Poisson v. Social Security

[NOT FOR PUBLICATION--NOT TO BE CITED AS PRECEDENT] United States Court of Appeals For the First Circuit No. 98-1566 KAREN A. POISSON FOR NICHOLAS D. POISSON, Plaintiff, Appellant, v. COMMISSIONER, SOCIAL SECURITY ADMINISTRATION, Defendant, Appellee. APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE [Hon. Paul J. Barbadoro, U.S. District Judge] Before Selya, Stahl and Lynch, Circuit Judges. Matthew B. Cox and Burns, Bryant, Hinchey, Cox & Rockefeller, P.A. on brief for appellant. Paul M. Gagnon, United States Attorney, Arthur J. Fried, General Counsel, Charlotte J. Hardnett, Principal Deputy General Counsel, John M. Sacchetti, Associate General Counsel, and Karen J. Aviles, Attorney, Office of the General Counsel, on brief for appellee. December 11, 1998 Per Curiam. In this action for a retroactive award of child's insurance benefits, claimant Karen Poisson, on behalf of her son Nicholas, appeals from a judgment dismissing the suit for lack of jurisdiction. The district court based its decision on Califano v. Sanders, 430 U.S. 99, 107-09 (1977), which held that the Commissioner's denial of a request to reopen an earlier claim is ordinarily not subject to judicial review. While this rule is not without exception, claimant has advanced no reason why it should not apply here. We therefore affirm. On July 1, 1989, several weeks after claimant became pregnant, her boyfriend Daniel Gagne was tragically killed in a motorcycle accident (without learning of the pregnancy). Nicholas was born on March 15, 1990. Soon thereafter, claimant applied for child's benefits but was unable to prove Gagne's paternity. Her claim was thus denied both initially (on May 6, 1990) and on reconsideration (four months later); no further review was sought. Instead, allegedly heeding advice given to her by agency personnel, claimant turned to state court in an attempt to obtain a paternity decree. On November 8, 1994, a settlement was reached with Gagne's parents (and approved by the court) acknowledging that Gagne was Nicholas' father. Armed with this new evidence, claimant filed a second application for child's benefits on November 10, 1994--only to discover that she had missed, by some six months, the four-year deadline for reopening her first claim. See 20 C.F.R. 404.988(b) (permitting reopening for "good cause" within four years of date of notice of initial determination); id. 404.989(a)(1) (defining good cause to include "new and material evidence"). As a result, she was successful only in part. The agency agreed to award benefits on a prospective basis (commencing in May 1994), but refused to reopen the first application so that benefits could be awarded retroactively to 1990. Claimant sought review of this latter ruling, first before an Administrative Law Judge (ALJ) and then before the Appeals Council, but to no avail. Her ensuing federal court action, as mentioned, was dismissed for lack of jurisdiction. Claimant now appeals from this determination. In contending that the district court had jurisdiction to entertain her suit, claimant advances a pair of contentions. First, she argues that she has satisfied the exception recognized by the Sanders Court for claims involving a colorable constitutional issue. See 430 U.S. at 109. Yet the constitutional claim she attempted to articulate below--that the Commissioner effectively requires that illegitimate children establish paternity solely by way of a court order, in contravention of due process and equal protection--is factually belied by the record. And the separate claim she appears to be advancing on appeal--that the immutable nature of paternity renders the denial of retroactive benefits in this context arbitrary and irrational--was not raised below, is unaccompanied by developed argumentation, and appears dubious. Cf. Shepherd ex rel. Shepherd v. Chater, 932 F. Supp. 1314, 1317-18 (D. Utah 1996) (upholding statutory twelve-month limit on retroactive child's benefits against constitutional attack). Alternatively, claimant asserts that because the 1990 and 1994 applications both hinged on the issue of paternity, the Commissioner "constructively" reopened the former when he favorably addressed the latter. And to that extent, claimant argues, the decision is subject to review. See, e.g., McGowen v. Harris, 666 F.2d 60, 65-66 (4th Cir. 1981). Admittedly, it is difficult to dispute that "[t]he ALJ of necessity reconsidered the merits of the earlier claim when granting the later one, because the claims were identical." Bolden ex rel. Bolden v. Bowen, 868 F.2d 916, 918 (7th Cir. 1989); accord Whitlock v. Chater, 959 F. Supp. 324, 331 (W.D. Va. 1997). As a result, if a reopening were possible here, it might well be appropriate to conclude that a de facto reopening had occurred (despite the ALJ's specific language to the contrary). Cf. Taylor ex rel. Peck v. Heckler, 738 F.2d 1112, 1114-15 (10th Cir. 1984) (finding de facto reopening where first and second claim, filed three years apart, were each rejected for insufficient proof of paternity). Yet we need not decide that issue, inasmuch as a reopening was not authorized here. Claimant did not satisfy any of the criteria in 20 C.F.R. 404.988(c) permitting reopening "at any time." See, e.g., Robinson v. Heckler, 783 F.2d 1144, 1146 n.3 (4th Cir. 1986). And as mentioned, she missed the four-year deadline that governs reopenings for "good cause." It is well settled that the Commissioner lacks discretion to reopen a claim, whether on a de facto basis or otherwise, except as permitted by regulation. See, e.g., King v. Chater, 90 F.3d 323, 325 (8th Cir. 1996); Boock v. Shalala, 48 F.3d 348, 352 (8th Cir. 1995) (Campbell, J., sitting by designation, for the court); Coates ex rel. Coates v. Bowen, 875 F.2d 97, 102 (7th Cir. 1989). And in circumstances similar to those here, courts have relied on this same rationale to withhold retroactive child's benefits where paternity (or dependency) was only established in a subsequent claim filed more than four years after the first. See, e.g., Hall v. Chater, 52 F.3d 518, 520- 21 (4th Cir. 1995); Bolden, 868 F.2d at 917-19; Robinson, 783 F.2d at 1146; Whitlock, 959 F. Supp. at 332. Such a result is admittedly harsh. We note, for example, that claimant has acted with reasonable diligence throughout. More important, as she emphasizes, the fact of paternity cannot change over time. Nonetheless, the administration of social welfare programs requires prophylactic rules, which unavoidably will often fit only roughly when applied to individual situations. See, e.g., Weinberger v. Salfi, 422 U.S. 749, 769 (1975). Because the applicable rules prohibit a reopening here, we conclude that no de facto reopening occurred. We therefore agree that the district court was without jurisdiction in light of the Sanders decision. Affirmed.