Acquiescence Ruling 98-4(6)
Drummond v. Commissioner of Social Security, 126 F.3d 837 (6th Cir. 1997)--Effect of Prior Findings 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.
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, the
Social Security Administration (SSA) must adopt a finding of a claimant's residual
functional capacity, or other finding 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.
Sections 205(a) and (h) and 702(a)(5) of the Social Security Act (42 U.S.C. 405(a)
and (h) and 902(a)(5)), 20 CFR 404.900, 404.957(c)(1), 416.1400, 416.1457(c)(1).
Sixth (Kentucky, Michigan, Ohio, Tennessee)
Drummond v. Commissioner of Social Security, 126 F.3d 837 (6th Cir. 1997).
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:
Grace Drummond applied for disability insurance benefits on July 6, 1987, claiming
a disability onset date of November 17, 1985. The claim was denied initially and upon
reconsideration. A hearing was held before an ALJ who concluded that the claimant
was not disabled and denied her claim. The ALJ found that Ms. Drummond was unable
to perform her past relevant work but retained the residual functional capacity for
Ms. Drummond filed a subsequent application for disability insurance benefits on June
21, 1989. This claim was denied initially and again upon reconsideration. After a
hearing was held, an ALJ found that the claimant suffered from combined musculoskeletal
and multiple body system impairments but retained the residual functional capacity
for medium level work and could perform her past relevant work as a textile machine
operator. Accordingly, the ALJ found that Ms. Drummond was not disabled. After the
Appeals Council denied the claimant's request for review, she sought judicial review.
The United States District Court for the Eastern District of Kentucky granted summary
judgment to SSA finding that substantial evidence supported SSA's denial of benefits.
On appeal to the Court of Appeals for the Sixth Circuit, Ms. Drummond argued that,
based on principles of res judicata, the first ALJ's determination that she was limited
to sedentary work must be followed by the second ALJ in the absence of evidence of
an improvement in her condition since the first hearing. Declining to address this
issue initially on appeal, the Sixth Circuit reversed the judgment of the district
court and remanded the case with instructions to remand it to SSA for further proceedings
to determine whether res judicata is applicable against SSA and, if so, whether there
was substantial evidence to support a finding that the claimant's condition had improved
since the time of her first application.
On remand, after oral argument was held before the Appeals Council on September 27,
1993, the Appeals Council issued a decision denying Ms. Drummond's claim for disability
insurance benefits. The Appeals Council found that 42 U.S.C. 405(h) could not be applied
against SSA as a bar to prevent reconsideration of an issue because SSA was not a
party to the benefits determination.
Ms. Drummond sought judicial review of the Appeals Council's decision and the United
States District Court for the Eastern District of Kentucky affirmed SSA's decision
denying disability benefits. The district court found that "administrative res judicata
does not apply to the Commissioner when a transitory condition such as health is involved....”
The claimant appealed this decision to United States Court of Appeals for the Sixth
Relying on the Fourth Circuit's decision in Lively v. Secretary of Health and Human Services, 820 F.2d 1391 (4th Cir. 1987), the claimant argued that res judicata applied and
that, absent evidence of an improvement in her condition, the first ALJ's finding
that she had a residual functional capacity limited to sedentary work was binding
on SSA in deciding her subsequent claim. Noting the similarity between the Lively case and the case at bar, the Sixth Circuit observed that the court in Lively had relied on "[p]rinciples of finality and fundamental fairness drawn from § 405(h)"
to conclude that "evidence, not considered in the earlier proceeding, would be needed
as an independent basis to sustain a finding [of the claimant's residual functional
capacity] contrary to the final earlier finding."
The Court of Appeals for the Sixth Circuit found the reasoning of the Lively court persuasive and stated that "[a]bsent evidence of an improvement in a claimant's
condition, a subsequent ALJ is bound by the findings of a previous ALJ." The court
held that SSA could not reexamine issues previously determined in the absence of new
and additional evidence or changed circumstances. The court indicated that to allow
such a reevaluation "would contravene the reasoning behind 42 U.S.C. § 405(h) which
requires finality in the decisions of social security claimants." The Court of Appeals
further stated that "[j]ust as a social security claimant is barred from relitigating
an issue that has been previously determined, so is the Commissioner."
After finding that there was no substantial evidence that Ms. Drummond's condition
had improved significantly during the time period between the two ALJ hearings, the
court concluded that SSA was bound by its previous finding that the claimant was limited
to sedentary work. The Court of Appeals thereupon reversed the judgment of the district
court and remanded with instructions for the district court to remand the case to
SSA for an award of benefits.
Statement as to How Drummond Differs From SSA 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.
The Sixth Circuit concluded that where a final decision of SSA after a hearing on
a prior disability claim contains a finding of a claimant's residual functional capacity,
SSA may not make a different finding in adjudicating a subsequent disability claim
with an unadjudicated period arising under the same title of the Act as the prior
claim unless new and additional evidence or changed circumstances provide a basis
for a different finding of the claimant's residual functional capacity.
Explanation of How SSA Will Apply The Drummond Decision Within The Circuit
This Ruling applies only to disability findings in cases involving claimants who reside
in Kentucky, Michigan, Ohio, or Tennessee 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 a finding of a claimant's residual functional capacity 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, as appropriate, which was made in a final decision by an ALJ or the Appeals Council
on a prior disability claim.
When adjudicating a subsequent disability claim with an unadjudicated period arising
under the same title of the Act as the prior claim, adjudicators must adopt such a
finding from the final decision by an ALJ or the Appeals Council 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.