AR 86-4(3): Paskel v. Heckler , 768 F.2d 540 (3d Cir. 1985) 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

AR 86-4(3)

EFFECTIVE DATE: 03/24/86

ISSUE:

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.

STATUTE/REGULATION/RULING CITATION:

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

CIRCUIT:

THIRD (DELAWARE, NEW JERSEY, PENNSYLVANIA, VIRGIN ISLANDS)

Paskel v. Heckler , 768 F.2d 540 (3d Cir. 1985)

APPLICABILITY OF RULING:

DESCRIPTION OF CASE:

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

ended 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.

HOLDING:

ions 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.

HOLDING:

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.

STATEMENT AS TO HOW PASKEL DIFFERS FROM SOCIAL SECURITY

POLICY:

ed 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.

STATEMENT AS TO HOW PASKEL 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 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.

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.

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 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.

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.

EFFECTIVE DATE:

Date of publication