16-3365 Adelman v. Berryhill
UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT
SUMMARY ORDER Rulings by summary order do not have precedential effect. Citation to a summary order filed on or after January 1, 2007, is permitted and is governed by Federal Rule of Appellate Procedure 32.1 and this Court=s Local Rule 32.1.1. When citing a summary order in a document filed with this Court, a party must cite either the Federal Appendix or an electronic database (with the notation Asummary order@). A party citing a summary order must serve a copy of it on any party not represented by counsel.
At a stated term of the United States Court of Appeals for the Second Circuit, held at the Thurgood Marshall United States Courthouse, 40 Foley Square, in the City of New York, on the 8th day of August, two thousand eighteen.
PRESENT: GERARD E. LYNCH, CHRISTOPHER F. DRONEY, Circuit Judges, WILLIAM K. SESSIONS III, District Judge.*
_____________________________________ JED C. ADELMAN,
Plaintiff-Appellant,
FREDERICK ADELMAN, ABBEY ADELMAN,
Intervenors,
v. No. 16-3365-cv
NANCY A. BERRYHILL, Acting Commissioner of Social Security Administration,
Defendant-Appellee. _______________________________________
* Judge William K. Sessions III, of the United States District Court for the District of Vermont, sitting by designation. FOR PLAINTIFF-APPELLANT and CAROYLN A. KUBITSCHEK, Lansner & INTERVENORS: Kubitscheck, New York, NY.
FOR DEFENDANT-APPELLEE: JOSEPH A. MARUTOLLO, Assistant United States Attorney (Varuni Nelson, Arthur Swerdloff, Assistant United States Attorneys, on the brief), for Richard P. Donoghue, United States Attorney for the Eastern District of New York, Brooklyn, NY.
Appeal from the judgment of the United States District Court for the Eastern District of
New York (Sandra J. Feuerstein, Judge).
UPON DUE CONSIDERATION WHEREOF, IT IS HEREBY ORDERED,
ADJUDGED, AND DECREED that the judgment of the District Court filed September 29,
2016, be and hereby is VACATED and REMANDED.
Appellant Jed C. Adelman appeals the district court=s judgment denying the
Commissioner=s motion for judgment on the pleadings and granting in part Adelman=s
cross-motion for judgment on the pleadings. The district court ruled in Adelman=s favor, holding
that Adelman did not owe the agency for an overpayment of Social Security disability benefits
for the period from February 2002 through March 2003. Adelman contends, however, that he
was also entitled to retroactive reinstatement of his benefits from April 2003 onwards as a
collateral consequence of the district court=s holding, because the Commissioner has failed to
carry her burden to provide a valid reason why Adelman=s benefits should have been terminated
in March. We assume the parties= familiarity with the underlying facts, the procedural history of
the case, and the issues on appeal, and repeat them here only as necessary to explain our
decision.
2 BACKGROUND
The parties agree that Adelman is permanently intellectually disabled. He began to receive
childhood disability benefits based on his father=s Social Security record in September 1999. In
February 2001, Adelman obtained a job making deliveries and performing other related work at
the State University of New York at Stony Brook (ASUNY@) through the New York State Office
of Vocational and Educational Services for Individuals with Disabilities. While employed at
SUNY, Adelman received assistance from a job coach, who helped him learn new tasks and
succeed in his job, as well as other accommodations for his disability.
I. Administrative Proceedings
In April 2003, the Social Security Administration (ASSA@) sent Adelman a Notice of
Disability Cessation, stating that AAdelman=s disability ha[d] ended and that he [was] not entitled
to Social Security disability payments beginning September 2001@ because he had engaged in
substantial gainful work activity (ASGA@). Admin. R.1 at 105. Because the SSA had continued to
send Adelman checks through March 2003, the SSA further stated that he was required to refund
over $16,000 to the SSA within 30 days.
