Joe Whitcomb
On January 5, 2024, the United States Court of Appeals for the Ninth Circuit heard an appeal from Juanita L. Cross, who challenged the denial of her application for supplemental security income (SSI). The case, Cross v. O'Malley, arose from the United States District Court for the Western District of Washington, where Magistrate Judge Sarah Kate Vaughan initially upheld the denial of benefits.
Background of the Case
Juanita Cross first applied for SSI benefits on January 11, 2019, claiming a disability under Title XVI of the Social Security Act. The Social Security Administration (SSA) denied her application on June 12, 2019, and after reconsidering her case, reaffirmed the denial on September 11, 2019. Dissatisfied with these outcomes, Cross requested a hearing, which was held on December 9, 2020, before Administrative Law Judge (ALJ) David Johnson.
On January 29, 2021, ALJ Johnson issued a ruling, finding that Cross was not disabled under SSA standards. In his decision, the ALJ used the standard five-step process to assess disability claims, as outlined by the SSA’s regulations. He determined that Cross had the residual functional capacity to perform a full range of work at all exertional levels with some restrictions, and that there were a significant number of jobs in the national economy that she could perform.
Cross's Argument on Appeal
Following the ALJ’s decision, Cross sought judicial review. She argued that the SSA’s 2017 revised regulations for evaluating medical evidence were invalid. Cross contended that the regulations improperly allowed ALJs to avoid explaining how they considered certain factors, such as the “examining relationship” between a claimant and medical sources or the specialization of the doctors involved.
Under prior SSA rules, these factors were considered key in evaluating medical opinions. Cross argued that the revised regulations, which removed the requirement to explicitly address these factors unless there were equally supported and consistent medical opinions, violated both the Social Security Act and the Administrative Procedure Act (APA).
Legal Context of the 2017 SSA Regulations
The 2017 regulations at issue changed how ALJs assess medical evidence, eliminating the need to assign specific evidentiary weight to treating or examining physicians. Instead, the regulations require ALJs to focus on the “supportability” and “consistency” of medical opinions with other evidence in the record. While ALJs can still consider other factors, such as the examining relationship or the doctor's specialization, they are not required to do so unless two medical opinions are equally well-supported and consistent with the record.
The SSA explained that these changes were necessary due to shifts in healthcare practices, noting that many individuals now receive care from multiple providers rather than maintaining a long-term relationship with a single treating physician. The agency also emphasized that the new regulations aimed to increase objectivity and efficiency in evaluating disability claims.
Court's Review and Findings
In reviewing the case, the Ninth Circuit addressed whether the SSA’s 2017 regulations complied with both the Social Security Act and the APA. The court noted that the SSA has broad authority to create rules regarding the evaluation of medical evidence. The court further emphasized that the regulations were designed to reflect changes in healthcare practices and were intended to foster a fair and efficient administrative process.
The Ninth Circuit also considered the SSA’s response to public comments when it issued the revised regulations. The agency argued that supportability and consistency were the most objective and important factors for evaluating medical opinions, given that many claimants now receive care from various medical sources.
Conclusion
After reviewing the case, the Ninth Circuit ruled that the SSA's 2017 medical-evidence regulations were lawful and consistent with the Social Security Act and the APA. Therefore, the court affirmed the ALJ’s decision, concluding that Juanita Cross was not disabled under SSA standards.