I-2-1-12.Reconstructed Paper Claim(s) File

Last Update: 6/9/14 (Transmittal I-2-110)

A. General

Office of Appellate Operations (OAO) staff will make every attempt to obtain a missing claim(s) file before remanding the case to the hearing level. See Hearings, Appeals and Litigation Law (HALLEX) manual I-2-1-14 and I-3-0-71 B. If all attempts to locate the missing claim(s) file are unsuccessful, the Appeals Council must remand the case to the administrative law judge (ALJ) based on a missing claim(s) file. In its order, the Appeals Council will instruct that the claim(s) file be reconstructed.

A reconstructed claim(s) file must be clearly marked, with “Reconstructed” in bold letters across the front of the file.

B. Developing Issues for a Reconstructed Claim(s) File

1. Developing Non-Medical Issues

The hearing office (HO) will reconstruct a claim(s) file by requesting that the appropriate field office (FO) redevelop the nonmedical aspects of the claim, including taking of the medical history, obtaining copies of form SSA-831 or SSA-833, if necessary, and securing new medical release forms. The FO will forward the redeveloped nonmedical evidence to the HO. The HO will mark each piece of redeveloped nonmedical evidence as “reconstructed.”

If the HO does not receive the redeveloped non-medical record within 15 days of the date the request was initiated, the HO will refer the matter to the appropriate Office of Disability Adjudication and Review (ODAR) regional office (RO). The ODAR RO will work with the Office of the Regional Commissioner (ORC), which is responsible for coordinating efforts to locate and reconstruct missing claim(s) files.

2. Developing Medical Issues

The HO will reconstruct the medical issues by requesting that the appropriate Disability Determination Services (DDS) office redevelop the medical evidence. The HO will provide DDS with copies of forms SSA-3368 and SSA-3369, as well as original medical release forms. Ultimately, the ALJ will determine what medical evidence to redevelop.

The DDS has 90 days to complete development of the medical record and forward the redeveloped medical evidence to the HO. However, the HO may send a status request to the DDS if the HO has not received any reconstructed medical evidence within 30 days. The HO will mark each piece of redeveloped medical evidence as “reconstructed.” If the HO does not receive the reconstructed medical record, it will refer the matter to the ODAR RO. The ODAR RO will work with the ORC to obtain the missing information.

C. Additional Actions When Received Information Is Incomplete

If the HO receives all developed non-medical and medical information, but determines the reconstructed claim(s) file is incomplete, HO staff will complete the Memorandum for Requesting Missing Medical Evidence, available in the Document Generation System. The memorandum must include a description of the missing evidence and any available information that would help in obtaining the information. For example, if copies of form SSA-3368, SSA-3369, or SSA 3820 are available (and applicable), the HO should include copies with the memorandum.

The HO will then send the memo to the ODAR RO and request assistance in obtaining the missing evidence. The ODAR RO will work with the ORC and request that the missing information be obtained on an expedited basis.

NOTE:

If the HO staff locates a lost claim(s) file and a new hearing has not already been conducted, the HO will use the expedited clarification procedures in HALLEX I-2-1-85 D.