Adelman and his parents, acting on his behalf, made several efforts to challenge that
decision. First, in written submissions to the agency, they argued that Adelman continued to be
disabled and that his work through the special program at SUNY should not be deemed to
evidence a disqualifying ability to perform SGA. The Adelmans= submissions repeatedly insisted
not only that Adelman had not been overpaid through March 2003, but also that he should have
1 Citations to the Administrative Record below are denoted AAdmin. R.@ Citations to the Appendix filed by Adelman are denoted AApp.@ Citations to the Supplemental Appendix filed by the Commissioner are denoted ASupp. App.@
3 continued to receive benefits thereafter. See, e.g., id. at 173B74 (letter from Adelman=s mother
asserting that he remained disabled and his benefits should not have been suspended); 191
(January 30, 2004 ARequest for Assistance,@ indicating that Adelman was appealing an ASGA
determination@ and that he Abelieves he should still be covered based on his participation in the
>EARN= Program at Stony Brook@). In November 2003, however, the SSA stated that it was
declining to reconsider its decision, and in May 2004, it provided Adelman with a second Notice
of Disability Cessation, stating that Adelman=s benefits had been stopped Abecause of his work,@
and that payments could Ano longer@ be restarted without a new application because he had
engaged in SGA during Ahis extended period of eligibility.@2 Id. at 276.
Adelman then began what became a decade-long administrative process involving four
hearings before two different Administrative Law Judges (AALJs@), as well as three decisions
from the SSA=s Appeals Council, which, after twice remanding the case for rehearing based on
procedural errors, issued a final decision in the Commissioner=s favor in 2014. Throughout those
proceedings, Adelman and his parents, most often acting pro se, argued that the Commissioner
had not shown that Adelman had a disqualifying ability to perform SGA, because he was unable
to work without substantial accommodations. See, e.g., id. at 81 (argument by briefly retained
counsel that Adelman=s work Ashould not be considered SGA, due to the fact that he continues,
after all these years, to still need a job coach@); 505 (Adelman=s father, arguing same). That
position was supported by an SSA regulation providing that work performed under Aspecial
conditions that take into account [the claimant=s] impairment@ may not constitute SGA if that
2 That letter appears to refer to the period of time claimants are given to file a claim for Areentitlement@ to benefits following a disqualifying period of SGA, pursuant to 20 C.F.R. ' 404.1592a.
4 work Adoes not show that [the claimant] ha[s] the ability to do [SGA].@ 20 C.F.R. ' 404.1573(c).
Neither the ALJs nor the Appeals Council meaningfully considered the import of that regulation
for Adelman=s case. Instead, the hearings before the ALJs primarily focused on whether
Adelman=s net earnings through March 2003 met the salary threshold for SGA. All three ALJ
decisions found that, at some point during Adelman=s employment at SUNY, he earned enough
money to constitute SGA and, accordingly, that he was required to pay back benefits received
from that point forward.
Besides objecting to the SSA=s claim for reimbursement, Adelman and his parents further
argued that Adelman remained entitled to receive benefits because he remained disabled and had
never engaged in disqualifying SGA. For instance, Adelman=s father, Intervenor Frederick
Adelman, wrote to the Appeals Council in August 2008, questioning why the Appeals Council
did not Aremand the case back to the SSA for payment of benef[its.]@ Admin. R. at 640.
Adelman=s father wrote to the Appeals Council again in September 2009, again asserting that the
Council Ashould consider remanding back for payment of benefits.@ Id. at 608; see also id. at 503
(arguing that Adelman Ashould not have been cut off from his benefit@). But despite those
arguments, and despite the fact that, as the third ALJ decision noted, each of the intervening
Appeals Council decisions had ordered the ALJ on remand to consider Awhether the claimant
continues to be disabled for Title II purposes because of his work and earnings,@ id. at 23, the
first ALJ decision concluded that Adelman=s benefits were properly terminated in March 2003
on the basis of his SGA, and the second and third ALJ decisions did not consider Adelman=s
entitlement to benefits after March 2003.
