Michelle Valent v. Comm'r of Soc. Sec.
Opinion of the Court
The Commissioner of Social Security imposed an assessment of $51,410 and a civil monetary penalty of $75,000 on petitioner Michelle Valent after the Social Security Administration found that Valent failed to disclose that she had engaged in paid work activity while receiving Social Security disability benefits. Valent argues that
She therefore contends that her failure to disclose her paid work activity was not a material omission, such an omission being a prerequisite for the Administration to impose an assessment and a penalty under 42 U.S.C. § 1320a-8(a). Finally, she asserts that even if her failure to disclose her paid *518work activity was a material omission, she did not have actual or constructive knowledge that her omission was material. For the reasons set forth below, we DENY Valent's petition for review and AFFIRM the judgment of the Departmental Appeals Board.
I. BACKGROUND
A. Statutory framework
The Social Security Act provides for the payment of benefits to individuals with a "disability," which, as relevant here, is defined as a "medically determinable physical or mental impairment" that prevents a person from doing "any substantial gainful activity" for at least 12 months.
Once an individual qualifies for benefits, the Commissioner must periodically verify that the beneficiary continues to be eligible for the program, a process called a "continuing disability review."
B. Factual background
Valent applied for Social Security disability benefits in October 2003. The Administration found that she was disabled since March 2003, based primarily on various psychological problems, including depression. The Commissioner conducted a continuing-disability review in 2010 and found that Valent remained disabled.
But in January 2012, the Administration's Office of Inspector General (IG) received a tip that Valent had been working since 2009 at the War Era Veterans Alliance, an organization founded and owned by her brother and sister-in-law. A month later, the IG began an investigation into whether Valent had indeed worked at the Alliance. Valent signed forms during that investigation affirming that she had not earned income since 2003 or worked since 2004.
The IG, to the contrary, concluded that Valent had been working at the Alliance since 2009 and that her failure to report her paid work activity was an omission of a "material fact." See 42 U.S.C. § 1320a-8(a). Based on that omission, the IG recommended that Valent be assessed $68,547 (the amount of benefits paid to her since she had returned to work) and that she pay a civil penalty of $100,000 for her failure to report her paid work activity to the Administration. Section 1320a-8(a)(1)(C) authorizes the Administration to impose a penalty of up to $5,000 for each statement or representation in which an individual receiving Social Security disability benefits withheld material information. The IG determined that Valent made 41 material omissions-one for each month during which she received benefits without disclosing her work activity that generated earnings. He then decided to impose a penalty of $100,000 instead of the maximum penalty of $205,000.
*519C. Procedural background
Valent requested a hearing before an administrative law judge (ALJ), who heard testimony from the tipster and from Valent's brother, among others. Her brother testified that he had assigned Valent simple tasks and paid her about $400 per week, essentially as an act of charity. In a June 2014 decision, the ALJ agreed with the IG's finding that Valent had indeed worked for and been paid by the Alliance, her brother's motivation notwithstanding. But the ALJ disagreed with the IG that Valent's unreported work activity was an omission of a "material fact" because, according to the ALJ,
The Departmental Appeals Board (the Board) reversed the ALJ's ruling in November 2014, concluding that the ALJ's interpretation of
On remand, the ALJ reiterated his opinion that § 421(m)(1)(B) barred the Administration from considering Valent's work activity. He therefore concluded that Valent had no reason to know that her failure to disclose her work activity was an omission of a material fact. Ultimately, the ALJ held that the Social Security Act and the Administration's regulations "are not clear enough for a person of reasonable intelligence to know what activity is reportable as work activity." The ALJ accordingly again declined to impose either an assessment or a penalty.
Once more, the Board reversed the ALJ's decision. It noted that constructive knowledge that an omission of fact is material is sufficient under 42 U.S.C. § 1320a-8(a). Furthermore, the Board disagreed with the ALJ's conclusion that the regulatory scheme is so confusing that a reasonable person would not know that withholding the report of gainful work activity constitutes the omission of a material fact. So although the Board deferred to the ALJ's findings of fact, it imposed a special assessment of $51,210 and a penalty of $75,000, both of which were less than the amounts originally levied by the IG. This petition for review followed.
