Robert S. WILSON, Jr., Plaintiff-Appellant, v. Margaret M. HECKLER, Secretary of Health and Human Services, Defendant-Appellee

761 F.2d 1383, 1985 U.S. App. LEXIS 31170, 9 Soc. Serv. Rev. 383
CourtCourt of Appeals for the Ninth Circuit
DecidedMay 24, 1985
Docket84-2248
StatusPublished
Cited by15 cases

This text of 761 F.2d 1383 (Robert S. WILSON, Jr., Plaintiff-Appellant, v. Margaret M. HECKLER, Secretary of Health and Human Services, Defendant-Appellee) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Robert S. WILSON, Jr., Plaintiff-Appellant, v. Margaret M. HECKLER, Secretary of Health and Human Services, Defendant-Appellee, 761 F.2d 1383, 1985 U.S. App. LEXIS 31170, 9 Soc. Serv. Rev. 383 (9th Cir. 1985).

Opinion

REINHARDT, Circuit Judge:

Robert Wilson appeals the district court’s grant of summary judgment in favor of the Secretary. We affirm.

I. FACTUAL BACKGROUND

In December, 1971, appellant began receiving disability benefits from the state of Arizona. On January 1, 1974, appellant was “grandfathered” into the newly created Supplemental Security Income (“SSI”) program, pursuant to Title XVI of the Social Security Act, 42 U.S.C. §§ 1381-1383c. In 1981, appellant’s SSI benefits were terminated because his wife’s income exceeded the permissible limit.

On July 1, 1981, appellant filed an application for disability benefits under Title II of the Social Security Act, 42 U.S.C. §§ 401-433 (1983). Appellant’s application was denied both initially and upon reconsideration. Appellant then requested a hearing on his application, which was conducted on September 1, 1982. Subsequent to the hearing, an administrative law judge concluded that appellant had failed to prove that he was “disabled” within the meaning of Title II as of December 31, 1975, the date on which his insured status expired. Upon affirmation of the ALJ’s determination by the Appeals Council, appellant brought this action against the Secretary in district court in order to set aside the Secretary’s finding and to obtain disability benefits. The district court granted summary judgment in favor of the Secretary.

II. ISSUES ON APPEAL

Appellant raises three issues on this appeal. First, appellant contends that since he had been receiving SSI disability benefits, and since the standards of eligibility under SSI and Title II are virtually identical, he is automatically entitled to benefits under Title II. Second, appellant contends that the Secretary’s implementation of the SSI program so as to afford him benefits constituted a determination of disability, and that in the absence of any reason to believe that this determination was wrong, the Secretary is estopped from now finding that he is ineligible for Title II benefits. Finally, in his “statement of issues,” appellant sets forth a third issue: whether the Secretary’s finding as to disability is supported by substantial evidence.

A. Relationship Between Appellant’s SSI Eligibility and Title II Eligibility

Prior to implementation of the SSI program, the federal government assisted state aid programs for the disabled with matching funds. See Livermore v. Heckler, 743 F.2d 1396, 1398 (9th Cir.1984). In 1972, Congress enacted the SSI program, through which it provided benefits directly to disabled individuals. See 42 U.S.C. § 1381 (1983); Grunfeder v. Heckler, 748 F.2d 503, 505 (9th Cir.1984). The SSI program established uniform standards of eligibility which, in some cases, were more stringent than the requirements for the state programs that SSI replaced. Thus, in some circumstances, “the statutory revision threatened to deprive individuals of the continued right to receive disability benefits.” Finnegan v. Matthews, 641 F.2d 1340, 1346 (9th Cir.1981). In order to avoid this harsh and unintended effect of the SSI program, the SSI legislation contained a “grandfather clause” that specifically exempted recipients of state disability benefits from the burden of satisfying the new uniform federal standards. Id. 1 Thus, as a beneficiary of this statutory exemption, appellant was eligible to receive *1385 SSI benefits without having to satisfy the federal standards of eligibility.

Appellant points initially to the substantial similarity between the standards of eligibility under SSI and Title II, arguing that one who is eligible for SSI benefits is necessarily eligible for Title II benefits. However, our review of the record reveals that appellant received his SSI benefits solely because he fell within the grandfather clause. There is no evidence in the record indicating that appellant independently satisfied the federal standards for eligibility. Rather, because appellant had previously met the state standards of disability, the grandfather clause entitled him to receive benefits under SSI. Thus, regardless of the similarity between the SSI and Title II eligibility requirements, the fact that appellant did not independently meet the standards of eligibility under SSI bars any contention that he is automatically entitled to Title II benefits.

We are unable to conclude that one who is grandfathered into the SSI program is presumed to have met the federal standards of eligibility. It is clear that the purpose of the grandfather clause was to prevent the harsh and often unfair operation of a statutory change. See Finnegan, 641 F.2d at 1346. Neither the language of the grandfather clause nor its legislative history indicates that a grandfatheree is to be deemed to have met the federal requirements. Rather, for purposes of the SSI program, the clause waives the federal standards of eligibility for those who have previously met state standards. Accordingly, we conclude that appellant’s eligibility for SSI benefits does not automatically entitle him to Title II benefits.

Appellant also points to the state standard under which he was found eligible to receive state disability benefits, contending that the Arizona standard is more rigorous than those under SSI and Title II. Appellant argues that since he has satisfied the more rigorous state standard, he should, ipso facto, be conclusively presumed to have met the Title II standard. Although appellant’s argument finds some support in logic, it overlooks the fact that entitlement to Title II benefits must be based upon a determination of disability by the Secretary. Pursuant to 20 C.F.R. § 404.1504, the Secretary has reserved for herself the determination of entitlement to Title II benefits. 2 Here, the only determination of disability was made by the state of Arizona and is not binding on the Secretary. See id; see also Little v. Richardson, 471 F.2d 715, 716 (9th Cir.1972) (in determining entitlement to social security disability benefits, the Secretary is in no way bound by prior state disability determinations). Thus, although the Arizona standard does appear to be more rigorous than those under SSI and Title II, the fact that state officials have determined that he satisfies the state standard does not relieve him of his burden of proving to the Secretary that he is disabled within the meaning of Title II.

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761 F.2d 1383, 1985 U.S. App. LEXIS 31170, 9 Soc. Serv. Rev. 383, Counsel Stack Legal Research, https://law.counselstack.com/opinion/robert-s-wilson-jr-plaintiff-appellant-v-margaret-m-heckler-ca9-1985.