Adelman=s administrative challenges culminated in an August 12, 2014, decision of the
Appeals Council. That decision describes the issues before the Council as Awhether the claimant 5 was overpaid benefits and if so, whether recovery of the overpayment may be waived.@ App. at
179. In the course of concluding that Adelman owed the agency for overpayments, the Council
acknowledged Adelman=s assertion that he had not been overpaid Abecause he was employed in a
special program.@ Id. at 180. Instead of engaging with that argument, however, the Council, like
the ALJs, focused on Adelman=s net earnings during the relevant period, rather than the supports
he had needed to obtain it. The Council concluded that Adelman=s disability had Aceased due to
[SGA] in November 2001,@ and accordingly, that he was not entitled to receive any benefits
beginning in February 2002 and was required to return those that were erroneously given to him.
Id. at 183B84. The decision did not directly address Adelman=s argument that, because he had
never engaged in SGA, he remained eligible for benefits both during the alleged overpayment
period and thereafter.
II. District Court Proceedings
Adelman, acting pro se, appealed the Council=s final decision to the district court. In
addition to challenging the overpayment decision, Adelman asked the district court to Amodify
the decision of the defendant to grant monthly maximum insurance and/or Supplemental
Security Income benefits to the plaintiff, retroactive to the date of the initial disability.@ Supp.
App. at 7. Both parties cross-moved for judgment on the pleadings. Adelman=s motion sought to
vacate the overpayment obligation, and also repeatedly requested that the court direct the SSA to
restore his benefits. See, e.g., Supp. App. at 65 (AClaimant is entitled to full retroactive benefits if
the record shows that benefits were improperly denied. . . . Disability benefits wrongfully
terminated should be reinstated without further agency proceedings.@); see also id. at 37, 44, 74.
In his conclusion and request for relief, Adelman again asked the court to: (1) vacate his
overpayment obligation; (2) Aremand this case for calculation of benefits;@ and (3) conclusively 6 state that Adelman had fully repaid a previous uncontested overpayment of SSI benefits.3 Id. at
86.
On September 19, 2016, the district court granted Adelman=s first request for relief,
holding that he had not been engaged in SGA between February 2002 and March 2003, and thus
was not wrongfully paid disability benefits during that time. Adopting the argument that
Adelman had been making through a decade of administrative proceedings, the court relied on
20 C.F.R. ' 404.1573(c) to conclude that, although Adelman had earned enough at his job to
meet the salary threshold for SGA, Adelman=s work had been performed under Aspecial
conditions,@ in that he was able to perform his work only with the assistance of a job coach and
other accommodations. Because the Commissioner had failed to demonstrate that working with
such accommodations showed that Adelman had the ability to perform SGA, see Supp. App. at
108B09, the court held that the Appeals Council lacked substantial evidence to support its
finding that Adelman was not entitled to retain the disability benefits he received between
February 2002 and March 2003. The district court did not address Adelman=s other requests for
relief.
Adelman filed a notice of appeal from the district court=s decision on September 30,
2016. While that appeal was pending, the Commissioner moved the district court to alter or
amend its decision. The Commissioner noted that the district court had not resolved whether
3 Adelman concedes that he was previously overpaid SSI benefits, but contends that the SSI overpayment was fully recouped in 2005. The Commissioner asserts that the repayments had been deducted from Adelman=s disability benefits, but when those benefits were terminated, Adelman=s tax refunds had to be withheld in order to satisfy that obligation. The district court did not resolve that issue. Because the parties both referred to the issue in their briefs before this court, however, we assume that it remains a live dispute and direct the district court to address it on remand.
7 Adelman was owed benefits for April 2003 and beyond, and requested a remand so that the
agency could determine that issue in the first instance. The district court denied the motion,
holding that remand was unnecessary because the court had limited its ruling to the issue
presented in the Appeals Council=s decision, namely, whether Adelman owed for overpayments
in the period ending in March 2003. The court reasoned that the Administrative Record was
insufficient to permit the court to rule on Adelman=s eligibility for benefits thereafter. Instead, it
stated that Adelman would need to submit a new application including evidence that his
continued employment did not constitute SGA in order to demonstrate his entitlement to receive
disability benefits going forward.