II. ANALYSIS
A. Standard of review
We review the Administration's interpretation of law under the framework established in Chevron, U.S.A., Inc. v. Natural Resources Defense Council, Inc. ,
For agency determinations that are not interpreting a statute, we will set them aside only if they are "arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law." Steeltech, Ltd. v. EPA ,
B. Section 421(m) of the Social Security Act is ambiguous, and the Administration's interpretation of that section is based on a permissible construction of the statute.
The key interpretive question before us is whether the failure of an individual who receives Social Security disability benefits to report work activity that generates earnings constitutes the omission of a "material fact" under 42 U.S.C. § 1320a-8(a). That statute authorizes the Commissioner to impose an assessment and a penalty when a recipient of Social Security disability benefits "omits from a statement or representation ... or otherwise withholds disclosure of, a fact which the person knows or should know is material to the determination of any initial or continuing right to or the amount of monthly insurance benefits." 42 U.S.C. § 1320a-8(a)(1)(C).
Under step one of the Chevron framework, Congress has not "directly spoken to the precise question at issue." See Chevron ,
The Second Circuit in Cappetta v. Commissioner of Social Security Administration ,
Although we disagree with the Second Circuit's holding that the statute unambig uously *521authorizes the Commissioner to "consider a failure to report work activity that generates profit or pay 'material' for purposes of § 1320-8," Cappetta ,
Having determined that the statutory scheme is ambiguous, we now move on to the second step of the Chevron framework: "whether the agency's answer is based on a permissible construction of the statute." See Chevron ,
We conclude that the Administration's interpretation is a permissible construction of the statute. Valent's position is that the Administration can consider "substantial gainful activity" but not "work" or "work activity." As the Commissioner argues, however, this construction of the statutory scheme "makes no sense" and "would be impossible to implement." The Administration would be unable to examine a beneficiary's substantial gainful activity without considering the beneficiary's work activity that generates profit or pay.
Nor does the Administration's interpretation read out or ignore
The Administration's interpretation of the statutory scheme is further supported by the legislative history of
As the Second Circuit held in Cappetta , "[t]hose observations support the Commissioner's reading of the statute, because they demonstrate Congress's clear intent to continue making substantial gainful activity-which the SSA assesses by looking primarily at earnings derived from work -relevant and applicable to SSDI beneficiaries." Cappetta ,
C. The Administration's imposition of an assessment and a penalty in this case is consistent with its permissible construction of the Social Security Act.
This leaves the question of how to apply the above principles to the present case. Both the IG and the Board found that Valent made a material omission under 42 U.S.C. § 1320a-8 when she failed to disclose her work activity with the War Era Veterans Alliance, an activity that generated profit or pay. According to the dissent, Valent's assessment and penalty in this case were based solely on her failure to report work activity, not on her failure to disclose earnings. Dissenting Op. 526-27. The dissent further notes that the Commissioner's counsel agreed during oral argument that the Commissioner imposed an assessment and a penalty in the present case based on Valent's failure to disclose work activity. Dissenting Op. 526-27.
But the dissent overlooks the Administration's conclusion that work activity is a necessary component of substantial gainful activity, which is a proper ground for terminating benefits under
The dissent also contends that "the Commissioner imposed the sanction based solely on Valent's failure to report 'work activity' period -without regard to whether she received any earnings from that activity." Dissenting Op. 526 (emphasis in original). We respectfully disagree. In the IG's June 3, 2013 letter to Valent, the IG states that Valent "failed to report to [the Administration] that [she] worked at the War Era Veterans Alliance" and that her brother, the coowner of the Alliance along with Valent's sister-in-law, "paid [her] $400 per week." Valent was thus being paid for her work, and the Administration took this fact into account when it imposed an assessment and a penalty. Whether the Administration can impose an assessment and a penalty on a beneficiary who fails to disclose unpaid work activity is not a question before us because Valent engaged in and failed to disclose her paid work activity with the Alliance.
D. Valent had constructive notice that her failure to report her work activity that generated profit or pay was a material omission that misled the Administration.
As we concluded earlier (see Part II.B. above), we defer to the Administration's permissible determination that a failure to report work activity that generates profit or pay is a material omission under 42 U.S.C. § 1320a-8. We now turn to the two other elements of § 1320a-8 : (1) whether Valent knew or should have known that her omission was material, and (2) whether she knew or should have known that her omission was misleading to the Administration. See 42 U.S.C. § 1320a-8(a)(1)(C). The Board, in its second decision in this case, concluded that Valent should have known that the failure to report her paid work activity with the Alliance was a material omission that misled the Administration.
