venous thrombosis and thrombophlebitis;
 
(2) status post pulmonary emboli; and
 
(3) intracerebral hemorrhage.

 Record at 215.

 Though he remained on medication and was required to wear an elastic leg support garment, plaintiff's physical condition gradually improved over the ensuing months. A cardiac status evaluation performed at the request of the Secretary by Dr. Ronald C. Gove, M.D., on August 6, 1984, suggested that, despite fleeting chest pain in the treadmill evaluation, plaintiff was "nondiagnostic for coronary artery ...


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