Aspects of Disability Decision Making: Data and Materials

D. Important Recent Court Cases and Litigation Affecting the DisabilityProcessISSUE: Medical Improvement StandardThe principal court cases involving the medicalimprovement standard include Morrison, Doe, andDecker, (WA), Holden (OH), Lopez (9 th Circuit).Lawsuits were filed in the 1980s challengingthe standard that SSA used to cease disability benefitsfor cases that were undergoing a continuingdisability review. As a result of the Social SecurityDisability Benefits Reform Act of 1984 (P.L. 98-460),there were 17 medical improvement cases that wereremanded to SSA to have the cases reviewed underthe new medical improvement standard establishedin the law.ISSUE: Pain and Other SymptomsThe principal court cases involving the assessmentof pain and other symptoms include Hyatt(NC), Luna (CO), and Polaski (8 th Circuit).The Social Security Disability Benefits Reform Actof 1984 (P.L. 98-460), codified SSA’s policy for evaluatingpain. It sunset on January 1, 1987 and was notreplaced.In the 1980s, both before and after P.L. 98-460,there was much litigation over how SSA assessedallegations of pain. Although the agency concludedthat the court rulings were not in conflict with itspolicy, many courts found that SSA did not giveadequate consideration to the claimant’s allegationsand other subjective evidence, and instead relied tooheavily on objective medical findings to substantiateor rebut pain allegations. In November 1991,SSA issued an agency regulation that incorporatedthe pain standard that was articulated in thePolaski case.ISSUE: Treating Physician’s OpinionThe principal court cases involving treatingphysician’s opinion include Schisler (NY), andAldrich (VT).Until the 1980s there were no agency regulationson this issue except a short rule that said SSAwas not bound by a treating physician’s opinionabout whether a claimant was disabled. Prior toAugust 1991, several circuit court decisions, includingthe Schisler case, pointed to the need for a clearpolicy statement that would encourage adjudicationuniformity and provide the public and the courtswith a clear explanation of SSA’s policy on theweighing of treating source opinions.The Schisler ruling issued on March 8, 1989and effective in the States of the 2 nd Circuit (NY, VT,and CT), was written by the court because it foundthat the language drafted by SSA was, in the court’sview, out of synch with 2 nd Circuit law. Recognizingthe need for detailed regulations to provide uniformityacross the country, SSA issued regulationson medical source opinion that were published inAugust 1991. The regulations were challenged inthe 2 nd Circuit, and in the third of the Schisler decisions,a unanimous court upheld them as withinthe Commissioner’s authority to make rules eventhough it was not completely consistent with2 nd Circuit law up to that point.ISSUE: Disabled Widow(er)sThe principal court cases involving disabledwidows include Hill (NY), Askin (11 th Circuit),Begley (TN), and Bozzi (3 rd Circuit).The issue in these cases was the medical evaluationstandard that SSA used in determiningdisability in disabled widow, widower, or survivingdivorced spouse claims. The agency did not providethese individuals with a residual functional capacityevaluation when adjudicating their disability claim.The standard that adjudicators must use for evaluatinga widow’s entitlement after December 1990is required by the Omnibus Budget Reconciliation Actof 1990 (P.L. 101-508). The standard for evaluatinga widow’s entitlement before January 1991 isrequired by the SSR 91-3p, which was published onMay 5, 1991.ISSUE: HIV/AIDSThe principal court cases involving HIV/AIDSinclude Rosetti (3 rd Circuit), and S.P. (NY).The issue was the standards, policies, practices,and procedures that SSA used in evaluating disabilityclaims based in whole or in part on infectionwith HIV/AIDS. Plaintiffs alleged that SSA failed topromulgate properly regulations for claimants sufferingfrom HIV/AIDS by publishing them in theFederal Register for public comments. HIV/AIDS wassubsequently established as an impairment in SSA’sListings of Impairments (14.08 and 114.008).ISSUE: Not SevereA principal court case involving “not severe” isDixon (NY).This case challenged the validity of SSA’s regulationsthat dealt with non-severe impairments (i.e.,step 2 of the agency’s sequential evaluation process)and SSA’s policy of not considering the combinedAspects of Disability Decision Making: Data and Materials 101