[Federal Register Volume 59, Number 129 (Thursday, July 7, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-16418]
[[Page Unknown]]
[Federal Register: July 7, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Social Security Administration
Social Security Acquiescence Ruling 94-2(4)--Lively v. Secretary
of Health and Human Services, 820 F.2d 1391 (4th Cir. 1987)--Effect of
Prior Disability Findings 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, HHS.
ACTION: Notice of Social Security Acquiescence Ruling.
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SUMMARY: In accordance with 20 CFR 422.406(b)(2) published January 11,
1990 (55 FR 1012), the Commissioner of Social Security gives notice of
Social Security Acquiescence Rule 94-2(4).
EFFECTIVE DATE: July 7, 1994.
FOR FURTHER INFORMATION CONTACT:
Gary Sargent, Litigation Staff, Social Security Administration, 6401
Security Blvd., 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 422.406(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 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 Fourth Circuit. This
Social Security Acquiescence Ruling will apply to all determinations
and decisions made on or after July 7, 1994. If we made a determination
or decision on your application for benefits between June 29, 1987, the
date of the Court of Appeals' decision and July 7, 1994, the effective
date of this Social Security Acquiescence Ruling, you may request
application of the Social Security Acquiescence 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 Programs Nos. 93.802 Social
Security-Disability Insurance; 93.803 Social Security-Retirement
Insurance; 93.805 Social Security-Survivors Insurance; 93.806-
Special Benefits for Disabled Coal Miners; 93.807-Supplemental
Security Income.)
Dated: May 11, 1994.
Shirley S. Chater,
Commissioner of Social Security.
Acquiescence Ruling 94-2(4)
Lively v. Secretary of Health and Human Services, 820 F.2d 1391
(4th Cir. 1987)--Effect of Prior Disability Findings 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, an
adjudicator must adopt a finding regarding a claimant's residual
functional capacity, or other finding required under the applicable
sequential evaluation process for determining disability, made in a
final decision by an Administrative Law Judge or the Appeals Council on
a prior disability claim arising under the same title of the Social
Security Act.*
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*Although Lively 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
Section 205(a) and (h) and 1102 of the Social Security Act (42
U.S.C. 405(a) and (h) and 1302), 20 CFR 404.955, 404.957(c)(1),
404.981, 416.1455, 416.1457(c)(1), 416.1481.
Circuit
Fourth (Maryland, North Carolina, South Carolina, Virginia, West
Virginia) Lively v. Secretary of Health and Human Services, 820 F.2d
1391 (4th Cir. 1987).
Applicability of Ruling
The Ruling applies to determinations or decisions at all levels of
the administrative review process (i.e., initial, reconsideration,
Administrative Law Judge hearing and Appeals Council).
Description of Case
In a decision dated October 19, 1981, an Administrative Law Judge
found that the plaintiff, Mr. Lively, was not disabled under Rule
202.10 of the medical-vocational guidelines, 20 CFR Part 404, Subpart
P, Appendix 2, and denied his application for disability insurance
benefits. In applying Rule 202.10, the Administrative Law Judge found
that Mr. Lively had the residual functional capacity for light work.
The decision that Mr. Lively was not entitled to disability insurance
benefits became the final decision of the Secretary and was affirmed by
the district court.
The plaintiff filed a second application for disability insurance
benefits on December 14, 1983. After holding a hearing, an
Administrative Law Judge concluded that the plaintiff was not entitled
to disability insurance benefits. The Administrative Law Judge
determined that Mr. Lively retained the functional capacity for the
performance of work activity of any exertional level on and prior to
December 31, 1981, the date his insured status expired. The
Administrative Law Judge did not discuss in his decision the 1981
finding by another Administrative Law Judge that the plaintiff had the
residual functional capacity to do only light work. This decision
became the final decision of the Secretary and was appealed to the
district court. The case was referred to a United States Magistrate who
found that the evidence before the Administrative Law Judge on the
plaintiff's 1983 application was sufficient to sustain the Secretary's
decision that the plaintiff was not disabled as of December 31, 1981.
The district court adopted the Magistrate's Report and Recommendation.
Mr. Lively then appealed to the United States Court of Appeals for the
Fourth Circuit.
Holding
The Fourth Circuit stated that:
Congress has clearly provided by statute that res judicata
prevents reappraisal of both the Secretary's findings and his
decision in Social Security cases that have become final, 42 U.S.C.
Sec. 405(h), and the courts have readily applied res judicata to
prevent the Secretary from reaching an inconsistent result in a
second proceeding based on evidence that has already been weighed in
a claimant's favor in an earlier proceeding.
The court noted that the plaintiff became 55 years of age two weeks
after the Administrative Law Judge, in connection with the first
application for benefits, found that Mr. Lively was limited to light
work. The court further noted that a person with the plaintiff's
education and vocational background who is 55 years of age or older and
limited to light work would be considered disabled under Rule 202.02 of
the medical-vocational guidelines, 20 CFR Part 404, Subpart P, Appendix
2. The court found it inconceivable that Mr. Lively's condition had
improved so much in two weeks as to enable him to perform medium work.
Accordingly the court held:
Principles of finality and fundamental fairness * * * indicate
that the Secretary must shoulder the burden of demonstrating that
the claimant's condition had improved sufficiently to indicate that
the claimant was capable of performing medium work. * * *
[E]vidence, not considered in the earlier proceeding, would be
needed as an independent basis to sustain a finding contrary to the
final earlier finding.
Statement as to How Lively Differs From SSA 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.
The United States Court of Appeals for the Fourth Circuit concluded
that where a final decision of the Secretary after a hearing on a prior
disability claim contained a finding about a claimant's residual
functional capacity, the Secretary may not make a different finding in
adjudicating a subsequent disability claim with an unadjudicated period
arising under the same title of the Act as the prior claim unless there
is new and material evidence relating to the claimant's residual
functional capacity.
Explanation of How SSA Will Apply the Decision Within the Circuit
This Ruling applies only to disability findings in cases involving
claimants who reside in Maryland, North Carolina, South Carolina,
Virginia, or West Virginia at the time of the determination or decision
on the subsequent claim at the initial, reconsideration, Administrative
Law Judge hearing or Appeals Council level. It applies only to a
finding regarding a claimant's residual functional capacity 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 a final decision by an Administrative Law Judge or
the Appeals Council on a prior disability claim. When adjudicating a
subsequent disability claim with an unadjudicated period arising under
the same title of the Act as the prior claim, adjudicators must adopt
such a finding from the final decision by an Administrative Law Judge
or the Appeals Council 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.
[FR Doc. 94-16418 Filed 7-6-94; 8:45 am]
BILLING CODE 4190-29-M
