for the same title, but for a different benefit type (e.g., claimant wants to file a new title II disabled widow(er)’s benefit application and the claimant has a claim pending for title II disability insurance benefits);
a continuing disability review; an expedited reinstatement (EXR) claim; an age 18 redetermination; or a remand from Federal court to the AC level.IMPORTANT: Do not accept or process a new disability application if the claimant has a prior disability claim for the same title and benefit type pending at any level of administrative review. See Procedural Change for Subsequent Disability Applications Effective July 28, 2011 DI 51501.001.
When a claim is pending at the AC level and an individual files a subsequent claim (DI 12045.010A.) under the same title or different title, the subsequent claim will be processed as a new initial claim. The subsequent claim will be processed under current claims processing procedures with normal appeals through the filing of a request for an ALJ hearing. This process also includes new claims filed when an appeal of a continuing disability review (CDR) is pending at the AC level. It does not include claims that are merely duplicates; e.g., a claim for disability insurance benefits in which the date last insured expired before the ALJ's decision on the prior application for the same benefits.
For subsequent nonmedical claims with a new issue, the claim will be processed as a new initial claim. For subsequent nonmedical claims involving issues that have already been decided, the subsequent claim will be sent to the AC for association. See GN 03104.370.
Take the following action when a subsequent claim has been filed:
Ask the claimant or representative if he or she has filed a Request for Review (RR) of an ALJ decision on a prior claim. Obtain a CPMS query to verify. The RRD field on the query is the request for review date; this indicates if a claim is pending at the AC level. The ADD field on the query indicates whether the AC has taken action on the RR.
Follow current instructions to process the claim if it is determined that NO RR has been filed or that NO appeal is pending at the AC level.
If it is determined that a RR has been filed and that an appeal is pending at the AC level, take the subsequent application using current procedures.
Secure a SSA-1696-U4 if the claimant is represented.A new SSA-1696-U4 is necessary even if the representative is the same as on the prior claim. SSA will apply the fee agreement rules as if there was a single application or claim (See GN 03940.038C.2.).
Item 3 - Show the potential onset date (POD) as the day after the ALJ decision.Item 4 - Check “Other” as the reason and show “Appeal pending at AC level on prior claim dated mm/dd/yy.” (See note in DI 12045.027C.1.f. regarding onset restriction.)
Secure appropriate medical Forms SSA-3368-BK, SSA-827's, etc. using current processing procedures.The DDS will follow normal development of medical history covering the 12 month period beginning with the date of the subsequent application.
“Onset Restriction—Prior claim dated mm/dd/yy pending at the Appeals Council level.”Initial claims, closed period cases, and cessations (CDR) – “Onset restriction--Onset date cannot be established earlier than the day after the date of the ALJ decision.”
Explain to the claimant that, until the AC completes its action, we will not be deciding the period on or before the date of the ALJ decision (see DI 12045.027C.1.g.), because that period is before the AC on the appeal of the ALJ decision on the prior claim. Explain that there will be separate notices for each claim and that each notice will explain the claimant's appeal rights.
The period on or before the date of the ALJ decision rests with the AC; therefore, the DDS will not establish an onset date earlier than the day after the date of the ALJ decision . A claimant may allege any onset date, even if that date is in the period covered by the ALJ's decision on the prior application. Do not try to persuade the claimant to allege a specific onset date. The date of the ALJ decision can be found on the ALJ decision notice located in the Online Retrieval System (ORS) or the electronic folder.
Take the following action if a subsequent claim and request for review are filed simultaneously:
Determine if the claimant has filed an earlier subsequent claim via MCS/MSSICS. If a subsequent claim had been filed earlier, see DI 12045.027C.3. Secure the subsequent application and medical development as indicated in DI 12045.027C.1.Process the RR using current procedures. Include with the RR a Report of Contact with the following information, “On mm/dd/yy, a subsequent claim was filed by claimant. Notification will be sent to AC if the DDS allows the subsequent claim.”
Take the following action in lieu of securing a new (or third) application:
Obtain an MBR, SSID or DDSQ to determine the date of the previous subsequent application and whether it has been processed.
