[Federal Register Volume 62, Number 232 (Wednesday, December 3, 1997)]
[Notices]
[Pages 64038-64039]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-31591]
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SOCIAL SECURITY ADMINISTRATION
[Social Security Acquiescence Ruling 97-4(9)]
Chavez v. Bowen; Effect of a Prior Final Decision That a Claimant
is Not Disabled, And of Findings Contained Therein, On Adjudication of
a Subsequent Disability Claim Arising Under the Same Title of the
Social Security Act--Titles II and XVI of the Social Security Act
AGENCY: Social Security Administration.
ACTION: Notice of Social Security Acquiescence Ruling.
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SUMMARY: In accordance with 20 CFR 402.35(b)(2), the Acting
Commissioner of Social Security gives notice of Social Security
Acquiescence Ruling 97-4(9).
EFFECTIVE DATE: December 3, 1997.
FOR FURTHER INFORMATION CONTACT:
Gary Sargent, Litigation Staff, Social Security Administration, 6401
Security Boulevard, Baltimore, MD 21235, (410) 965-1695.
SUPPLEMENTARY INFORMATION: Although not required to do so pursuant to 5
U.S.C. 552(a)(1) and (a)(2), we are publishing this Social Security
Acquiescence Ruling in accordance with 20 CFR 402.35(b)(2).
A Social Security Acquiescence Ruling explains how we will apply a
holding in a decision of a United States Court of Appeals that we
determine conflicts with our interpretation of a provision of the
Social Security Act (the Act) or regulations when the Government has
decided not to seek further review of that decision or is unsuccessful
on further review.
We will apply the holding of the Court of Appeals decision as
explained in this Social Security Acquiescence Ruling to claims at all
levels of administrative adjudication within the Ninth Circuit. This
Social Security Acquiescence Ruling will apply to all determinations
and decisions made on or after December 3, 1997. If we made a
determination or decision on your application for benefits between
April 19, 1988, the date of the Court of Appeals decision, and December
3, 1997, the effective date of this Social Security Acquiescence
Ruling, you may request application of the Ruling to your claim if you
first demonstrate, pursuant to 20 CFR 404.985(b) or 416.1485(b), that
application of the Ruling could change our prior determination or
decision.
If this Social Security Acquiescence Ruling is later rescinded as
obsolete, we will publish a notice in the Federal Register to that
effect as provided for in 20 CFR 404.985(e) or 416.1485(e). If we
decide to relitigate the issue covered by this Social Security
Acquiescence Ruling as provided for by 20 CFR 404.985(c) or
416.1485(c), we will publish a notice in the Federal Register stating
that we will apply our interpretation of the Act or regulations
involved and explaining why we have decided to relitigate the issue.
(Catalog of Federal Domestic Assistance Program Nos. 96.001 Social
Security - Disability Insurance; 96.002 Social Security - Retirement
Insurance; 96.004 Social Security - Survivors Insurance; 96.005
Special Benefits for Disabled Coal Miners; 96.006 Supplemental
Security Income.)
Dated: September 17, 1997.
John J. Callahan,
Acting Commissioner of Social Security.
Acquiescence Ruling 97-4(9)
Chavez v. Bowen, 844 F.2d 691 (9th Cir. 1988)--Effect of a Prior
Final Decision That a Claimant is Not Disabled, And of Findings
Contained Therein, On Adjudication of a Subsequent Disability Claim
Arising Under the Same Title of the Social Security Act--Titles II and
XVI of the Social Security Act.
