ORDERS:
ORDER AND DECISION
STATEMENT OF THE CASE
This matter is before the Administrative Law Judge Division pursuant to the appeal of Shirley
Faye Littlejohn ("Littlejohn") from a decision of a hearing officer of the South Carolina Department
of Health and Human Services ("Department"). The Department found that Littlejohn was not
entitled to Medicaid benefits under the "Aged, Blind and Disabled" eligibility category as she was
not disabled. A hearing for oral arguments at the Administrative Law Judge Division was scheduled
for November 30, 1998 at 1:00 p.m. Notice of the hearing was sent to both parties by certified mail,
return receipt requested. Charles Black, Esquire appeared on behalf of the Department. This
tribunal waited until 1:30 p.m. for Littlejohn to arrive at the hearing; however, she did not appear.
Littlejohn submitted no request for a continuance or any other communication to this tribunal prior
to the hearing. Mr. Black declined to move for dismissal of the appeal, and, rather than presenting
oral argument, he consented to my consideration of this appeal on only the written briefs and the
record. For the reasons stated herein, Littlejohn's motion is denied and the decision of the
Department is affirmed.
BACKGROUND
Littlejohn submitted an application for Medicaid benefits to the Department on October 15,
1996 under the disability provision of the "Aged, Blind and Disabled" ("ABD") eligibility category.
Her application was referred to the Disability Determination Division of the South Carolina
Department of Vocational Rehabilitation for an independent disability determination. Littlejohn's
application was denied on February 6, 1997 because she was determined not to be disabled.
Littlejohn appealed the determination to the Division of Appeals and Hearings at the Department.
A fair hearing was conducted by the Department on April 28, 1997. On June 3, 1997, the
Department's hearing officer issued an Administrative Decision finding that Littlejohn was not
disabled and denying her application for Medicaid. Littlejohn appealed the decision to the
Administrative Law Judge Division. This tribunal remanded the case to the hearing officer to allow
Littlejohn to supplement the record with medical evidence previously unavailable to her. A second
fair hearing was conducted on April 16, 1998 for the limited purpose of considering the additional
evidence. On June 16, 1998, the hearing officer issued an Administrative Decision denying
Littlejohn's application for Medicaid. Littlejohn appealed this decision to the Administrative Law
Judge Division.
ISSUE ON APPEAL
Is there substantial evidence in the record to support the hearing officer's determination that
Littlejohn is not disabled?
STANDARD OF REVIEW
The provisions of the South Carolina Administrative Procedures Act ("APA") govern an
appeal from a final administrative decision. Lark v. Bi-Lo. Inc., 276 S.C. 130, 276 S.E.2d 304
(1981). Under the APA, the Administrative Law Judge may reverse or modify the decision if
substantial rights of the appellant have been prejudiced because the findings, inferences, conclusions
or decisions are:
(a) in violation of constitutional or statutory provisions;
(b) in excess of the statutory authority of the agency;
(c) made upon unlawful procedure;
(d) affected by other error of law;
(e) clearly erroneous in view of the reliable, probative and substantial
evidence on the whole record; or
(f) arbitrary or capricious or characterized by abuse of discretion or
clearly unwarranted exercise of discretion.
S.C. Code Ann. § 1-23-380(A)(6) and (B) (Supp. 1997).
Substantial evidence is that evidence which, in considering the record as a whole, would
allow reasonable minds to reach the conclusion that the administrative agency reached. E.g.,
Jennings v. Chambers Development Co., Op. No. 2877 (S.C.Ct.App. filed August 10, 1998) (Shealy
Adv.Sh. # 28 at 23). This tribunal may not substitute its judgment for that of the administrative
agency as to the weight of the evidence on questions of fact. Lark v. Bi-Lo, Inc., 276 S.C. 130, 276
S.E.2d 304 (1981). The possibility of drawing two inconsistent conclusions from the evidence does
not prevent an administrative agency's finding from being supported by substantial evidence. Id.
Where there is a conflict in the evidence, the administrative agency's findings of fact are conclusive.
Id.; see also Harbin v. Owens-Corning Fiberglas, 316 S.C. 423, 450 S.E.2d 112 (Ct. App. 1994)
(existence of any conflicting opinions between doctors is a matter left to the administrative agency).
The burden is on the appellant to show convincingly that the Board's order is without
evidentiary support or is arbitrary or capricious as a matter of law. See Hamm v. Public Service
Commission of South Carolina, 310 S.C. 13, 425 S.E.2d 28 (1992); Hamm v. American Tel. & Tel.
Co., 302 S.C. 210, 394 S.E.2d 842 (1990).
DISCUSSION
Motion for "Default Judgment"
During the briefing stage of this appeal, Littlejohn submitted a written "Motion for Default
Judgment Against Respondent." In the motion, Littlejohn asks this tribunal to reverse the denial of
her application for Medicaid on the ground that the Department filed its responsive brief after the
expiration of the time limit specified in ALJD Rule 36(A). The motion is denied.
This tribunal has relaxed its rules for Littlejohn by granting her an extension of time in which
to file her written brief. Additionally, Littlejohn failed to appear at the hearing to argue her motion.
Under these circumstances, relaxing the briefing deadline for the Department is appropriate.
In any event, this tribunal does not have the authority to reverse the decision of an
administrative agency on a ground not listed in S.C. Code Ann. § 1-23-380(A)(6) (Supp. 1997). See
Lark v. Bi-Lo. Inc., 276 S.C. 130, 276 S.E.2d 304 (1981). Although a party's compliance with the
rules of this tribunal is important, noncompliance does not relieve the appellant of his or her burden
to show that the administrative agency committed reversible error. See Hamm v. Public Service
Commission of South Carolina, 310 S.C. 13, 425 S.E.2d 28 (1992) .
