EFFECTIVE DATE: 03/24/86
AR 86-5(9): Leschniok v. Heckler, 713 F.2d 520 (9th Cir. 1983) Necessity of a Determination under Sections 225(b) and/or 1631(a)(6) of the Social Security Act for a Disability Benefits Recipient Engaged in an Approved Vocational Rehabilitation Program Prior to Cessation of His/Her Benefits Based on Medical Recovery -- Titles II and XVI of the Social Security Act
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
NINTH (ALASKA, ARIZONA, CALIFORNIA, GUAM, HAWAII, IDAHO, MONTANA, NEVADA, NORTHERN MARIANA ISLANDS, OREGON, WASHINGTON)
Leschniok v. Heckler, 713 F.2d 520 (9th Cir. 1983)
APPLICABILITY OF RULING:
- This ruling applies to determinations or decisions at all administrative levels (i.e., initial, reconsidera- tion, administrative law judge hearing and Appeals Council).
DESCRIPTION OF CASE:
William E. Leschniok, named plaintiff, has been receiving dis- ability benefits and was enrolled in an approved vocational rehabilitation (VR) program. He was found by the Secretary to have medically recovered and his disability benefits were termi- nated without a determination under section 225(b) of the Social Security Act, 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 ceased, if the individual is participating in an approved VR program and the Commissioner of Social Security determines that continuation of the program will increase the likelihood that the person may be permanently removed from the disability benefit rolls. Mr. Leschniok filed an administrative appeal of his benefit termination and following a hearing an administrative law judge (ALJ) found that he had improved medi- cally. The ALJ did not apply section 225(b). The decision of the ALJ was not administratively appealed. Mr. Leschniok, on behalf of himself and a class of others similarly ceased without section 225(b) determinations, filed an action in the district court requesting declaratory relief and preliminary and permanent injunctions restraining the Secretary from terminating disability benefits to individuals participating in vocational rehabilita- tion programs without first determining whether section 225(b) required that disability benefits be continued. The district court found jurisdiction and denied claimant's motion for a preliminary injunction. Claimants appealed to the Court of Appeals for the Ninth Circuit which reversed and remanded the case with instructions to grant the injunctive relief.
The circuit court held that the statutory language of section 225(b) of the Social Security Act expressly provides that disability benefit payments are to continue for an individual in a VR program if the Commissioner of Social Security determines that completion of the rehabilitation program will increase the likelihood that the claimant may be permanently removed from the disability benefit rolls. The Ninth Circuit held that the district court abused its discretion in failing to issue a preliminary injunction.
STATEMENT AS TO HOW LESCHNIOK DIFFERS FROM SOCIAL SECURITY POLICY:
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 programs even where there was reasonable expectation of recovery before the termina- tion of the program, but it was rather the intent of the provi- sion 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. There- fore, 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.
According to the circuit court in Leschniok, the stat- utes preclude the Secretary from terminating or suspending benefits upon cessation of an individual's disability 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.
EXPLANATION OF HOW SSA WILL APPLY THE DECISION WITHIN THE CIRCUIT:
This ruling applies only to cases involving the suspension or termination of disability benefits to an individual whose dis- ability 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 Alaska, Arizona, California, Guam, Hawaii, Idaho, Montana, Nevada, Northern Mariana Islands, Oregon or Washington 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 program will in- crease 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.
Date of Publication
 Since Mr. Leschniok's claim, as well as the claims of other class members, was for Title II disability benefits, the court dis- cussed only section 225(b), not 1631(a)(6). However, since the provisions are the same, the court's ruling would apply to Title XVI cases, as well as Title II cases.
 Since there is no SSI program in Guam, this Ruling will apply only to Social Security disability claims there.