I-5-4-21-B.McDonald et. al. v. Bowen
|Definition of Class|
|Implementation of Court Order|
|Adjudication of Cases|
|Option for Appeals Council Review|
|- AC Remand|
ISSUED: December 8, 1987
This Instruction applies only to cases involving persons residing in Massachusetts. It is being issued nationally for informational purposes only.
SGPD Bulletin No. III-19(86) dated September 3, 1986, described the order issued on July 17, 1986 by the U.S. Circuit Court of Appeals for the First Circuit in the McDonald case. The circuit court reversed the district court's decision of December 19, 1985, insofar as it enjoined the Secretary from applying the “not severe” regulations. However, the circuit court upheld the district court's supplemental order, issued on March 10, 1986, requiring the Secretary to consider the combined effects of multiple nonsevere impairments when readjudicating claims of class members who received final decisions of the Secretary prior to December 1, 1984. This TI sets out procedures for readjudicating cases under the McDonald court order. SSA will readjudicate the claims of all class members who exhausted their administrative remedies and who were denied benefits based on the policy of not considering the combined effects of multiple nonsevere impairments (the policy which was in effect through November 30, 1984).
II. Definition of Class
For purposes of this TI, the McDonald class consists of Massachusetts title II and title XVI disability claimants who were denied benefits because they did not have a severe impairment (s) and:
who exhausted their administrative remedies (that is, had an AC decision or AC denial of the request for review of an ALJ decision) between 6/28/84 and 11/30/84; and
whose claims were denied without consideration of the combined effect of multiple nonsevere impairments.
III. Implementation of Court Order
A. Identification of Class Members
Identification of the class members began January 5, 1987 with the receipt in OHA Headquarters of a computer-generated list of Appeals Council actions and decisions. The Litigation Staff, Office of Deputy Commissioner for Programs (ODCP), has sent OHA Headquarters an updated list of file locations of potential class member cases. The Division of Support Services, OAO, will retrieve files from OHA components, State agencies and Social Security field offices. ODCP Litigation Staff will arrange for the retrieval of files located in the Federal Records Center and Processing Centers (including the Office of Disability Operations (ODO)). All located files will be sent to OAO Branch 3 which is responsible for screening and processing the McDonald cases. (OGC has provided notice of class relief in all pending court cases. Accordingly, OHA will not have to take any action to identify class members with cases pending before the courts.)
B. Notification of Class Members
OAO should prepare and send a letter and option form (Attachment 1), with a self-addressed, franked envelope, to each identified class member. The claimant must complete and return the option form within 20 days from the date of the letter and the analyst must establish a control diary for 30 days. If the claimant affirmatively replies to the letter or does not return the option form, the Appeals Council or ALJ must readjudicate the case. If the claimant returns the form stating he or she does not want another Appeals Council review, it is not necessary for the Appeals Council to readjudicate the case. Since these cases involve implementation of a court order, all cases must receive expeditious handling.
IV. Adjudication of Cases
The appeals Council will readjudicate the McDonald cases under SSA's current policy, in effect since December 1, 1984, of considering the combined effects of multiple nonsevere impairments. Current policy is described in SSR 85-28.
The Appeals Council should issue a decision in the case if possible, or, if not, remand the case to an ALJ for a new hearing and decision. (See sample remand order in Attachment 2).
The Appeals Council or Administrative Law Judge must issue a replacement decision, that is, a decision which covers the period only through the date of the prior decision. New evidence may be considered only if it pertains to the period covered by the prior decision. For consideration of disability after the period covered by the prior decision, the claimant must file a new application.
If the AC or ALJ determines that the claimant was in fact under a “disability” on or before the date of the prior decision, it must be further determined through appropriate development whether such “disability” has continued to the current date. The rules of retroactivity and res judicata will apply to all new applications. A notation should be made in every decision that, if res judicata is applicable in any future cases, it will apply only as of the date of the prior decision; not from the date of the new decision. The existing regulatory provisions for reopening prior applications will apply to a new application.
Any HO questions concerning this TI should be directed to the OHA RO Hotline. RO and CO questions should be directed to the Division of Litigation Coordination and Implementation on FTS 235-3743.