EFFECTIVE DATE: 03/24/86
Whether a disability benefits recipient, who was expected to recover and despite evidence that his/her medical condition was no longer disabling, is entitled to a determination under Sections 225(b) and/or 1631(a)(6) of the Social Security Act prior to cessation of his/her benefits, when the recipient is engaged in an approved vocational rehabilitation program.
Sections 225(b) and 1631(a)(6) of the Social Security Act (42 U.S.C. Sections 425(b) and 1383(a)(6)); 20 C.F.R. 404.316(c), 404.337(c), 404.352(c), 404.1586(f), 404.1596(c), 416.1321(d), 416.1338
THIRD (DELAWARE, NEW JERSEY, PENNSYLVANIA, VIRGIN ISLANDS)
Paskel v. Heckler, 768 F.2d 540 (3d Cir. 1985)
Judith Paskel applied for supplemental security income (SSI) benefits in June 1979 and was found to be disabled due to epilepsy. The Pennsylvania State Agency placed Ms. Paskel on its "diary system." In May 1981, Ms. Paskel enrolled in a state- approved vocational rehabilitation (VR) program. Pursuant to her diary schedule, she was reexamined in February 1982, and was found to have medically recovered. Her SSI benefits were terminated without a determination under section 1631(a)(6) of the Social Security Act (contained prior to codification in section 301 of the Social Security Disability Amendments of 1980), which provides that payment to an individual of benefits based on disability shall not be terminated or suspended because the impairment, on which the individual's eligibility was based, has or may have ceased, if the individual is participating in an approved VR program and the Commissioner of Social Security determines that the completion or specified continuation of such program will increase the likelihood that the individual may be permanently removed from the disability benefit rolls. Ms. Paskel filed an administrative appeal on the issue of recovery and following a hearing an administrative law judge (ALJ) found that Ms. Paskel's seizure disorder was under control. Ms. Paskel sought review of the ALJ's decision by the Appeals Council raising the claims that she was denied a section 301 determination and that she remained disabled. The Appeals Council denied Ms. Paskel's request for review. Ms. Paskel, on behalf of herself and a class of disability recipients residing in Pennsylvania and who were similarly denied section 301 determinations under Titles II and XVI, appealed the denial to the Federal district court. The district court granted summary judgment for Ms. Paskel and the class, holding that the portions of the regulations relied on by the Secretary of Health and Human Services in failing to make section 301 determinations were invalid. The Secretary appealed to the Court of Appeals for the Third Circuit, defending the validity of her regulations. The Third Circuit Court of Appeals affirmed the orders of the district court and remanded the case for further consideration.
The circuit court held that the statutory language of sections 225(b) and 1631(a)(6) of the Social Security Act unambiguously provides that disability benefit payments are to continue for an individual in a VR program if the Commissioner makes the required determination that continuation or completion of the approved program is likely to enable the individual to be permanently removed from the disability benefits rolls and that it followed that benefits to an individual enrolled in a VR program may not be terminated until such a determination had been made. The Secretary's promulgation of regulations (including 20 C.F.R. 404.1586(f) and 416.1338(a)) requiring that an individual, in order to be entitled to a 301 determination, must not have been expected to recover medically before the completion of the VR program at the time he/she began the program, was found invalid. The court noted that the effect of such an interpretation was that a disability recipient, such as Ms. Paskel, who was "diaried" would never be entitled to a 301 determination because by definition persons on the diary system were expected to recover. The Third Circuit further held that while the legislative history created some ambiguity about congressional intent regarding the issue, it was not sufficiently persuasive to overcome the specific language of the statute.
In preparing the regulations to implement sections 225(b) and 1631(a)(6) of the Social Security Act, the Social Security Administration (SSA) was guided by the intent of Congress as expressed in the legislative history of Section 301 of the Social Security Disability Amendments of 1980 (contained in sections 225(b) and 1631(a)(6)). The conference committee had stated that it was not the intent of the provision to continue benefits to individuals permitted to enter approved VR program even where there was reasonable expectation of recovery before the termination of the program, but it was rather the intent of the provision to consider only those exceptional cases where the disabled beneficiary was not expected at the beginning of the program to recover medically before the end of the program but did. Therefore, according to SSA's regulations implementing sections 225(b) and 1631(a)(6) of the Social Security Act, only individuals, who at the beginning of their participation in VR programs were not expected to recover medically before scheduled completion dates, were entitled to section 301 determinations prior to benefit termination when their impairments were no longer disabling. 20 C.F.R. 404.316(c), 404.337(c), 404.352(c), 404.1586(f), 404.1596(c), 416.1321(d), 416.1338.
The circuit court in Paskel held that the regulation impermissibly added a requirement to continuation of disability benefits that was neither expressly nor implicitly contained in section 301 of the Social Security Disability Amendments of 1980 (codified at 42 U.S.C. sections 425(b) and 1383(a)(6)). According to the court, the statutes preclude the Secretary from terminating or suspending benefits upon cessation of an individual's disability, regardless of whether medical recovery was expected, if the individual is participating in an approved VR program and the Commissioner of Social Security determines that the completion of such program will increase the likelihood that such individual may be permanently removed from the disability benefit rolls.
This ruling applies only to cases involving the suspension or termination of disability benefits to an individual whose disability has ceased and who was, at the time of the suspension or termination, or who is participating in an approved VR program and who resides in Delaware, New Jersey, Pennsylvania or the Virgin Islands at the time of the determination or decision at any level of administrative review, i.e., initial, reconsideration, administrative law judge hearing or Appeals Council review.
Disability benefits to such an individual cannot be terminated or suspended if the individual is participating in an approved VR program and the Commissioner of Social Security determines that specified continuation or completion of such programs will increase the likelihood that such individual may be permanently removed from the disability benefit rolls. Such a "likelihood determination" must be made for the above described individual regardless of whether at the time he/she began the VR program his/her medical recovery was expected prior to the completion date.
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