[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)<SUP>1</SUP> 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.<SUP>2</SUP>
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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