DISCUSSION
On appeal, neither party challenges the district court=s ruling that Adelman did not owe
the Commissioner for overpayments, because he was not wrongfully paid benefits between
February 2002 and March 2003.4 Adelman, however, argues that the ruling vacating the Appeal
Council=s overpayment decision as invalid should also carry additional consequences for the
SSA: specifically, he argues that, because the Commissioner bears the burden in a termination
proceeding, the district court should also have ordered that the Commissioner pay back disability
benefits from April 2003 onwards and reinstate his disability benefits going forward until such
time as the Commissioner provides a valid reason why his entitlement should end.5 The
4 Adelman=s counsel reports that the Commissioner has refunded the sums it had previously seized from Adelman=s father to satisfy the overpayment obligation. 5 Adelman did not amend his notice of appeal to include the district court=s ruling on the Commissioner=s motion for reconsideration, which squarely rejected his request for reinstatement. Adelman=s notice of appeal and opening brief were filed pro se, however, and we must construe those submissions liberally and interpret them Ato raise the strongest arguments that they suggest.@ Triestman v. Fed. Bureau of Prisons, 470 F.3d 471, 474 (2d Cir. 2006) 8 Commissioner contends that we lack subject matter jurisdiction over this appeal to the extent that
it concerns post-March 2003 disability benefits because Adelman has not administratively
exhausted his claims for these benefits. She further argues that, even if the matter is remanded to
the SSA for reinstatement, it would be Adelman=s burden to reestablish his entitlement to
benefits during the contested period and going forward. We disagree with the Commissioner on
both counts.
I. Exhaustion
Jurisdiction over social security disability appeals derives from 42 U.S.C. ' 405(g),
which provides in relevant part:
Any individual, after any final decision of the Commissioner of Social Security made after a hearing to which he was a party, . . . may obtain a review of such decision by a civil action . . . . in [a] district court of the United States . . . .
The right to appeal pursuant to ' 405(g) has a Anon-waivable and a waivable element.@ Smith v.
Schweiker, 709 F.2d 777, 780 (2d Cir. 1983). The first, Anon-waivable@ C i.e., jurisdictional C
element is that the claimant must have presented a claim for benefits to the SSA. Id. The second,
Awaivable@ C i.e., prudential C element is that the claimant must have Afully exhaust[ed] his
administrative remedies before obtaining judicial review.@ Id. These two elements give effect to
' 405(g)=s requirement that appeal be taken from a Afinal decision@ of the Commissioner. Abbey
v. Sullivan, 978 F.2d 37, 43 (2d Cir. 1992).
(parenthetical emphasis omitted). Because Adelman=s opening brief focuses on the relief omitted by the district court in its first decision, which was the same relief it denied on reconsideration, we conclude that Adelman has adequately appealed the district court=s ruling on that issue.
9 Adelman satisfied the jurisdictional element of the exhaustion requirement by presenting
his request for reinstatement to the SSA. Both the Supreme Court and this Court have made clear
that this element may be satisfied by something less than a formal application to the agency for
the relief sought before the courts. For instance, in Mathews v. Eldridge, 424 U.S. 319 (1976),
the Supreme Court held that the presentment element was met where the claimant answered a
state agency questionnaire and wrote a letter objecting to the state agency=s tentative
determination that his disability had ceased, and the SSA thereafter accepted the state agency=s
determination. Id. at 329. The Court concluded that, through those actions, the plaintiff had
Aspecifically presented the claim that his benefits should not be terminated because he was still
disabled.@ Id. Later, in City of New York v. Heckler, 742 F.2d 729 (2d Cir. 1984), aff=d sub nom.,
Bowen v. City of New York, 476 U.S. 467 (1986), we held that the presentment element was
satisfied where the claimants completed a Social Security questionnaire indicating in writing that
they remained disabled and desired benefits. Id. at 735.
