AR 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.

AR 97-4(9)

EFFECTIVE/PUBLICATION DATE: 12/3/97

Acquiescence Ruling 97-4(9)

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) [1] 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. [2]

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.

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 court then found that Mr. Chavez's "attainment of 'advanced age'

constitutes a changed circumstance precluding the application of res

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

o 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."

nation 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

led, 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.

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.

[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.

4, 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.