We agree with the Board that the statutory scheme and the Administration's regulations put Valent on constructive notice that her failure to report was material. As the ALJ held on remand, "[t]he Administrative Procedure Act requires publication of legislative rules adopted by federal agencies and, based on that publication[,] the public has at least constructive, if not actual knowledge of the requirements of the regulations." Several regulations put Valent on notice of her need to report work activity that generated profit or pay, and that a failure to do so would mislead the Administration.
"Substantial gainful activity" is defined in
*524The dissent, however, argues that the Administration's own regulation-specifically,
If you are currently entitled to disability insurance benefits as a disabled worker ... and at the time we are making a determination on your case you have received such benefits for at least 24 months, we will not consider the activities you perform in the work you are doing or have done during your current period of entitlement based on disability if they support a finding that your disability has ended.
The regulation is consistent with the position advanced by the Administration in this case. In particular, the regulation states that the Administration "will not consider the activities you perform in the work you are doing."
E. The issues raised in Valent's supplemental brief are not reviewable.
This brings us to one final matter to be decided, which is based on our request that the parties file supplemental briefs to address the Second Circuit's decision in Cappetta . In the course of doing so, Valent raised three new issues in her supplemental brief: (1) whether the Board can impose an assessment and penalty in the first instance, (2) whether the assessment and penalty are supported by substantial evidence, and (3) whether the Administration considered the fact that it suffered no actual loss. But these new arguments are not properly before us because they were not raised in Valent's opening brief. See Island Creek Coal Co. v. Wilkerson ,
III. CONCLUSION
For all of the reasons set forth above, we DENY Valent's petition for review and AFFIRM the judgment of the Board.
Dissenting Opinion
DISSENT
In every case where an Article III court defers to the Executive's interpretation of a statute under Chevron , our constitutional separation of powers is surely disordered. That disorder, the Supreme Court has said, is constitutionally permissible. But it is disorder nonetheless. For whenever a federal court declares a statute ambiguous and then hands over to an executive agency the power to say what the statute means, the Executive exercises a power that the Constitution has assigned to a different branch.
One can conceive of this transfer in two ways. As Chevron itself conceives of it, the executive branch resolves the ambiguity by *525exercising legislative power to define the statute's terms.
Under Chevron itself, courts should ensure that this disorder happens as rarely as it lawfully can. Chevron directs courts to exhaust all the "traditional tools of statutory construction"-and there are many of them-before surrendering to some putative ambiguity and thereby allowing the Executive to exercise power belonging to another branch. See
But that is hardly what happens in reality. Instead, the federal courts have become habituated to defer to the interpretive views of executive agencies, not as a matter of last resort but first. In too many cases, courts do so almost reflexively, as if doing so were somehow a virtue, or an act of judicial restraint-as if our duty were to facilitate violations of the separation of powers rather than prevent them.
In this case, respectfully, the tools of statutory construction are hardly employed. Rather than analyze the interpretive issue, the majority merely frames it. And the agency's interpretation-now the law of our circuit-construes the words of the statute in a manner that no ordinary speaker of the English language would recognize. (Agencies are experts at policy, but not necessarily at statutory interpretation.) Meanwhile, the majority overlooks more case-specific grounds on which Valent is entitled to relief.
I.
The question presented by this case is whether the Social Security Act authorized the Commissioner to sanction Valent for her failure to report her "work activity." The Act allows the Commissioner to impose certain penalties and assessments for each instance in which a person "omits from a statement or representation ... or otherwise withholds disclosure of, a fact which the person knows or should know is material to the determination of any initial or continuing right" to disability insurance benefits. 42 U.S.C. § 1320a-8(a)(1)(C). To impose a penalty and assessment, the Commissioner bears the burden of proving *526three elements: first, that a person failed to disclose a "material fact"; second, that the person had reason to know the fact was "material"; and third, that the person had reason to know that failure to disclose the fact was "misleading" to the agency.
The Commissioner imposed the assessment and penalty (hereinafter, "the sanction") against Valent based solely on her failure to disclose her "work activity" at the Alliance. R. 18 at 835; see also R. 18 at 119. Valent argues that her work activity could not be "material" because the Commissioner could not use it as evidence against her. Section § 421(m)(1)(B) provides in relevant part:
(m) Work activity as basis for review
(1) In any case where an individual entitled to disability insurance benefits ... has received such benefits for at least 24 months-
...