Issue: Whether, in making a disability determination or decision on
a subsequent disability claim with respect to an unadjudicated period,
where the claim arises under the same title of the Social Security Act
(the Act) as a prior claim on which there has been a final decision by
an Administrative Law Judge (ALJ) or the Appeals Council that the
claimant is not disabled, the Social Security Administration
(SSA)1 must: (1) apply a presumption of continuing
nondisability and, if the presumption is not rebutted by the claimant,
determine that the claimant is not disabled; and (2) if the presumption
is rebutted, adopt certain findings required under the applicable
sequential evaluation process for determining disability, made in the
final decision by the ALJ or the Appeals Council on the prior
disability claim.2
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\1\ Under the Social Security Independence and Program
Improvements Act of 1994, Pub. L. No. 103-296, effective March 31,
1995, SSA became an independent Agency in the Executive Branch of
the United States Government and was provided ultimate
responsibility for administering the Social Security and
Supplemental Security Income programs under titles II and XVI of the
Act. Prior to March 31, 1995, the Secretary of Health and Human
Services had such responsibility.
\2\ Although Chavez was a title II case, similar principles also
apply to title XVI. Therefore, this Ruling extends to both title II
and title XVI disability claims.
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Statute/Regulation/Ruling Citation: Sections 205(a) and 702(a)(5)
of the Social Security Act (42 U.S.C. 405(a) and 902(a)(5)), 20 CFR
404.900, 404.957(c)(1), 416.1400, 416.1457(c)(1).
Circuit: Ninth (Alaska, Arizona, California, Guam, Hawaii, Idaho,
Montana, Nevada, Northern Mariana Islands, Oregon, Washington)
Chavez v. Bowen, 844 F.2d 691 (9th Cir. 1988)
Applicability of Ruling: This Ruling applies to determinations or
decisions at all administrative levels (i.e., initial, reconsideration,
ALJ hearing and Appeals Council).
Description of Case: Mr. Chavez first applied for disability
insurance benefits on June 1, 1982. On March 30, 1983, an ALJ awarded
Mr. Chavez a closed period of disability from March 3, 1981, through
May 1982. In determining that disability had ended, the ALJ found that,
although Mr. Chavez could not perform his past relevant work, he was
able to engage in a wide range of at least light substantial gainful
activity. Mr. Chavez did not appeal this decision. Therefore, it became
final and binding.
On July 18, 1983, Mr. Chavez filed another application for
disability insurance benefits. In a decision dated May 10, 1984, an ALJ
found that Mr. Chavez could perform work-related activities except for
work involving constant standing, walking, and lifting, and carrying
more than 20 pounds. The ALJ then found that Mr. Chavez's past work as
a backhoe operator did not require excessive standing and lifting and
that his impairments therefore did not prevent him from resuming his
past work. The decision made no reference to the findings of the first
ALJ. This decision became the final decision of the Secretary.
Upon appeal, the district court granted the Secretary's motion for
summary judgment. The district court found that substantial evidence
supported the finding that the claimant could perform light work and,
therefore, was not disabled. Mr. Chavez appealed this decision to the
United States Court of Appeals for the Ninth Circuit.
Holding: The Ninth Circuit stated that:
The principles of res judicata apply to administrative decisions,
although the doctrine is applied less rigidly to administrative
proceedings than to judicial proceedings. The claimant, in order to
overcome the presumption of continuing nondisability arising from the
first administrative law judges's findings of nondisability, must prove
``changed circumstances'' indicating a greater disability. (Citations
omitted.)
The court then found that Mr. Chavez's ``attainment of `advanced
age' constitutes a changed circumstance precluding the application of
res
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judicata to the first administrative law judge's ultimate finding
against disability.'' In addition, the court concluded that ``[t]he
first administrative law judge's findings concerning the claimant's
residual functional capacity, education, and work experience are
entitled to some res judicata consideration in subsequent
proceedings.''
