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Administrative Law Court
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SC Administrative Law Court Decisions

CAPTION:
Shirley Faye Littlejohn vs. SCDHHS

AGENCY:
South Carolina Department of Health and Human Services

PARTIES:
Petitioners:
Shirley Faye Littlejohn

Respondents:
South Carolina Department of Health and Human Services
 
DOCKET NUMBER:
98-ALJ-08-0443-AP

APPEARANCES:
Charles Black, Esquire, for Respondent
 

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).


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