Fabel v. Shalala
| Decision Date | 03 July 1995 |
| Docket Number | Civ. A. No. 93-5160. |
| Parties | Jacqueline FABEL, Plaintiff, v. Donna E. SHALALA Secretary of Health and Human Services, Defendant. |
| Court | U.S. District Court — District of New Jersey |
Polonsky & Polonsky, P.C. by Alan H. Polonsky, Audubon, NJ, for plaintiff.
U.S. Attys. Office by Susan J. Steele, Sp. Asst. U.S. Atty., Newark, NJ, for defendant.
Claimant Jacqueline Fabel brought this action pursuant to 42 U.S.C. § 405(g) (1991) of the Social Security Act (the "Act") for review of a final determination by the Secretary of Health and Human Services ("the Secretary") denying her application for disability insurance benefits. Because the Court finds that the Social Security Ruling on which the Secretary relied to reach its conclusion is inconsistent with the plain language of the Act, the Secretary's decision is reversed.
Claimant was born on April 13, 1938. (R. at 28) On July 8, 1991, she applied for disability insurance benefits, alleging that as of December 25, 1990, her multiple sclerosis, (R. at 28), precluded her from engaging in "substantial gainful activity" as that term is used in the Act. (R. at 25). See 20 C.F.R. § 404.1572. On July 31, 1991, approximately three weeks after applying for benefits and before her award of benefits was approved, (R. at 17), claimant returned to work. (R. at 146). During the period she was working, she earned over $1000 a month. (R. at 30) On March 20, 1992, she stopped working due to difficulties connected with her multiple sclerosis. (R. at 146). On October 10, 1991, the Social Security Administration ("the SSA"), determined that claimant was disabled from the period commencing December 25, 1990. (R. at 14, 28). Claimant was deemed conclusively disabled from the beginning of this period because her multiple sclerosis met the Listing of Impairments, Medical List Number 11.09.1 (R. at 28). See 20 C.F.R. App. 1, Subpart P, Regulations No. 4; 20 C.F.R. § 404.1520(d).
On May 1, 1992, the SSA revised its original determination and changed claimant's disability onset date from December 25, 1990, to March 20, 1992. (R. at 30). The SSA based this determination on the claimant's work activity from July 31, 1991, through March 19, 1992. (R. at 18). The SSA upheld this determination upon reconsideration. (R. at 35).
On September 9, 1992, claimant requested a hearing before an Administrative Law Judge ("ALJ"), contending that her work activity between July 31, 1991, and March 19, 1992, should have been considered a "trial work period" pursuant to 42 U.S.C. § 422(c), and that the original disability onset date of December 25, 1990, should be reinstated. (R. at 44). The claimant did not contest the SSA's evaluation of the facts, but rather challenged the decision on purely legal grounds. (R. at 146). She therefore waived her right to admit additional testimony and requested a decision based solely on the evidence of record. (R. at 14, 146).
On May 5, 1993, the ALJ heard argument on the case and denied claimant's request to reinstate the SSA's original determination of a December 25, 1990, disability onset date. (R. at 18). The ALJ, in making his decision, relied on the SSA's interpretation of the Act in Social Security Ruling ("SSR") 82-52 and Social Security Acquiescence Ruling ("AR") 92-6(10). SSR 82-52 held that a claimant is not entitled to a trial work period and must be denied benefits if she engages in work activity either before approval of a disability insurance award or before twelve months have elapsed since her disability onset date. AR 92-6(10) limited certain appellate court cases rejecting SSR 82-52 to their respective Circuits. The ALJ's ruling became the final decision of the Secretary when, on October 22, 1993, the Appeals Council denied plaintiff's request for review. (R. at 4-5). Claimant sought review of the Secretary's decision by this Court through a Complaint filed on November 23, 1993. See 5 U.S.C. § 706; 42 U.S.C. § 405(g).
