CLARE R. HOCHHALTER, Magistrate Judge.
The plaintiff, Donald T. Johns ("Johns"), seeks judicial review of the Social Security Commissioner's denial of his request for a waiver of overpayment of Supplemental Security Income ("SSI") pursuant to 42 U.S.C. § 205(b). For the reasons set forth below, the decision of the ALJ is affirmed.
Johns was honorably discharged from the United States Marine Corp in 1976. (Tr. 99). Deemed to have a service-connected disability of twenty percent, he was awarded a modest monthly benefit by the United States Veterans Administration ("VA").
Johns filed an application for Title XVI SSI payments on July 15, 2010, alleging a disability onset date of January 2010. (
Johns' application for SSI was granted and he began receiving monthly SSI payments in 2010. The amount he received was offset or reduced by the amount of his monthly VA benefits.
On March 3, 2012, the Social Security Administration ("SSA") issued a notice advising Johns that, because he showed "no income from February 2012 on," his monthly SSI payments would increase effective April 2012. (Tr. 24-27).
On July 12, 2013, the SSA issued a notice to Johns that, from April 2012 through June 2013, he received overpayments totaling $3,481.00 due to a mistaken belief on its part that he no longer had other sources of income. (Tr. 28-31). It further advised that it would deduct $71 from his SSI payments every month to offset the overpayment or, in the alternative, he could repay the entire $3,481.00 by check, money order, or credit card. (
Johns had apparently spent the $3,4181.00 on dental care and so he could not simply return it to the SSA. On July 24, 2013, he filed a request for a waiver of overpayment on the grounds that he "was never told [his] payment was changing or why it was changing[,] [he was] not aware there was anything wrong[,] [and he] did not tell social security that [his] VA benefits stopped." (Tr. 36-38)
On November 6, 2013, Johns reported to the SSA's office in Bismarck, North Dakota, for a "personal conference." (Tr. 49). That same day the SSA denied Johns' waiver request, opining:
(Doc. No. 503).
An administrative law judge ("ALJ") convened an administrative hearing at Johns' request on March 21, 2014. (Tr. 55, 59-60, 69-73, 130-146). Johns testified at the hearing that he suffers from schizophrenia, which sometimes affects his judgment, and that the stress regarding the overpayment had exacerbated his symptoms. (Tr. 135-137). He also testified about his VA benefits, how he obtained them, and how he had always taken issue with how the SSA had used them when calculating his SSI payments. (Tr. 136-37). When asked to explain what he meant by "issue," he responded that he had "an issue with them taking something like the veteran's benefits away from [him]." (Tr. 137). When the topic of finances and his ability to management them was broached, he testified that while he lived on his own he would look to family for help budgeting his money. (Tr. 138, 141).
On April 15, 2014, the ALJ issued an order denying Johns' waiver request. (Tr. 10-17,107-114). The ALJ accepted the SSA's determination that, from April 2012 until June 2013, Johns was overpaid SSI in the amount of $3,481.00. The ALJ further concluded that Johns was "not without fault in causing the overpayment" as he should have recognized that the SSA had erred when recalculating his SSI benefits and reported it. Specifically, he opined:
(Doc. No. 13-4).
On May 1, 2014, Johns requested a review the ALJ's decision by the Appeals Council. (Tr. 115-120). Unable to locate Johns' file, the Appeals Council issued an order on February 24, 2017, remanding the matter back to the ALJ for a de novo hearing. (Tr. 121-125). On June 23, 2017, it vacated its remand order as it had located Johns' file. (Tr. 128-129). On August 23, 2017, it denied Johns' request for review, making the ALJ's decision the final decision of the Commissioner. (Tr. 3-5).
Johns initiated the above-entitled action by Complaint on October 10, 2017. He filed a Motion for Summary Judgment on January 24, 2018. The SSA subsequently filed its own motion for summary judgment. Both motions have now been fully briefed and are ripe for the court's consideration.
Title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq., provides for the payment of monthly benefits to indigent persons under the SSI program.
An overpayment of SSI occurs when a beneficiary is paid more than the amount due for a given period. 20 C.F.R. § 416.537(a). If an SSI beneficiary has been overpaid, the SSA can recoup the overpayment by reducing the amount of future benefit payments.
An SSI beneficiary may request both a reconsideration of the overpayment determination and a waiver of overpayment collection.
20 C.F.R. § 416.550;
Although a finding of fault "depends on all of the circumstances in the particular case," an individual will be found to be at fault in connection with an overpayment when an incorrect payment resulted from a "[f]ailure to furnish information which the individual knew or should have known was material" or from "[a]n incorrect statement made by the individual which he [or she] knew or should have known was incorrect," or where the individual "did not return a payment which he [or she] knew or could have been expected to know was incorrect." 20 C.F.R. § 416.552. In determining whether an individual was without fault in connection with an overpayment, the SA must "specifically take into account any physical, mental, educational, or linguistic limitation of [the] individual (including any lack of facility with the English language)." 42 U.S.C. § 1383(c)(1)(A); 20 C.F.R. § 416.552. Among other things, the Agency must consider "the individual's understanding of the reporting requirements, the agreement to report events affecting payments, knowledge of the occurrence of events that should have been reported, ... [and] ability to comply with the reporting requirements." 20 C.F.R. § 416.552.