Disability Evaluation Process
The Department is the state agency charged with administering the Medicaid Program, which
is a joint venture between the states and federal government to provide medical assistance to
individuals meeting certain financial and other criteria. Appellant applied for Medicaid benefits
under the ABD coverage group, which includes those persons who are over 65 years of age, blind
or disabled. Appellant applied under the disability provision on October 15, 1996.
Federal criteria contained in regulations issued by the Social Security Administration are used
to determine whether an applicant is "disabled." These criteria are the same as those used by the
Social Security Administration in determining whether an individual qualifies for certain Social
Security benefit programs, such as cash assistance payments of the Supplemental Security Income
Program.(1)
In South Carolina, the Department and the Social Security Administration have both
contracted with the South Carolina Department of Vocational Rehabilitation ("VR") to perform
disability determinations for the respective programs. Therefore, when an individual applies to the
Medicaid program or to the Social Security Administration for benefits that are related to disability,
the case is referred to VR. VR evaluates the case based on federal disability criteria and issues a
finding as to whether a person is "disabled" under those criteria.
The federal regulations governing the disability determination process establish a sequential
step evaluation to determine whether an individual is disabled. See 20 C.F.R. 416.920. VR first
determines whether the applicant is engaged in "substantial gainful activity" at the time of the
application. In other words, "is the applicant currently working?" If the applicant is not currently
working, the process proceeds to the second step, in which the Department decides whether the
applicant suffers from a medically determinable "severe impairment" that may reasonably be
expected to last for more than one year or to result in death. If the applicant does suffer from a
"severe impairment," that impairment (or combination of impairments) is compared to the regulatory
listing of impairments that are considered to result in disability. If the applicant's impairment meets
or equals one of these listings, the applicant is considered to be disabled.
If the applicant's impairment does not meet or equal one of the regulatory listings, then the
applicant's age, education and work experience are considered to determine whether there is any
substantial gainful activity existing in the national economy in which the applicant could engage.
This step is known as the evaluation of an individual's "residual functional capacity,"or what the
individual can still do in light of his/her impairment, age, education, and work experience. If the
individual is deemed unable to engage in his/her previous work, then a determination is made, taking
into account his/her impairment, age, education, and work experience, as to whether any other work
opportunities exist in the national economy that would be suitable for the applicant.
Disability Determination in this Case
In this case, Littlejohn was not engaged in substantial gainful activity at the time of her
application. The impairments listed in her application were hepatitis and diabetes. Additionally,
Littlejohn's medical records indicated cirrhosis of the liver and porphyria cutanea tarda. A disability
examiner and a physician on VR's staff evaluated clinical records of Littlejohn's treating physician
and a special laboratory report from Tuomey hospital. Based upon this evaluation, VR determined
that Littlejohn's impairments were not severe enough to cause her any restrictions in a work
environment. Based upon the medical evidence and the hearing testimony, the hearing officer also
found that Littlejohn was not disabled. Littlejohn appealed this decision to the Administrative Law
Judge Division, and this tribunal remanded the case to the hearing officer to receive additional
evidence previously unavailable to Littlejohn.
Upon remand, VR conducted a re-evaluation of Littlejohn's medical records, including the
additional records previously unavailable to her. A clinical psychologist and a board certified
internist on VR's staff reviewed all of the records and determined that Littlejohn did have two severe
impairments: (1) mental impairment (demential due to alcoholism and an antisocial personality
disorder); and (2) porphyria cutanea tarda ("PCT"). Because these impairments did not meet or equal
a listing in the federal regulations, VR's physicians conducted a residual functional capacity
evaluation to determine Littlejohn's capabilities in light of her impairments, age, education and work
experience.
The records indicated that at the time of her application, Littlejohn was 52 years of age and
held a GED and one and one-half years of junior college. She was previously employed as a live-in
caretaker, a driver, a waitress, a housekeeper, a telemarketer and a cashier. VR's physicians
determined that Littlejohn retained the ability to perform sedentary or light work, with duties which
can be learned in a short period of time and requiring only short, simple instructions. Based upon
the medical evidence, the evaluation of VR's physicians, and the hearing testimony, the hearing
officer found that Littlejohn was not disabled, as she was capable of performing light or sedentary
work.
Substantial evidence in the record supports the hearing officer's determination that Littlejohn
was not disabled on the date of her application.(2) The evidence shows that at the time of her
application, Littlejohn's diabetes was controllable with medication and diet and her liver function
was within normal ranges. Further, there is evidence indicating that Littlejohn's PCT could be
controlled by phlebotomy and would not restrict her ability to do light work. There is also evidence
indicating that Littlejohn's mental impairment would not prevent her from performing simple
unskilled work away from the general public.
I conclude that the hearing officer's final order is not clearly erroneous in view of the reliable,
probative and substantial evidence in the record as a whole. Therefore, the Department's decision
must be affirmed.
ORDER
IT IS THEREFORE ORDERED that the decision of the Department of Health and Human
Services is affirmed.
AND IT IS SO ORDERED.
______________________________
STEPHEN P. BATES
Administrative Law Judge
January 26, 1999
Columbia, South Carolina
1. In 1994, Littlejohn applied for Supplemental Security Income benefits. Her claim is still
pending with the Social Security Administration.
2. Any claim of a deteriorated condition after the date of application should be addressed by
a new application for Medicaid benefits. See Oliver v. Secretary of Health and Human Serv.,
804 F.2d 964 (6th Cir. 1986). |
