United States District Court, N.D. Alabama, Southern Division
DANIEL L. CHAPEL, Claimant,
NANCY A. BERRYHILL, ACTING COMMISSIONER OF SOCIAL SECURITY Respondent.
OWEN BOWDRE CHIEF UNITED STATES DISTRICT JUDGE
claimant, a recipient of disability benefits, appeals the
Administrative Law Judge's denial of his request for a
repayment waiver for overpaid disability benefits under 42
U.S.C. § 204(b). The Social Security Administration
found that it overpaid the claimant disability benefits
during two periods when he engaged in substantial gainful
work without notifying the Administration, and for that
reason it sought repayment from the claimant. In a decision
dated July 25, 2015, the ALJ determined that the claimant was
liable for repayment of $39, 824 in disability insurance
benefits paid to him from April 1998 through December 1999
and April 2011 through August 2013, because he was not
without fault in causing the overpayments. (R. 14, 16-17).
1, 2017, the Appeals Council denied the claimant's
request for review; consequently the ALJ's decision
became the final decision of the Commissioner of the
Administration. (R. 5). The claimant has exhausted his
administrative remedies, and this court has jurisdiction
pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3).
appeal, the claimant argues that he was without fault in
causing the overpayments because he did report his work to
the Administration, and thus repayment should be waived.
Additionally, the claimant presented this court with
additional evidence that was not in the record for the
underlying administrative proceedings. For the reasons
stated below, the court REVERSES and REMANDS the ALJ's
decision for further development of the record.
court finds that the issue on appeal is whether the ALJ fully
and fairly developed the record concerning the claimant's
STANDARD OF REVIEW
standard for reviewing the Commissioner's decision is
limited. This court must affirm the ALJ's decision if he
applied the correct legal standards and if substantial
evidence supports his factual conclusions. See 42
U.S.C. § 405(g); Graham v. Apfel, 129 F.3d
1420, 1422 (11th Cir. 1997); Walker v. Bowen, 826
F.2d 996, 999 (11th Cir. 1987).
. . . presumption of validity attaches to the [ALJ's]
legal conclusions, including determination of the proper
standards to be applied in evaluating claims.”
Walker, 826 F.2d at 999. This court does not review
the ALJ's factual determinations de novo. The
court will affirm those factual determinations that are
supported by substantial evidence. “Substantial
evidence” is “more than a mere scintilla. It
means such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.”
Richardson v. Perales, 402 U.S. 389, 402 (1971).
42 U.S.C. § 423(d)(1)(A), a person is entitled to
disability benefits when the person 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. §
Commissioner of Social Security is permitted to recover
overpayments when the Administration has overpaid benefits to
the beneficiary. 20 U.S.C. § 1383(b)(1)(A). However,
repayment of the overpaid amount may be waived if: (1) the
beneficiary is found to be “without fault”
regarding the overpayment, and (2) recovery would defeat the
purpose of the Act or “would be against equity and good
conscience.” Id. at 404(b)(1). The beneficiary
bears the burden of proving that he is without fault in
causing the overpayment of benefits and must do so before the
Secretary may consider the second tier of the waiver statute.
Viehman v. Schweiker, 679 F.2d 223, 227 (11th Cir.
of a beneficiary's fault is a highly subjective inquiry,
considering criteria such as the beneficiary's age,
intelligence, education, and physical and mental condition,
as well as “the interaction between the intentions and
state of mind of the claimant and the peculiar circumstances
of his situation.” Jefferson v. Bowen, 794
F.2d 631, 633 (11th Cir. 1986) (quoting Harrison v.
Heckler, 746 F.2d 480, 482 (9th Cir. 1984)).
claimant challenges the Administration's initial
determination of the amount of an overpayment, the
Commissioner must present reliable substantial evidence of
the particular overpayments. The burden of proof of the fact
and amount of overpayments is on the Commissioner. Mackey
v. Astrue, No. 3:08-CV-1019-J-TEM, 2010 WL 3833659, at
*7 (M.D. Fla. Sept. 28, 2010) (citing McCarthy v.
Apfel, 221 F.3d 1119, 1126 (9th Cir. 2000); Cannuni
ex rel. Cannuni v. Schweiker, 740 F.2d 260, 263 (3rd
Cir. 1984); United States v. Smith, 482 F.2d 1120,
1124 (8th Cir. 1973)).
the ALJ has an affirmative duty to develop a full and fair
record. Brown v. Shalala, 44 F.3d 931, 934 (11th
Cir. 1995); Lucas v. Sullivan, 918 F.2d 1567, 1573
(11th Cir. 1990); Smith v. Bowen, 792 F.2d 1547,
1551 (11th Cir. 1986); Cowart v. Schweiker, 662 F.2d
731, 735 (11th Cir. 1981). This duty exists even if the
claimant is represented by counsel or waived his right to
representation. Cowart, 662 F.2d at 735. However,
“where the right to representation has not been waived,
the hearing examiner's obligation to develop a full and
fair record rises to a special duty.” Graham,
129 F.2d at 1422. This special duty requires the ALJ to be
“especially diligent” and to “scrupulously
and conscientiously probe into, inquire of, and explore for
all the relevant facts.” The ALJ must ensure that
favorable as well as ...