(B) no work activity engaged in by the individual may be used as evidence that the individual is no longer disabled[.]
As an initial matter, the majority repeatedly misstates the basis on which the Commissioner imposed the sanction at issue here. The Commissioner did not, as the majority recites throughout its opinion, impose the sanction based on Valent's failure to report "work activity that generates earnings " or "work activity that generates profit or pay [.]" Maj. Op. at 520, 522 (emphasis added). That characterization distorts the question presented by blending a fact that the agency may use as evidence against a beneficiary (i.e. , her earnings) with a fact the agency may not (i.e. , her work activity). Instead, the Commissioner imposed the sanction based solely on Valent's failure to report "work activity" period -without regard to whether she received any earnings from that activity. For example, the ALJ on remand noted: "It is important to recognize that the [Inspector General] did not charge [Valent] with failure to report earnings or failure to report substantial gainful activity, both of which are material facts. The [IG] cited failure to report work activity as the basis for the [sanction.]" R. 18 at 124 (emphasis added). The Board likewise wrote that the Inspector General had proposed the sanction for Valent's "failure to disclose that she had worked while receiving [benefits.]" R. 18 at 10. The Commissioner's brief to this court likewise recited that Valent had "withheld information that she was engaged in work activity while receiving disability benefits." Comm'r Br. at 21. True, as the majority points out, the IG's letter to Valent recited that she had received a stipend from her brother in exchange for her work activity. But the fact remains that the Commissioner's stated basis for imposing the sanction was solely her work activity. The Commissioner's counsel expressly conceded the point at oral argument:
*527COURT: As I understand the record here, the Commissioner sought this penalty and repayment of benefits solely on the ground of her failure to disclose work activity, not substantial gainful or earnings.
GOVERNMENT: That's correct.
COURT: Why in the world did the Commissioner do that?
GOVERNMENT: I don't know.
Oral Arg. at 28:02.
Working from this mistaken understanding of the basis for the Commissioner's action, the majority then says that the statute is ambiguous because §§ 421(m)(1)(B) and (2)(B)"appear to conflict with one another." Maj. Op. at 520. That two provisions appear to conflict, however, does not mean they are ambiguous. Instead that means we must use all the tools of statutory construction, if at all possible, to interpret the statute as "an harmonious whole." FDA v. Brown & Williamson Tobacco Corp .,
More to the point, on the basis of a conclusory statement about the two provisions at issue, and the mere fact of another court's conflicting decision, the majority moves past Chevron 's "step one" and allows the Executive to assume the judicial role. A court more vigilant about the constitutional separation of powers might instead observe that the verbs in the operative provisions here are different: section 421(m)(1)(B) says that a beneficiary's work activity may not be "used as evidence that [she] is no longer disabled,"
*528The interpretation to which the majority then defers is almost a test case for how far an agency can go in Chevron 's "step two." Specifically, the agency notes that § 421(m)(1)(B) includes the phrase "no longer disabled[,]" and that, in the agency's paraphrase, disability as defined by
II.
Valent is also entitled to relief for a simpler reason: the agency has failed to show that she knew or had reason to know that her work activity was material. The majority finds this element of the sanction met for the same reason the Board did in its second decision: that (in their view) an agency regulation required her to report her work activity. See Maj. Op. at 523 (citing 20 C.F.R. 404.1588(a) ). But the majority overlooks that the Board itself expressly rejected this very position in its first decision below, when the Board held that this same regulation was "relevant" but "not determinative" of the question whether Valent knew or had reason to know that her work activity was material. R. 18 at 240.
Under the Administrative Procedure Act, we set aside agency action that is "arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law."
Finally, a more pertinent regulation-unmentioned by the Commissioner in her brief-seriously undermines the agency's position here. Specifically, in response to the enactment of § 421(m), the Commissioner promulgated a regulation, entitled "How we will determine whether your disability *529continues or ends." See
If you are currently entitled to disability insurance benefits as a disabled worker ... and at the time we are making a determination on your case you have received such benefits for at least 24 months, we will not consider the activities you perform in the work you are doing or have done during your current period of entitlement based on disability if they support a finding that your disability has ended.
I respectfully dissent.
Reference
- Full Case Name
- Michelle VALENT, Petitioner, v. COMMISSIONER OF SOCIAL SECURITY, Respondent.
- Cited By
- 9 cases
- Status
- Published