Appeal from the Circuit Court of Pulaski County. No. 92-MR-15. Honorable George Oros, Judge Presiding.
The opinion of the court was delivered by: Chapman
JUSTICE CHAPMAN delivered the opinion of the court:
Azonia Parker applied for and was denied medical assistance by the Pulaski County Department of Public Aid. The denial was upheld after an administrative hearing before the Illinois Department of Public Aid (the Department) and an appeal to the circuit court. The issue before this court is whether the Department's decision to deny Azonia Parker medical assistance is against the manifest weight of the evidence. We affirm.
On September 26, 1991, plaintiff applied for medical assistance benefits. She reported that she is disabled, is unemployed, and has no income. At that time Azonia Parker was 55 years old and lived with her husband, aged 59, and two children, ages 19 and 24. The Pulaski County Department of Public Aid (the County Department) forwarded a determination-of-disability packet to its determinations review unit on October 22, 1991. Included in this packet was a letter from Dr. Steven Beatty, dated October 17, 1991, in which Dr Beatty wrote:
"[Parker] is suffering from * * * deep venous thrombosis. In addition, she has a chornic [sic] marked anxiety disorder with extreme lability of affect. Louise is capable of walking only short distances and because of her venous thrombosis disease cannot stan [sic] for any length of time. She is clearly unable to perform any meaningful work at this time. I do not expect this to improve any with therapy.
I am enclosing a copy of my previously filled out form. I understand it has been construed so as to imply that the patient was not disabled. Clearly this patient is unable to work at this time in any gainful way and any implication to the opposite is deeply regretted."
Also included in the determination-of-disability packet was a questionnaire completed by Dr. Beatty in which he diagnosed Parker as suffering from severe hypothyroidism, severe anemia, and deep venous thrombosis. Dr. Beatty reported that Parker was not confined to bed or chair and required no help in locomotion. He noted that she was only able to perform minimal self-help activities, but that her situation might improve in three to six months with treatment. The questionnaire contains no details about the date of onset of Parker's complaints, the duration of the conditions, and the current treatment for the conditions.
The determination-of-disability packet also included a form completed by Marla McAdoo, a County Department caseworker. McAdoo reported that Parker was currently ambulatory in her home only, but that she did not require the use of an appliance such as a cane or walker. McAdoo noted that Parker completed high school at the age of 20 and is a homemaker.
A third report included in the determination-of-disability packet is signed by a reviewing physician whose name is illegible. The report, dated November 11, 1991, states that the October 17, 1991, report was evaluated and that the records do not attest to conditions severe enough to result in 12 continuous months of disability. The reviewing physician found the hypothyroidism difficult to understand and believed that Parker would recover from the deep venous thrombosis within three to six months after treatment.
On November 27, 1991, plaintiff was notified that her application for medical assistance was denied on the ground that she did not meet the department's definition of disabled. Parker appealed this decision. In addition to those documents which were before the County Department, additional medical records pertaining to Parker were forwarded to the Illinois Department of Public Aid.
The additional medical records include reports of followup care Dr. Beatty rendered for Parker's hypothyroidism, anemia, and deep venous thrombosis, between August 12, 1991, and December 12, 1991. The medical records state that on October 15, 1991, the deep venous thrombosis and hypothyroidism were doing relatively well. The record states that at the December 12, 1991, office visit, Parker's leg was entirely normal with very minimal chronic edema.
Also included in the medical records are documents pertaining to Parker's July 26, 1991, through August 7, 1991, hospitalization: a discharge summary, a history and physical examination report, an x-ray report, and a report from an electrocardiogram taken July 26, 1991. Both the discharge summary and the history and physical examination report state that Parker was hospitalized because of pain and swelling in her right leg. It is stated that there was no definite evidence of deep venous thrombosis; however, such condition could not be definitively established or excluded because of the technical limitations of Parker's obesity which prevented examination of the veins in her legs. Parker was treated as though she had deep venous thrombosis. While hospitalized she was found to be profoundly hypothyroid. Her anemia was presumed to be due to hypothyroidism. Upon discharge, she was given medications and instructions regarding their use.
In a report dated February 21, 1991, a document signed by an unknown physician states that the medical reports are adequate. This physician concluded that Parker's hypothyroidism can be treated with medication and should not prevent her from working. The physician found that the deep vein thrombosis was successfully treated and that Parker shows no evidence of thrombophlebitis. The doctor noted that Parker has full ability to sit, bend, stoop, turn, and lift slight weights.