Adelman has done far more here: as described above, during the administrative
proceedings Adelman and his parents repeatedly argued that he remained entitled to benefits, and
discussed how those benefits should be calculated, in letters submitted to the agency. Indeed, in
its final decision, the Appeals Council recognized that an argument for reinstatement had been
made on Adelman=s behalf. The Commissioner does not dispute that Adelman has adequately
presented his claim for reinstatement to the SSA, but instead focuses her arguments on the
prudential element of the exhaustion requirement.
As the Supreme Court reminds us, once a claimant has satisfied the jurisdictional
requirement of presenting a claim to the agency, Aapplication of the exhaustion doctrine is
>intensely practical.=@ City of New York, 476 U.S. at 484, quoting Eldridge, 424 U.S. at 331 n.11. 10 Accordingly, the Commissioner Amay waive, or be said by a court to have waived,@ the
requirement that a claimant fully exhaust his administrative remedies. Smith, 709 F.2d at 780.
Relevant to the present circumstance, waiver Amay be inferred where the plaintiffs= legal claims
are collateral to their demand for benefits.@ Id.; accord Skubel v. Fuoroli, 113 F.3d 330, 334 (2d
Cir. 1997).
To the extent that Adelman=s appeal seeks interim reinstatement retroactive to April 2003
and going forward until the Commissioner can reevaluate his eligibility for benefits, his request
is collateral to his exhausted claims in the most literal sense: he is simply requesting that the
district court be made to effectuate the natural consequence of its decision vacating the Appeals
Council=s final order. By (belatedly) conceding that Adelman is not required to return the
benefits he received between February 2002 and March 2003, the Commissioner has effectively
conceded that Adelman was entitled to receive benefits during that time. It follows that there is
currently no valid decision explaining why Adelman=s entitlement to benefits should have ended
in or before March 2003. As discussed further below, the Commissioner bears the burden in
termination proceedings. Thus, we see no reason why Adelman should not also receive benefits
retroactive to that date and going forward, unless and until the Commissioner demonstrates that
Adelman=s entitlement to benefits has ended.6
6 We recognize that the SSA=s decision to terminate disability benefits and its decision to recover overpaid benefits are ordinarily two separate administrative actions, see 20 C.F.R. _ 404.902(h) (termination); _ 404.902(j) (overpayment), each requiring a different showing by the Commissioner, see, e.g., 20 C.F.R. _ 404.1594 (setting forth requirements for termination); _ 404.506 (regarding waiver of overpayment), and that vacating a termination decision is not necessarily Acollateral@ to vacating an overpayment decision. Here, however, the two decisions stand or fall together: the same notice from the SSA both terminated Adelman=s benefits and sought to recover overpaid benefits on the unsupported basis that Adelman=s work for SUNY during a particular time period was SGA. It is thus apparent without further factual development 11 When a court invalidates the Commissioner=s decision to terminate a claimant=s disability
benefits, it has the power to order interim reinstatement until the Commissioner can reach a valid
termination decision.7 For instance, in City of New York, a class of plaintiffs alleged that the SSA
had terminated the benefits of mentally ill claimants by making procedurally defective
determinations regarding their residual functional capacity. 742 F.2d at 731B33. We affirmed the
district court=s interim reinstatement order, which Aha[d] the effect of awarding interim benefits
to terminated class members until such time as the SSA makes a procedurally correct
determination that they are no longer eligible for disability benefits.@ Id. at 740. We reasoned
that the interim reinstatement order simply returned the wrongfully terminated claimants to their
prior status by reimposing the terms of the only valid Afinal decision@ still on the books C
namely, the one that had granted the claimants entitlement to benefits in the first instance. We
explained that, A[o]nce the District Court properly invalidated the Secretary=s termination
