Brief Fact Summary. The United States District Court for the District of Maryland, at Baltimore affirmed the Appellee, Richard S. Schweiker the Secretary of the Department of Health and Human Services’ (Appellee) denial of the Appellant, Leon B. McLain’s (Appellant) claim for disability insurance and Supplemental Security Income benefits (SSI) under Titles II and XVI of the Social Security Act (the Act). The Appellant appealed.
Synopsis of Rule of Law. In order to establish a prima facie case of disability, all that a claimant must ordinarily show is his inability to perform his past specific relevant jobs. When a claimant establishes a prima facie case, the burden then shifts to the Secretary of the Department of Health and Human Services to come forward with proof of the claimant’s capacity to perform alternate work.
The ALJ must consider objective medical facts and the opinions and diagnoses of both treating and examining medical professionals, which constitute a major part of the proof of disability cases.View Full Point of Law
Issue. Did claimant establish a prima facie case that he was unable to work due to his disabilities and thus was eligible for benefits pursuant to Titles II and XVI of the Social Security Act?
Held. Yes. Concluding that the Department of Health and Human Services failed to carry its burden of providing evidence that, considering the Appellant’s skills and abilities, there was alternative work available in the national economy that he could perform, the court vacated the district court’s judgment affirming the denial of disability insurance and benefits and remanded the case.
Discussion. As a general rule, a claimant seeking benefits pursuant to entitlement programs (in this case, SSI benefits) must first appear before an ALJ in order to establish a prima facie case. Only after having exhausted administrative remedies may he or she bring the case before an appellate court. As the court in McLain explained, “The procedure for arriving at a determination of disability under the Social Security Act places the initial burden of proof on the claimant to show that, because of his impairment, he is unable to perform his previous work. Once a prima facie showing of disability has been made by the claimant, then the burden of going forward shifts to the Secretary of the Department of Health and Human Services.” After this shift, the issue becomes one of proof. As the court noted, “To overcome a prima facie case of disability, the secretary must establish that the claimant has sufficient residual functional capacity to engage in an alternative job existing in the n
ational economy.” The court proffered examples of the nature of such proof that would be deemed acceptable: “Objective medical facts and the opinions and diagnoses of the treating and examining doctors constitute a major part of the proof to be considered in a disability case and may not be discounted by the administrative law judge.” The court specifically observed the low threshold a claimant needs to cross, stating, “In order to establish a prima facie case of disability, all that a claimant must ordinarily show is his inability to perform his past specific relevant jobs.” The court specifically noted the kind of testimony necessary to refute a claimant’s prima facie case: “The testimony of a vocational expert is ordinarily required in order for the Secretary of the Department of Health and Human Services to meet his burden of coming forward with proof of the claimant’s capacity to perform alternate work. The presence of a vocational expert is particularly appropriate in a case inv
olving a nonexertional disability.” Here, the Secretary failed in its refutation. The court noted that the medical evidence unanimously supported the conclusion that the Appellant has a serious psychiatric disorder that prevented him from performing his previous jobs. Thus, the court instructed the district court to remand to the Department of Health and Human Services for further proceedings so that it could advance the appropriate proof to counter the Appellant’s prima facie case.