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

AR 86-5(9)

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:

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:

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

f 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.

HOLDING:

The circuit court held that the statutory language of section

225(b) [1] 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:

am 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.

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, [2] 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.

suspension or termination, or who is

participating in an approved VR program and who resides in Alaska,

Arizona, California, Guam, [2] 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.

EFFECTIVE DATE:

Date of Publication

[1] 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.

[2] Since there is no SSI

program in Guam, this Ruling will apply only to Social Security disability

claims there.