UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
_______________________________________
)
VIRGINIA JAMES, )
)
Plaintiff, )
)
v. ) Civil Action No. 10-1944 (RBW)
)
ROBIN WELLS, )
)
Defendant. )
_______________________________________)
MEMORANDUM OPINION
This matter is before the Court on a motion to dismiss filed on behalf of the
Commissioner of Social Security (“Commissioner”).1 For the reasons discussed below, the
motion will be granted.
I. BACKGROUND
In 1995, an administrative law judge (“ALJ”) determined that the plaintiff was entitled to
receive disability insurance benefits (“DIB”), see Mot. to Dismiss and Supporting Mem. of P. &
A. (“Def.’s Mem.”), Ex. A (Notice of Decision – Fully Favorable dated July 3, 1995), as of
March 2002, see Compl., Ex. (Letter to LaVonnia Johnson, Office of Eleanor Holmes Norton,
1
The named defendant, Robin Wells, is an employee of the Social Security
Administration. Mot. to Dismiss and Supporting Mem. of P. & A. at 1 n.1. It does not appear,
however, that the plaintiff brings any claim against Ms. Wells in her individual capacity. The
plaintiff acknowledges that she named Ms. Wells in error, and explains that her “intention was to
file . . . against [the] Social Security [Administration].” Mot. for My Claim Not to be Dismissed
at 6 (page numbers designated by the Court); see id. at 12. The Court proceeds as if plaintiff
brought this action under 42 U.S.C. § 405(g) against the Commissioner of Social Security. In
this Memorandum Opinion, the Court will refer to the defendant as the “Commissioner.”
1
U.S. House of Representatives, from Lorna Walters, District Manager, Philadelphia Region,
Social Security Administration, dated September 15, 2006) at 1. Payments commenced in
September 1995, and the plaintiff received $12,849.68 to “covere[]back payments due from
03/92 to 09/95 on the Social Security Disability Record.” Compl., Ex. at 1. In 2001, the Social
Security Administration (“SSA”) learned “that certain years of [the] plaintiff’s earnings were not
included in calculating her monthly DIB payment.” Def.’s Mem. at 2. The plaintiff had been
receiving a monthly benefit of $499.00, and beginning in May 2001 her monthly benefit was set
to increase to $513.00 “to account for her increased earnings in prior years.” Id.; see id., Ex. C-1
(Letter to plaintiff from Carolyn Colvin, Deputy Commissioner for Operations, SSA, dated April
12, 2001). In April 2001, the plaintiff received a total of $1,833.00, an amount which included
both a “one-time back payment” of $1334.00 and her monthly benefit of $499.00.2 Def.’s Mem.
at 2.
The plaintiff claims that she was entitled to receive her regular monthly benefit payment
of $499.00 in April 2001 in addition to the one-time back payment of $1,833.00. Compl. at 5.
She brings this action to recover not only the $499.00 payment allegedly owed for April 2001,
but also an award of $100,000.00 as compensatory damages “on the basis of negligence on the
part of Social Security.” Compl., Ex. [Dkt. #1-1] at 1.
After this litigation commenced, the Commissioner “found an untimely Request for
Reconsideration mailed by plaintiff [postmarked] July 10, 2001.” Def.’s Mem. at 2-3; see id.,
2
SSA records reflect that the plaintiff’s “regular monthly payment for $499.00 was
deposited to her checking account on April 3, 2001; a $1334.00 underpayment was deposited on
April 6, 2001, and her new benefit payment amount of $513.00 was deposited on May 3, 2001.”
Def.’s Mem., Ex. D (Fact Sheet) at 1.
2
Ex. E-1 (Request for Reconsideration dated June 29, 2001). Although a request for
reconsideration ordinarily must be filed no later than 60 days after the claimant’s receipt of the
notice of the Commissioner’s initial decision, see 20 C.F.R. § 404.909(a)(1), the Commissioner
found good cause for the late filing, see 20 C.F.R. § 404.911, because he “did not issue [to the]
plaintiff a written notice denying her Request for Reconsideration on untimeliness grounds.”
Def.’s Mem. at 3. Instead, the Commissioner has reviewed the matter and found that “there was
no underpayment of benefits.” Id. at 3; see id., Ex. F-2 (Letter from Elaine Garrison-Daniels,
Assistant Regional Commissioner for Processing Center Operations, Mid-Atlantic Program
Service Center, dated February 17, 2011). The Commissioner so notified the plaintiff in writing,
and his letter included notice of her right to request a hearing before an ALJ. Id., Ex. F-3.
II. DISCUSSION
A federal district court has jurisdiction over a civil case challenging a final decision of
the Commissioner. See 42 U.S.C. § 405(g). This statute in relevant part provides:
Any individual, after any final decision of the Commissioner of
Social Security made after a hearing to which [she] was a party,
irrespective of the amount in controversy, may obtain a review of
such decision by a civil action commenced within sixty days after the
mailing to him of notice of such decision or within such further time
as the Commissioner of Social Security may allow.
***
The court shall have power to enter, upon the pleadings and transcript
of the record, a judgment affirming, modifying, or reversing the
decision of the Commissioner of Social Security, with or without
remanding the cause for a rehearing.