Bad faith is not necessary for a finding of fault; "`rather, an honest mistake may be sufficient to constitute fault.'"
The scope of this court's review is limited in that it is not permitted to conduct a de novo review. Rather, the court looks at the record as a whole to determine whether the Commissioner's decision is supported by substantial evidence.
"Substantial evidence is less than a preponderance of the evidence, but is `such relevant evidence as a reasonable mind would find adequate to support the [ALJ's] conclusion.'"
Johns does not dispute that he received an overpayment of benefits. Rather, he takes the tack that he did not perceive or appreciate the SSA's error and thus has no fault in connection with the overpayment. In so doing he asserts that the ALJ and, by extension, the Commissioner, failed to make an explicit credibility determination, consider how his schizophrenia affects his judgment, or seek corroboration from the VA and thus failed to demonstrate that he was his aware of his reporting obligations. He further asserts that the SSA provided him with erroneous information. Finally, he asserts that, by vacating its remand order and affirming the ALJ's decision, the Appeals Council engaged in an ultra vires act that denied him due process.
For support, Johns relies in part on the Eighth Circuit's holding in
Generally, in a waiver of overpayment-recovery case, "if an ALJ chooses not to believe a claimant, it is necessary that the fact finder articulate any reasons for questioning the claimant's credibility."
Contrary to Johns' assertions, the record evinces that the ALJ did endeavor to address Johns' credibility. For example, when concluding that Johns knew or should have known of his reporting requirement, the ALJ contrasted Johns stated belief that his call to Congress had resulted in a change in the law to his acknowledgment at the administrative hearing that he had reported his VA benefits as income when applying for SSI, was aware that his VA benefits factored into the calculation of his monthly SSI payments, had received notice from the SSA that it was increasing his monthly SSI payments because he was receiving no other income, and had neither been notified of any change in the law nor had made any inquiries about the state of the law. The ALJ also explicitly discounted Johns' assertions regarding the exacerbation of symptoms when dealing with the SSA as an after-the-fact rationalization, emphasizing the dearth of substantiating medical evidence or evidence that Johns had ever requested assistance from the SSA in navigating its rules and regulations.
The import of Johns concerns about what he perceives as a lack of inter-agency communication, i.e., the SSA purported failure corroborate with the VA his stated belief that his phone call to Congress changed the law, is not immediately apparent. There is nothing in the record to suggest, and Johns does not allege, that he communicated his belief regarding the state of the law to someone at the VA let alone anyone outside of the SSA.
As for Johns' reliance on the holding in
The court appreciates that Johns was deemed disabled because of his schizophrenia and therefore eligible for SSI. His disability is not a "trump card" that he can simply play when it comes to the issue of fault, however. Notably, he did not present any medical evidence or explanation throughout the administrative process that is demonstrative of the affect of schizophrenia on his judgment or how his schizophrenia was being managed/treated. Rather, he simply asserted, as he does now, that his schizophrenia can sometimes affect his judgment.
As discussed above, the burden is ultimately on Johns to demonstrate that he was without fault. Johns has not articulated how his disability affected his judgments or perception, and in so doing leave it to the court to speculate or surmise. This is something that the court cannot do, however. The ALJ determined that Johns did not meet this burden based upon the evidence before him. There is substantial evidence in the record to support his determination.
Johns' assertion that his reliance on erroneous information from the SSA somehow entitles him to waiver of overpayment is specious. The erroneous information to which Johns is referring is the notice he received from the SSA that his SSI payments would be increasing as he no longer had any sources of income. First, as noted above, an individual "is not relieved of liability and is not without fault solely because [the SSA] may have been at fault in making the overpayment." 20 C.F.R. § 416.552. Second, acceptance of Johns' assertion would require the court to ignore rules, regulations, and case law authorizing the SSA to recoup overpayments.
Johns' assertion that the SSA failed to adhere to its own guidelines is likewise specious. Obtaining waiver of overpayment collection is a two step process. The claimant must demonstrate that he was without fault in connection with an overpayment
Johns asserts that "[b]y issuing an Order to Vacate, without the ALJ first surrendering jurisdiction, the Appeals Council engaged in ultra vires act to deny [him] a de novo hearing under HALLEX-I-2-85(C)(2) (Hearings, Appeal and Litigation Manual)." (Doc. No. 15-1). In so doing, he acknowledges that "HALLEX's are not afforded controlling weight and are intended to be guidelines for interal use by Social Security..." (
The court can find no case law, regulation, policy statement, or documented procedure that supports Johns' assertion. The Commissioner does not, however, provide the court with clear statutory, regulatory, or procedural support for the proposition that the Appeals Council retained the necessary jurisdiction to act as it did in this matter. The sections of the Social Security Administration's Hearings, Appeals and Litigation Law Manual, known as HALLEX, relied upon by the Commissioner discuss only the circumstances under which an ALJ may seek clarification of an Appeals Council remand order.
The court finds there is substantial evidence in the record to support the Commissioner's decision and that Johns has not met his burden of establishing that the Appeals Council's actions were improper. Accordingly, the Commissioner's Motion for Summary Judgment (Doc. No. 16) is