Trujillo v. Heckler, Civ. A. No. 82-K-1505.

• Decision Date: 16 August 1983
• Docket Number: Civ. A. No. 82-K-1505.
• Citation: 569 F. Supp. 631
• Parties: John TRUJILLO, et al., Plaintiffs, v. Margaret HECKLER, Secretary, Department of Health and Human Services, Defendant.
• Court: U.S. Court of Appeals — Seventh Circuit

569 F. Supp. 631

John TRUJILLO, et al., Plaintiffs, v. Margaret HECKLER, Secretary, Department of Health and Human Services, Defendant.

Civ. A. No. 82-K-1505.

United States District Court, D. Colorado.

August 16, 1983.

Linda J. Olson and Michael J. Steiner, Legal Aid Soc. of Metropolitan Denver, Denver, Colo., for plaintiffs and some plaintiffs-intervenors.

Daniel M. Taubman, Colorado Coalition of Legal Service Programs, Denver, Colo., R. Eric Solem, Pikes Peak Legal Services, Colorado Springs, Colo., Carol Glowinsky, Legal Aid & Defender Program, Boulder, Colo., for all plaintiffs.

Bernard A. Poskus, Colorado Rural Legal Services, Grand Junction, Colo., for Rother.

William Redak, Jr., Longmont, Colo., for Gypin.

John G. Detmer, Denver, Colo., for Fontaine.

John R. Barksdale, Asst. U.S. Atty., Denver, Colo., for defendant.

ORDER GRANTING SUMMARY JUDGMENT

KANE, District Judge.

This case comes before me on cross-motions for partial summary judgment. At issue is whether the secretary may terminate social security disability benefits (SSDI) and supplemental security income benefits (SSI) without first finding a material medical improvement¹ in the recipient's condition or without giving a presumptive effect to the earlier determination of disability. In an earlier ruling I certified this case as a class action and denied the secretary's motion to dismiss for lack of jurisdiction.

The named plaintiffs are residents of Colorado. All are or were receiving Title II (SSDI) benefits or Title XVI (SSI) benefits pursuant to 42 U.S.C. § 401 et seq. and 42 U.S.C. § 1381 et seq., respectively. Some background on the Social Security Act is useful to the discussion which follows.

The social security disability program was enacted in 1956 as an insurance program to compensate individuals so disabled as to be unable to engage in any substantial work activity. As originally passed, the projected cost of the program was "modest." Congress felt it could be financed "over its entire future history by a tax rate of less than one-half of one percent." 128 Cong. Rec. S13120 (daily ed. Oct. 1, 1982) (remarks of Sen. Long). The cost of the program escalated rapidly, from 59 million dollars in 1956 to an estimated 18.5 billion in 1982. Id. Likewise, the number of disabled workers and beneficiaries rose from 149,850 in 1956 to an estimated 4,374,000 in 1982. Id.

Faced with an expensive and nearly unmanageable program, congress passed a series of amendments in 1980 designed to slow or halt the burgeoning number of beneficiaries. Social Security Disability Amendments Act of 1980, P.L. No. 96-265, 94 Stat. 441, codified in part at 42 U.S.C. § 421(h). The 1980 amendments authorized the secretary to review previously granted SSDI and SSI benefits to determine whether the recipients were still disabled. 42 U.S.C. § 421(h)(1). Under federal regulations interpreting the organic act as not requiring there to be medical improvement in the claimant's disability before termination,² the secretary began to review and terminate previously granted benefits in 1981.

The secretary was more successful at eliminating recipients than congress had anticipated. Instead of the 20 percent termination rate projected by the Social Security Administration, benefit terminations exceeded 40 percent.³ 128 Cong.Rec. S7558 (daily ed. June 24, 1982). In 1979 and 1980 the Social Security Administration reviewed 160,000 cases for continuing eligibility. The number rose to 357,000 in 1981, and to an estimated 567,000 and 840,000 in 1982 and 1983, respectively. Congress and the review process came under fire as a result. Particularly irksome was the fact that approximately 65 percent of the cases appealed to administrative law judges were reversed. 128 Cong.Rec. S7450 (daily ed. June 24, 1982). Such reversals, however often took up to two years, leaving needy individuals and families in sometimes desperate straits. To alleviate some of the resultant hardship, congress passed additional legislation in early 1983, which continued the payment of benefits during the pendency of an appeal to an administrative law judge, Pub.L. No. 97-455, § 2, 96 Stat. 2498, Jan. 12, 1983, codified at 42 U.S.C. § 423(g).

