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Smith v. Schweiker

decided: June 1, 1983.

LEON SMITH AND JANE DOE, ON BEHALF OF THEMSELVES AND ALL OTHERS SIMILARLY SITUATED, PLAINTIFFS-APPELLANTS, DAVID B. OWEN, CLARENCE H. HOLLIS, ELEANOR POPE AND MAYNARD NUNN, PLAINTIFFS-INTERVENORS-APPELLANTS,
v.
RICHARD S. SCHWEIKER, IN HIS OFFICIAL CAPACITY AS SECRETARY OF HEALTH AND HUMAN SERVICES AND THEODORE ALLEN, IN HIS OFFICIAL CAPACITY AS DIRECTOR OF THE VERMONT DISABILITY DETERMINATION SERVICES, DEFENDANTS-APPELLEES



Appeal from a final judgment of the United States District Court for the District of Vermont (Holden, Judge) dismissing a class action challenge to Vermont's approved method of terminating disability benefits previously awarded under either Title II or Title XVI of the Social Security Act, 42 U.S.C. §§ 401-431 (1976 and Supp. IV 1980), 42 U.S.C. §§ 1381-1383 (1976 and Supp. IV 1980). Dismissal affirmed for lack of jurisdiction.

Pierce, Winter and Pratt, Circuit Judges.

Author: Winter

WINTER, Circuit Judge:

This is an appeal from a dismissal of a class action challenging Vermont's method of terminating disability benefits previously awarded under either Titles II or XVI of the Social Security Act, as approved by the Secretary of Health and Human Services (Secretary). 42 U.S.C. §§ 401-431 (1976 and Supp. IV 1980); 42 U.S.C. §§ 1381-1383 (1976 and Supp. IV 1980). Because the federal courts have no jurisdiction over plaintiffs' claim, we affirm Judge Holden's order dismissing the suit.

BACKGROUND

The plaintiffs here include two named persons who initiated this action, five named intervening plaintiffs and a certified class. All of the named individuals had their disability benefits terminated but successfully pursued the available appeal process and are now classified as "currently disabled." They are thus presently receiving disability benefits. As certified, the class consists of "all present and future Vermont residents who were found eligible for Title II or Title XVI benefits by an Administrative Law Judge, the Appeals Council or a federal court and who received notice on or after June 1, 1979 that those benefits would terminate as a result of review by the Disability Determination Services."

The action was brought to challenge a portion of the test of "current disability" presently utilized by the Secretary and to require that "medical improvement" of a recipient's condition be proven before a termination of benefits. Under Titles II and XVI of the Social Security Act, an individual is disabled and thus eligible for benefits when he or she is unable

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 12 months.

42 U.S.C. §§ 423(d)(1)(A) and 1382c(a)(3)(A). To prove disability, an individual must establish that he or she suffers from a "physical or mental impairment" so severe 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, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work.

42 U.S.C. §§ 423(d)(2)(A) and 1382c(a)(3)(B).

To continue to receive benefits, a recipient must be able to demonstrate that he or she is "currently disabled." The standard applied by the Secretary in determining continued eligibility takes a variety of circumstances into account such as age, available work in the economy, and medical condition. Plaintiffs claim that such an overall review of the claimant's capacities is not permissible and that specific evidence of "medical improvement" is necessary before a recipient may be terminated.

Disability determinations are governed by procedures coordinated by the state and federal governments. In Vermont, claims are initially referred to the state Disability Determination Services (DDS) for review. If the claim is denied, a claimant may request reconsideration by DDS, and, if that is denied, a full hearing before an Administrative Law Judge (ALJ). 42 U.S.C. § 421(d); 20 C.F.R. §§ 404.930, 416.1429 (1982). The claimant may seek yet a fourth review of an adverse decision before the Social Security Administration's Appeals Council, 20 C.F.R. §§ 404.967, 416.1467 (1982), and, thereafter, a claimant may pursue his remedies in the federal courts. 42 U.S.C. § 405(g).

A favorable decision at any stage entitles the claimant to benefits. However, eligibility continues only so long as the disability exists, 20 C.F.R. §§ 404.1590, 416.990 (1982), and each successful claimant's case is subject to a "continuing disability investigation" (CDI). The CDI was at one time a random process but now mandatory as to each recipient unless specifically waived by the Secretary. 42 U.S.C. § 421(i) (Supp. IV 1980). Each successful claimant's case is reviewed at least once every three years "for purposes of continuing eligibility." Id. Benefits may be terminated "if the medical or other evidence shows that [the claimant] is not disabled or if there is not enough evidence to support a finding that disability continues." 20 C.F.R. §§ 404.1590, 416.990. The Secretary has interpreted this regulation to mean that a beneficiary may be terminated if the agency reviews the record and is satisfied under all the circumstances that evidence ...


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