decisions because of the acknowledged procedural illegality, the Court was clearly entitled to
reinstate the earlier favorable final decisions pending lawful redeterminations of each claimant=s
continuing eligibility.@ Id. Other Circuits have approved reinstatement after a wrongful
termination using similar reasoning. See, e.g., Mental Health Ass=n of Minn. v. Heckler, 720 F.2d
965, 972 (8th Cir. 1983) (affirming the district court=s prospective reinstatement order because
at the agency level that invalidating the overpayment aspect of the SSA=s decision necessarily means invalidating the termination aspect of the decision. In that sense, reinstating Adelman=s benefits on an interim basis retroactive to the flawed termination decision is collateral to the claim he administratively exhausted, namely, that he had not been overpaid benefits. 7 Ordinarily, the decision to grant or deny interim reinstatement is reviewed only for abuse of discretion. State of New York v. Sullivan, 906 F.2d 910, 918B19 (2d Cir. 1990). Here, however, there is no exercise of discretion to review because the district court did not deny interim reinstatement C rather, the court incorrectly found that it could not consider the termination decision at all. Therefore, we are not constrained by that standard of review. 12 that order Amerely reinstates certain plaintiffs to their former position@); Hayden v. Barnhart, 374
F.3d 986, 994 (10th Cir. 2004) (A[R]eversal in this case means that the case is simply remanded
to the agency, and that Ms. Hayden, who has already been adjudged to be disabled by the
Commissioner, maintains her disability status and is entitled to payment of any benefits that have
been withheld during the appeals process.@).8
We recognize that the exhaustion requirement plays a valuable role in the judicial review
of administrative proceedings. As the Supreme Court has explained:
Exhaustion is generally required as a matter of preventing premature interference with agency processes, so that the agency may function efficiently and so that it may have an opportunity to correct its own errors, to afford the parties and the courts the
8 The power to order interim reinstatement derives from 42 U.S.C. _ 405(i) and the court=s injunctive power thereunder. See City of New York, 742 F.2d at 740 (AThe Act authorizes benefit payments following a final decision by the Secretary or a final judgment by a court that a claimant is >entitled= to benefits . . . the payment of benefits to wrongfully terminated recipients follows a final decision of the Secretary and consequently is consistent with the requirements of section 405(i). . . . [W]here, as here, the award of interim benefits is necessary to make whole individuals harmed by the SSA=s failure to abide by the law, federal courts are not without authority to award the necessary relief.@). As the Tenth Circuit noted in Hayden, this conclusion finds further support in 20 C.F.R. _ 404.1597a(i)(6), which provides that if a decision terminating benefits on the ground that a disability has medically ceased is vacated by a federal court, A[c]ontinued benefits are payable to [the claimant] and anyone else receiving benefits based on [the claimant=s] wages and self-employment income or because of [the claimant=s] disability pending a new decision by the administrative law judge.@ See 374 F.3d at 994. Although this is not a medical cessation case, the same rationale that supports providing interim benefits under _ 404.1597a(i)(6) in medical cessation cases supports granting them in cases where the erroneous decision on remand involved an SGA determination: an erroneous finding of medical recovery at one point no more precludes the possibility of a later actual recovery than an erroneous finding of SGA in one time period precludes a later actual ability to perform SGA. In each case, the party that bears the burden in the termination proceeding should bear the risk of error and delay when the reason proffered for termination turns out to be mistaken and the record compiled by the agency does not address possible subsequent developments. Thus, our exercise of the Court=s remedial power in this case aligns with the policy evident in _ 404.1597a(i)(6) as well.
13 benefit of its experience and expertise, and to compile a record which is adequate for judicial review.