As part of their argument, plaintiffs contend that a complete reading of the Social Security Act demonstrates that congress intended termination reviews to be conducted on the basis of a medical improvement standard. In support of this position they have cited in their briefs several amendments to the act which refer to the cessation of disability.⁴ They interpret this language as requiring recovery from or improvement in a previously debilitating impairment. The plaintiffs also direct my attention to two Senate Finance Committee reports which specifically refer to a medical improvement. The first provides:

Paragraph (4) of the new § 222(c) provides that a period of trial work ... shall end with the month in which his physical or mental impairment improves to a point where by reason of such improvement he is able to engage in substantial gainful activity ...⁵

The act, itself, is silent as to the appropriate standard of review in a termination proceeding. It 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 has lasted or can be expected to last for a continuous period of not less than twelve months....

42 U.S.C. § 423(d)(1)(A).

Not only must an individual's physical or mental condition

be of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy....

42 U.S.C. § 423(d)(2)(A).

Section 425(a) permits the secretary to suspend disability benefits

on the basis of information obtained by or submitted to him, if he believes that an individual entitled to benefits under section 423 of this title ... may have ceased to be under a disability.... For purposes of this subsection, the term `disability' has the meaning assigned to such title in section 423(d) of this term.

In light of this reference back to § 423(d), one might expect a disability to have ceased where a beneficiary has the ability to engage in any substantial gainful work by reason of any medically determinable physical or mental improvement no longer expected to result in death or last longer than 12 months. It appears that the Social Security Administration interpreted that act in just such a fashion before 1976 or 1977.

In announcing her new rules in 1980, the secretary said:

We explain a new policy on when disability is considered to stop. At one time we would not find that disability or blindness had stopped unless the medical evidence showed that the person's condition had improved since we last determined that he or she was disabled. About three years ago, we changed this policy and began to find that disability or blindness had stopped if we found, on the basis of new evidence, that the person was not disabled or blind as defined by law. Emphasis added.

45 Fed.Reg. 55,568 (August 20, 1980).

The secretary argues that "the concept of cessation of disability is ... not the same as the concept of medical improvement." Although I do not necessarily agree with this exercise in casuistry, the secretary correctly points out that the legislative history of the 1983 amendment is rife with references to the lack of any medical improvement standard in the act. Senator Heinz pointed out that the amendment did not contain an improvement standard:

I want to point out that this bill has a serious omission: It fails to require that the Social Security Administration — before it may terminate benefits — show that an individual who was correctly awarded disability benefits has experienced significant medical improvement.

128 Cong.Rec. S13859 (daily ed. Dec. 3, 1982).

Senator Dole responded to Heinz's concerns with the following language:

I am certain that the medical improvement issue will be fully debated by the Finance Committee. While I cannot predict what action the Committee will take on this issue, I can assure the Senator I realize its importance....

* * * * * *

The issue ... is an important one, and I agree that we should hold hearings on this subject. We will address the issue early in next year's session.

* * * * * *

I shall certainly want to join you in looking at the issue next year — as part of a comprehensive review of the disability program.... We are not yet at the point where all the concerns about medical improvement have been resolved....

128 Cong.Rec. S13858, 13860 (daily ed. Dec. 3, 1982).

The secretary phrases the question aptly: "Why would Congress consider addressing the medical improvement issue if the Act already mandates application of a medical improvement standard?"

The point is well-taken. The confusion stems, in part, I believe, from congressional awareness that a substantial body of case law has sprung up around the appropriate standard of review in a termination proceeding. This was an issue which clearly troubled congress. One of the reasons for the high rate of reversals on appeal to administrative law judges was thought to be that administrative law judges were using different standards than the initial examiners. As Senator Cohen put it:

One reason for the discrepancy between the decisions made by the State agencies and the administrative law judges is that different standards are used. State claims examiners rely heavily on the program operating manuals — so-called POM's sic — which are internal Social Security Administration guidelines that are not published as regulations. The administrative law judges do not use the POM's but instead rely on the statutes, regulations, and court decisions. Our bill would require the same standards ... to be used by all

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