An administrative hearing was convened on April 1, 1992. The County Department's case consisted of the testimony of caseworker McAdoo. McAdoo identified Parker's application for medical assistance, the documents included in the determination of disability packets, and Parker's medical records. McAdoo testified that after Parker submitted her application for benefits, the determination review unit reviewed the medical records submitted and rendered its decision regarding Parker's ineligibility for medical assistance.
Azonia Parker testified that she is 55 years of age and five feet seven inches tall and weighs over 250 pounds. She received her GED in the 1960's. The last time she worked outside the home was in the 1960's when she worked for three months as a teacher's aide for the Head Start Program. Parker terminated her employment because her daughter was ill and required care. Parker testified that she has no income and that she and her husband live on his social security benefits, which total approximately $758 per month, and a union benefit of $48 per month.
Parker testified that she has a thyroid problem for which she takes one aspirin a day in place of blood thinner medication which the doctor discontinued. She experiences numbness and pain in her fingers and toes but did not report numbness in her hand to her physician. She cannot stand for more than 10 minutes at a time without her feet and legs swelling, and she requires assistance in ambulating. Parker believes she is presently unable to work because the doctor told her when she was discharged from the hospital in August of 1991 that she was not to do anything but light cooking and that she should sit occasionally and elevate her feet and legs. Parker did not state whether she was still under such orders from her physician at the time of the hearing.
She also testified that she experiences constant pain and swelling in her legs and hands. The pain radiates to her hips, knees, and arms, and the leg pain increases when she walks. She sits in a chair and lays down quite a bit at home to relieve her pain. She testified that she cannot sit comfortably in one spot for very long because it hurts her back and legs. Parker also testified that she experiences shortness of breath from walking around or getting nervous, but not when she is sitting and relaxing. She feels nervous and anxious quite often, but she has neither complained to a doctor nor received medical treatment for this condition.
Parker testified that she visits her doctor regularly and is currently taking aspirin and synthroid. She awakens at approximately 7:00 a.m. and retires for the evening at 5:30 or 6:00 p.m. She tosses and turns at night and sometimes will lay down for a few hours during the day. Parker prepares meals for the family, washes dishes once a day, and does the laundry. She testified that because of her condition she is unable to vacuum, scrub floors, dust, mop, or do yard work. She rarely reads but watches a lot of television. Parker's daughter drives Parker to the grocery store once every week or two.
Parker's landlord, Sammy Ulen, testified that he has known the Parkers for 10 years and has rented them their house for four years. Ulen testified that when the Parkers first moved into their house Alzonia was quite active. She would walk in the yard and do things around the house. During the past two years, however, Ulen has noticed a steady decline in Parker's activity. He sees Alzonia two to four times per month and has noticed that it takes her a long time to walk to the door when he knocks and that she no longer does much house or yard work.
On April 20, 1992, the Illinois Department of Public Aid issued its final administrative decision. This decision contained the hearing officer's findings of fact, which consisted largely of the medical information reviewed by the determinations review unit and brief summaries of the testimony taken at the hearing. The final administrative decision concluded that Azonia Parker did not prove that she is disabled, because the medical information failed to establish that she has any severe impairment which will last for the requisite minimum period of 12 months. Accordingly, the Department upheld the denial of Parker's application for medical assistance.
Parker filed a complaint for administrative review with the circuit court. The only issue identified for review before the circuit court was whether the final administrative decision was contrary to the manifest weight of the evidence. On March 15, 1993, the lower court affirmed the final administrative decision and found that the Department's finding was not against the manifest weight of the evidence. Parker raises two issues for our review: (1) whether the Department used the proper standards in determining disability, and (2) whether under the proper standards, substantial evidence supports the Department's finding that Parker was not disabled.
It is undisputed that applicants for the type of medical assistance sought here must be determined disabled as defined by the Social Security Administration (SSA). (See 305 ILCS 5/3-4 (West 1992).) The SSA defines disability:
"Disability [is] the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. To meet this definition, you must have a severe impairment, which makes you unable to do your previous work or any other substantial gainful activity which exists in the national economy. To determine whether you are able to do any other work, we consider your residual functional capacity and your age, education, and work experience." (20 C.F.R. sec. 404.1505 (1988).)
In evaluating disability, the SSA follows the procedure set out at 20 C.F.R. sec. 416.920 (1988). Basically this ...