Weinberger v. Salfi, 422 U.S. 749, 765 (1975). But none of those purposes justifies sending
Adelman=s claims for interim relief back to the beginning of the administrative process under the
present circumstances. Adelman=s benefits were terminated, and he was held accountable for the
receipt of allegedly unwarranted benefits, in April 2003, and he promptly challenged that
determination. His family argued throughout a decade of agency proceedings that Adelman=s
work in a specialized setting with substantial accommodations did not demonstrate an ability to
perform SGA, and although that position was ultimately vindicated by the district court, the SSA
resisted that outcome at every turn. Assuming Adelman could have filed new applications for
benefits while his lengthy proceedings were pending, each of those applications presumably
would have been premised on the same argument and would have been met with the same
intransigence. We see no benefit in forcing Adelman, a permanently intellectually disabled
person, to now undergo the burden and expense of this Sisyphean process once again simply
because the agency managed to ignore his meritorious argument for the first ten years during
which he made it. Cf. Liberty All. of the Blind v. Califano, 568 F.2d 333, 345 (3d Cir. 1977)
(observing Athe inutility of exhausting administrative remedies on a legal issue on which the
Secretary has had ample opportunity to take a definitive position, and indeed has done so@),
citing Salfi, 422 U.S. at 765.
II. Burden on Remand
The Commissioner assumes that if the matter is returned to the SSA for a calculation of
back benefits, Adelman will bear the burden of demonstrating that he was entitled to benefits for
each of the months that they have been withheld beginning in April 2003. As alluded to above,
14 however, we conclude that the relevant SSA regulation supports Adelman=s view as to the
burden of proof: that regulation provides that A[i]n most instances, we must show that you are
able to engage in substantial gainful activity before your benefits are stopped.@ 20 C.F.R.
' 404.1594(b)(5) (emphasis added); see also id. _ 404.1594(a) (AEven where medical
improvement related to your ability to work has occurred or an exception applies, in most cases
. . . we must also show that you are currently able to engage in substantial gainful activity before
we can find that you are no longer disabled.@ (emphasis added)); id. _ 404.1594(d) (AIf one of
these exceptions applies, we must also show that, taking all your current impairment(s) into
account, not just those that existed at the time of our most recent favorable medical decision, you
are now able to engage in substantial gainful activity before your disability can be found to have
ended.@ (emphasis added)); De Leon v. Sec=y of Health & Human Servs., 734 F.2d 930, 936 (2d
Cir. 1984) (quoting 42 U.S.C. ' 425(a) for the proposition that A[t]he Secretary is authorized to
terminate a claimant=s disability benefits whenever she obtains evidence that a claimant=s
disability has >ceased=@ (emphasis added)). That regulation does not indicate what the exceptions
to its rule might be, and the Commissioner has not given us any reason to think that this is one
such circumstance.
Instead, the Commissioner=s contrary position appears to stem from its erroneous view
that Adelman=s request for reinstatement is effectively a Areentitlement@ claim, pursuant to 20
C.F.R. ' 404.1592a. That regulation provides that if a claimant=s benefits have ceased due to his
performance of SGA during his trial work period, the Commissioner will nevertheless start
paying benefits again without requiring a new application if the claimant stops engaging in SGA
within a certain period thereafter. But because the SSA has not validly determined that Adelman
15 has ever engaged in disqualifying SGA, Adelman does not have a Areentitlement@ claim. And the
Commissioner has given us no other reason to impose a burden of proof on Adelman to correct
the agency=s decade-long failure to compile an adequate record.
CONCLUSION
In sum, we conclude that Adelman has adequately presented his request for retroactive
benefits and reinstatement to the SSA, and that that request for relief is collateral to the issue
finally decided by the Appeals Council. To be clear: we do not hold that Adelman has
demonstrated an affirmative entitlement to benefits for either the retroactive period or going
forward; indeed, we recognize that whether Adelman=s work at SUNY constituted SGA after
March 2003 is a separate question from whether it was SGA before that date, requiring different
evidence and different factual findings. We conclude only that the SSA has failed to carry its
burden to show that Adelman lacks such entitlement. Accordingly, appropriately calculated
retroactive and interim benefits should be awarded unless and until the SSA can demonstrate a
valid reason why Adelman=s benefits should be terminated.
Thus, for the reasons stated above, the judgment of the district court is VACATED
insofar as it fails to require reinstatement of Adelman=s benefits retroactive to April 2003, and
the matter is REMANDED for further proceedings consistent with this order.
FOR THE COURT: Catherine O=Hagan Wolfe, Clerk