The Act defines "disability" as an "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death ... or which ... can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 423(d)(1)(A) (1991) (emphasis added). The beginning of this twelve month period is referred to as the disability onset date. See 3 Social Security: Law and Practice, § 44:134 at 112. In order for work activity to be regarded as substantial gainful activity, it must be both substantial and gainful. See 20 C.F.R. § 404.1572. "Substantial work activity is work activity that involves doing significant physical or mental activities," 20 C.F.R. § 404.1572(a), and "gainful work activity is work activity that is ... usually done for pay or profit, whether or not a profit is realized." 20 C.F.R. § 404.1572(b).
Under the Act, an individual who meets four statutory conditions2 becomes "entitled to a disability insurance benefit (i) for each month beginning with the first month after his waiting period (as defined in subsection (c)(2) of this section) in which he becomes so entitled to such insurance benefits...." 42 U.S.C. § 423(a)(1). The statute defines waiting period as "the earliest period of five consecutive calendar months (A) throughout which the individual with respect to whom such application is filed has been under a disability...." 42 U.S.C. § 423(c)(2).
Under § 423(a)(1) an individual is therefore "entitled" to benefits five months after the date that her disability commences, regardless of when the SSA formally awards her a disability insurance benefit. For example, the SSA may not formally approve an award for months or even years after the application is filed, but the claimant is still entitled to benefits starting five months after the disability onset date determined by the SSA regardless of the date of the award. Indeed, after it makes a disability determination, the SSA must pay the claimant a maximum of one year's "pre-filing" retrospective benefits. 20 C.F.R. § 404.621(a)(1).
An individual who is "entitled" to disability insurance benefits may also engage in a trial work period. 42 U.S.C. § 422(c)(3). During this period, the disabled person "may perform services in as many as nine months, but these months do not have to be consecutive." 20 C.F.R. § 404.1592(e). The trial work period begins "with the month in which an individual ... becomes entitled to disability insurance benefits," 42 U.S.C. § 422(c)(3), and "ends with the close of ... the ninth month, beginning on or after the first day of such period, in which the individual renders services (whether or not such services are consecutive)." 42 U.S.C. § 422(c)(3). However, the trial work period cannot begin before the claimant files her application for benefits regardless of the alleged disability onset date. 20 C.F.R. § 404.1592(e). The purpose of the trial work period is to give the disabled person an opportunity to test her "ability to work and still be considered disabled." 20 C.F.R. § 404.1592(a). Hence, "any services rendered by an individual during a period of trial work is ... deemed not to have been rendered by such individual in determining whether his disability has ceased." 42 U.S.C. § 422(c)(2).
In short, under the Act, an individual becomes entitled to a trial work period at the same time she becomes entitled to a disability insurance benefit award, five months after her disability onset date. Therefore, while the Act defines a "disability" as an impairment which "can be expected to last for ... 12 months", 42 U.S.C. § 423(d)(1)(A), the Act also appears to entitle a claimant to a trial work period beginning five months after the alleged disability onset date, regardless of whether 12 months have passed.
In reviewing a final determination of the Secretary, her findings of fact that are supported by "substantial evidence" are conclusive. 42 U.S.C. § 405(g)(1991). However, because "the judiciary is the final interpreter of the Social Security Act," this Court reviews de novo whether the Secretary has applied the correct legal standards. Friedberg v. Schweiker, 721 F.2d 445, 447 (3rd Cir.1983).
The SSA originally found that in June of 1991, when she filed her application for disability insurance benefits, claimant expected to be unable to perform substantial gainful activity for a continuous period of not less than 12 months, beginning with her disability onset date of December 25, 1990. Claimant did not engage in any substantial gainful activity for more than five months after December 25, 1990, but rather did not begin working until July 31, 1991. Therefore, this Court need only decide whether the ALJ was correct in using claimant's work activity from July 31, 1991, to March 19, 1992, to establish that claimant was not disabled until March 20, 1992. We find that the ALJ was incorrect because the claimant's work activity from the period July 31, 1991, through March 19, 1992, constituted a trial work period within the meaning of the Act.
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