Id. The statute does not define the term “final decision.” Instead, “its meaning is left to the
Secretary [of the Department of Health and Human Services] to flesh out by regulation.”
3
Weinberger v. Salfi, 422 U.S. 749, 767 (1975).
SSA regulations set forth a four-step process by which a claimant achieves a final
decision suitable for judicial review. See 20 C.F.R. § 404.900(a) (listing steps of administrative
review process); see also Ryan v. Bentsen, 12 F.3d 245, 247 (D.C. Cir. 1993) (“The Secretary
renders a ‘final decision’ after a benefit claimant receives an initial determination of his right to
benefits by the regional SSA office, asks that office to reconsider its determination, requests a
hearing before an administrative law judge (ALJ) and requests Appeals Council review of the
ALJ’s decision.”).
A determination about the amount of a person’s benefits is an initial determination, 20
C.F.R. § 404.902(c), which “is binding unless [the claimant] request[s] a reconsideration within
the stated time period,” 20 C.F.R. § 404.905. A claimant may request reconsideration in writing
within 60 days of her receipt of notice of the initial determination. 20 C.F.R. § 404.909(a). A
determination on reconsideration is binding “unless . . . [the claimant] requests a hearing before
an [ALJ].” 20 C.F.R. § 404.921(a). A request for a hearing must be made in writing, 20 C.F.R.
§ 404.933(a), and filed within 60 days of the claimant’s receipt of the notice of the decision on
reconsideration, 20 C.F.R. § 404.933(b)(1). The ALF “shall issue a written decision that gives
the findings of fact and the reasons for [his] decision,” 20 C.F.R. § 404.953(a), and his decision
is binding unless the claimant requests a review by the Appeals Council, 20 C.F.R. § 404.955(a).
Such a request must be filed, in writing, within 60 days of the claimant’s receipt of the notice of
the ALJ’s hearing decision. 20 C.F.R. § 404.968(a)(1). “The Appeals Council’s decision . . . is
binding unless [the claimant] . . . file[s] an action in Federal district court,” and the action must
be filed within 60 days after receipt of the notice of the Appeals Council’s action. 20 C.F.R. §
4
404.981.
Ordinarily, a plaintiff’s failure to exhaust her administrative remedies at the agency level
prior to filing a lawsuit in federal district court would be a basis for dismissal of the lawsuit. See
Almaklani v. Sullivan, No. 90-754, 1990 WL 179595, at *1 (D.D.C. 1990) (dismissing for lack of
subject matter jurisdiction the complaint of applicants for survivors’ benefits who had not
exhausted administrative remedies following denial of their initial claim). Plaintiff contends that
she has made several contacts with SSA personnel and others, see Pl.’s Opp’n at 2-4, seeking the
additional benefits she believed were owed to her. She also asserts that she has not received
credit for “jobs that [she] worked and paid into Social Security that [were] not used to compute
[her] benefits.” Id. at 10-11. She challenges amounts deducted “to pay for Medicare.” Id. at 12.
According to the plaintiff, she has “used all the resources available to [her] when in fact [the]
Social Security Administration has been negligent for not sending [her] Administrative Appeals
rights info” and for “not responding to [her] reconsideration” request. Id. at 6.
In the Reply, the Commissioner acknowledges the agency’s failure to respond to the
plaintiff’s 2001 request for reconsideration. Reply Mem. in Supp. of Def.’s Mot. to Dismiss
(“Reply”) at 1. Further, he notes that the plaintiff “disputes whether she should have received an
additional $499.00 from the [SSA] in 2001 and whether she should be credited for additional
work that was not reported to the [SSA].” Id.; see Pl.’s Opp’n, Attach. 20 (Social Security Work
History). Such matters, the Commissioner argues, “are the types of issues that would benefit by
their further development at a hearing before an ALJ.” Id. The Court concurs.
The Supreme Court instructs that:
Exhaustion is generally required as a matter of preventing premature
interference with agency processes, so that the agency may function
5
efficiently and so that it may have an opportunity to correct its own
errors, to afford the parties and the courts the benefit of its experience
and expertise, and to compile a record which is adequate for judicial
review.
Weinberger v. Salfi, 422 U.S. at 765 (citation omitted). For the most part, the parties offer
correspondence to support of their respective positions, and the current record is not one on
which the Court could decide the merits of the complaint. Cf. Craigg v. Russo, 667 F.2d 153,
160 (D.C. Cir. 1981) (finding that, in the circumstances of that case, “it manifestly would be
inappropriate for us to undertake to decide the issues without the benefit of an administrative
decision by the federal agency charged with implementing the federal statute that is central to the
case”). Now that the Commissioner has acted on the plaintiff’s 2001 request for reconsideration,
the plaintiff may proceed with the next step of the administrative process – a hearing before an
ALJ. A hearing affords the plaintiff an opportunity to present evidence supporting her claims, as
well as an opportunity for the SSA to address those claims.
The Court will grant the Commissioner’s motion to dismiss and, as he suggests, will
“direct[] that the plaintiff should be granted a hearing before an [ALJ] on the issues that she has
raised in this case.” Reply at 2. An Order accompanies this Memorandum Opinion.
/s/
DATE: September 24, 2011 REGGIE B. WALTON
United States District Judge
6