Statement As To How Chavez Differs From Social Security Policy
Under SSA policy, if a determination or decision on a disability
claim has become final, the Agency may apply administrative res
judicata with respect to a subsequent disability claim under the same
title of the Act if the same parties, facts and issues are involved in
both the prior and subsequent claims. However, if the subsequent claim
involves deciding whether the claimant is disabled during a period that
was not adjudicated in the final determination or decision on the prior
claim, SSA considers the issue of disability with respect to the
unadjudicated period to be a new issue that prevents the application of
administrative res judicata. Thus, when adjudicating a subsequent
disability claim involving an unadjudicated period, SSA considers the
facts and issues de novo in determining disability with respect to the
unadjudicated period. SSA does not adopt findings from the final
determination or decision on the prior disability claim in determining
whether the claimant is disabled with respect to the unadjudicated
period. Further, under SSA policy, a prior final determination or
decision that a claimant is not disabled does not give rise to any
presumption of a continuing condition of nondisability. When a
subsequent claim involves an unadjudicated period, the determination or
decision as to whether a claimant is disabled with respect to that
period is made on a neutral basis, without any inference or presumption
that a claimant remains ``not disabled.''
The United States Court of Appeals for the Ninth Circuit held that
a final decision by an ALJ that a claimant is not disabled gives rise
to a presumption that the claimant continues to be not disabled after
the period adjudicated, and that this presumption of continuing
nondisability applies when adjudicating a subsequent disability claim
with an unadjudicated period arising under the same title of the Act as
the prior claim. In order to rebut the presumption of continuing
nondisability, a claimant must prove ```changed circumstances'
indicating a greater disability.'' In addition, the court indicated
that where the claimant rebuts the presumption by proving a ``changed
circumstance,'' principles of res judicata require that certain
findings contained in the final decision by the ALJ on the prior claim
be given some res judicata consideration in determining whether the
claimant is disabled with respect to the unadjudicated period involved
in the subsequent claim. The court concluded that where the final
decision by the ALJ on the prior claim, which found the claimant not
disabled, contained findings of the claimant's residual functional
capacity, education, and work experience, SSA may not make different
findings in adjudicating the subsequent disability claim unless there
is new and material evidence relating to the claimant's residual
functional capacity, education or work experience.
Explanation of How SSA Will Apply The Chavez Decision Within The
Circuit
This Ruling applies only to disability cases involving claimants
who reside in Alaska, Arizona, California, Guam, Hawaii, Idaho,
Montana, Nevada, Northern Mariana Islands, Oregon or Washington at the
time of the determination or decision on the subsequent claim at the
initial, reconsideration, ALJ hearing or Appeals Council level. It
applies only to cases involving a subsequent disability claim with an
unadjudicated period arising under the same title of the Act as a prior
claim on which there has been a final decision by an ALJ or the Appeals
Council that the claimant is not disabled.
When adjudicating the subsequent claim involving an unadjudicated
period, adjudicators will apply a presumption of continuing
nondisability and determine that the claimant is not disabled with
respect to that period, unless the claimant rebuts the presumption. A
claimant may rebut the presumption by showing a ``changed
circumstance'' affecting the issue of disability with respect to the
unadjudicated period, e.g., a change in the claimant's age category
under 20 CFR 404.1563 or 416.963, an increase in the severity of the
claimant's impairment(s), the alleged existence of an impairment(s) not
previously considered, or a change in the criteria for determining
disability.
If the claimant rebuts the presumption, adjudicators then must give
effect to certain findings, as explained below, contained in the final
decision by an ALJ or the Appeals Council on the prior claim, when
adjudicating the subsequent claim. For this purpose, this Ruling
applies only to a finding of a claimant's residual functional capacity,
education, or work experience, or other finding required at a step in
the sequential evaluation process for determining disability provided
under 20 CFR 404.1520, 416.920 or 416.924, or a finding required under
the evaluation process for determining disability provided under 20 CFR
404.1578, as appropriate, which was made in the final decision on the
prior disability claim. Adjudicators must adopt such a finding from the
final decision on the prior claim in determining whether the claimant
is disabled with respect to the unadjudicated period unless there is
new and material evidence relating to such a finding or there has been
a change in the law, regulations or rulings affecting the finding or
the method for arriving at the finding.
[FR Doc. 97-31591 Filed 12-2-97; 8:45am]
BILLING CODE 4190-29-F