Reestablish the previous application from MCS/MSSICS.Enter “ZZZ” in the first three positions of the unit field when establishing/reestablishing the systems record.
Secure SSA-3367-F4, SSA-3368-BK, and SSA-827's to update medical development for the period beginning with the date of the previous subsequent claim.
Send a Report of Contact via FAX to Office of Disability Adjudication and Review, Office of Appellate Operations (ODAR/OAO) at 703-605-7101 to the attention of Subsequent Application Coordinator; include the claimant's name, Social Security number, a statement that the second application was previously forwarded to AC for association, the date it was forwarded, and the fact that you are now forwarding the second application to the DDS for adjudication.
Take the following systems actions for Title XVI cases:
Control the prior claim (the claim pending at AC) with an MDW record and completion of Development Worksheet as shown below.
On the subsequent claim, include the following supplemental security record (SSR) remark: PRIOR CLAIM AWAITING AC DECISION
An ISSUE “AC APPEAL.” In the REMARKS for that ISSUE: Prior claim dated mm/dd/yy pending at the AC. The date of appeal and date sent to AC. An ISSUE “AC APPEAL.” In the REMARKS for that ISSUE: Prior claim dated mm/dd/yy pending at the AC. The date of appeal and date sent to AC. Set an appropriate tickle date for the AC's decision.Take the following systems actions for Title II claims:
Process the subsequent claim through MCS.Control the prior claim (the claim pending at the AC) with an MDW record and completion of Development Worksheet development worksheet as shown below.
An ISSUE “AC APPEAL.” In the REMARKS for that ISSUE: Prior claim dated mm/dd/yy pending at the AC. The date of appeal and date sent to AC. An ISSUE “AC APPEAL.” In the REMARKS for that ISSUE: Prior claim dated mm/dd/yy pending at the AC. The date of appeal and date sent to AC. Set an appropriate tickle date for the AC's decision.Take the following actions to route disability material to the DDS:
Route the disability claims folder containing: SSA-3368-BK, SSA-827, any other medical evidence, and CPMS query to the DDS.
Attach a flag (see DI 12045.027G., Exhibit 1) to the outside of material. Information needed for completion of the flag is on the CPMS query.
A flag is also required when a claimant who has not appealed an ALJ's decision on a prior application files a subsequent claim within the 60-day period for appeal following the ALJ's decision. This will ensure that there is a flag on the claim if the claimant later decides to appeal the decision. If a RR is not subsequently filed, the flag should be removed.
Take the following action if the subsequent claim results in an SGA denial:
Retain subsequent claims folder in field office (FO) until a decision is received on the prior claim.
If the DLI of the subsequent claim expires after the date of the ALJ decision on the prior claim, forward the subsequent claim to DDS for consideration of disability from the day after the ALJ decision through the DLI.
Transmit case control receipt for initial claims. Then take the following actions to process the DDS determinations for Title XVI and Title II claims either initial or reconsideration:
If the date of onset established is on or before the date of the ALJ decision for initial claim, closed period, or CDR cases, return the folder to the DDS for correction.
If the date of onset established is the day after the ALJ decision or later, follow current processing instructions as outlined in SI 00603.030 — SI 00603.036.
If the subsequent favorable claim is paper, FAX a copy of the SSA-831-U3 to the number below. This is necessary to provide the AC with advance notice that a subsequent favorable determination is on the way. Subsequent Application Coordinator Office of Appellate Operations (OAO) FAX number (703) 605-7101 If the subsequent favorable claim is electronic, the FO will send an email to OAO regarding the favorable determination. Send the email to: |||ODAR OAO The subject line should read: FAVORABLE SUBSEQUENT APPLICATION - Name of Claimant, SSN of claimant - Electronic Folder The FO should include any relevant information in the text of the message. Upon receipt of the email, OAO support staff will obtain an 'ACAPS' and/or 'LOTS' query and forward the email to the Branch Chief with jurisdiction of the pending request for review or court case. The Branch Chief will associate the email with the pending case and take further appropriate action per HALLEX I-5-3-17 III.B.1 (except the Branch Chief will not need to wait for the claims file for the subsequent favorable allowance since OAO will have immediate access to the EF via eView).