Barnhart v. Walton

The statutory definition of disability requires both an inability to engage in substantial gainful activity and a medically determinable impairment causing that inability. Grammatically, the 12-month phrase modifies “impairment,” and not “inability.” But that linguistic point establishes only that the statute does not expressly state how long the inability must last; it does not unambiguously prohibit the Agency's interpretation.

A neighboring provision requires an impairment to be severe enough that the claimant cannot perform prior work or other substantial gainful work in the national economy. It is at least reasonable to infer that the impairment must remain disabling in that sense for 12 months. Requiring a 12-month inability to perform substantial gainful activity is effectively another way of expressing that same requirement.

The Agency's construction sensibly carries out the statute's duration requirement. Congress plainly did not intend benefits for a claimant whose long-lasting medical condition briefly interrupts work but quickly permits a return to substantial gainful activity. A rule requiring the work-precluding inability to last, or be expected to last, 12 months coherently connects the impairment and inability components of disability.

The interpretation also reflected the Agency's longstanding administrative position, and Congress repeatedly amended or reenacted the relevant provisions without displacing that understanding. Although Title II contains a separate five-month waiting period, Title XVI does not, despite using the same definition of disability; that difference undermined Walton's argument that the waiting period made an additional 12-month inability requirement unreasonable.

Chevron deference was appropriate because the question was interstitial, central to a complex benefits program, and within the Agency's expertise. The Agency had considered the issue over time, and its current interpretation was embodied in formal regulations adopted through notice-and-comment rulemaking.

Walton argued that, before his return to work after 11 months, his impairment and inability to work could have been expected to last 12 months. On his view, he therefore became entitled to Title II benefits before returning to work, making his later cashier work protected trial work rather than disqualifying substantial gainful activity.

The statute does not specify the temporal perspective from which the Agency must measure whether an impairment or inability “can be expected to last” 12 months. The phrase can reasonably permit an early award of benefits before 12 months have passed, without requiring an adjudicator who later knows the claimant returned to work to ignore that fact and reconstruct a counterfactual prediction.

The Agency's rule reasonably permits the use of hindsight. Once a claimant has returned to substantial gainful activity before the 12-month period ends and before any disability determination, the Agency may treat that actual return as dispositive rather than requiring an administrator to decide the difficult hypothetical question of whether the claimant's earlier inability would have been expected to continue absent the unexpected improvement.

Although Walton's approach might create a stronger incentive for an early return to work, the statute did not require the Agency to make that consideration controlling. The Agency could address work incentives through other regulations while adopting a clear, administrable duration rule for the large number of disability claims it must decide.