I-5-3-21.National Adjudication Team Instructions

1. Actions a NAT AA Will Take

Once a case has been assigned and is ready for prehearing review, NAT AAs will confirm that he or she has jurisdiction to review the case (e.g., the case was selected by the NAT administrative team, the request for hearing (RH) was timely filed, etc.).

The NAT AA will also initiate case development, including:

• Updating earnings queries;

• Requesting medical and other evidence, as appropriate, to assess impairment severity and formulate the residual functional capacity;

• Requesting vocational evidence regarding work history (20 CFR 404.1565 and 416.965) or to assess past relevant work;

• Consulting with the NAT administrative team as to whether requesting interrogatories from an ME or vocational expert (VE) is appropriate (i.e., a response to interrogatories is likely to result in a fully favorable OTR decision);

• When approved, requesting interrogatories by adhering to existing procedures for obtaining expert testimony outlined in HALLEX I-2-5-34 and I-2-5-50, as well as other applicable instruction regarding interrogatories in HALLEX I-2-5-42 through I-2-5-60; and

• Adding any ME or VE interrogatory and response to the claim(s) file, even if the response prevents the issuance of a fully favorable OTR decision.

Additionally, the NAT AA will:

• If necessary, call an unrepresented claimant or an appointed representative, document the contact on a form SSA-5002, Report of Contact, and associate the completed form with the claim(s) file;

• Consider whether the conditions for reopening a prior disability denial made at the initial or reconsideration level are present (see 20 CFR 404.988 and 416.1488); and

• Use electronic tools, including the Hearings and Case Processing System (HACPS), the Attorney Adjudicator Resources link on the Office of the Chief Administrative Law Judge (OCALJ) intranet site, and vocational resources, such as the OASYS program found in the Digital Library.

2. Actions a NAT AA Will Not Take

As part of prehearing review, NAT AAs will not:

• Discuss amending the onset date with an unrepresented claimant;

• Request consultative examinations;

• Take sworn testimony;

• Reopen prior decisions (ALJ, Appeals Council, or court);

• Issue an order of dismissal;

• Issue OTR decisions when the RH was untimely filed;

• Issue unfavorable or partially favorable OTR decisions;

• Issue an OTR decision on a RH based solely on non-disability issues (e.g., overpayments);

• Issue an OTR decision in cases involving a closed period of benefits, or an onset date after the date last insured; or

• Use the HACPS to generate instructions or hypotheticals.

1. NAT AA Actions

When the NAT AA finds a fully favorable OTR decision is warranted, he or she will:

• Request assignment of his or her adjudicator code to the case in CPMS;

• Review eView for recently added electronic flags or messages;

• Ensure that all medical and other evidence is associated with the claim(s) file;

• Review the Information/Certified Earnings Record, Detailed Earnings Query, Summary Earnings Query, and the National Directory of New Hires (NDNH) to obtain information about work activity, disability insured status, and prior filing, as applicable, and associate the queries in section D of the claim(s) file (see the Standard Hearings Operations Procedure (SHOP) section 3.2.10);

• Draft and issue a policy compliant, legally sufficient, and fully favorable OTR decision (see HALLEX I-2-8-25 and Social Security Ruling (SSR) 96-1p: Policy Interpretation Ruling Application by the Social Security Administration (SSA) of Federal Circuit Court and District Court Decisions), including checking the box “Attorney Advisor Decision” on the Claimant/Rep/ALJ Info tab in the Findings Integrated Templates (FIT) (to ensure FIT generates the correct notice and decision language);

• Confirm the decision notice is correct;

• Complete the Hearing Level Disposition screen in CPMS, ensuring the impairment codes and regulation basis codes accurately reflect the decisional findings (codes automatically propagated into FIT may not be correct), and checking the “On-The-Record” box on the hearing level disposition screen;

• Prepare an order approving or disapproving a fee agreement, as applicable (see HALLEX I-1-2-12) (if a fee petition is later filed, see HALLEX I-5-3-21 III.F.3. below);

• Sign the decision and any associated fee agreement order; and

• Update the status to show the appropriate employee for mailing and closing the case.

2. NAT Administrative Team Actions

When the decision is ready for mailing, the NAT administrative team will follow the OHO SHOP to release the case, specifically:

• Reopening prior claims in eView, when applicable;

• Using central print whenever possible to mail the decision, or, when not available, preparing copies of the decisional documents for the claimant, the representative (if any), and the claim(s) file;

• Closing the case in CPMS;

• Forwarding any fee agreement documents to the effectuating component; and

• When central print is not available, releasing the dated decision and any associated fee authorization to the claimant and appointed representative, if any.

1. Revising a NAT AA decision

A NAT AA may issue a revised fully favorable OTR decision of his or her own prior decision if:

• A substantive error is discovered or additional evidence is received that, although not precluding the issuance of a fully favorable OTR decision, affects the NAT AA decision;

• A revised decision will not be any less favorable to the claimant; and

• The case has not been selected for own motion review by the Appeals Council. See 20 CFR 404.969 and 416.1469.

When revising a decision, the NAT AA will send a letter to the claimant and representative, if any, indicating the decision contained a substantive error or is affected by new evidence, and the decision is being revised. For additional instruction, see HALLEX I-2-9-80.

2. Vacating a NAT AA Decision

When necessary, an action vacating a NAT AA decision must be taken as soon as possible. Vacating a NAT AA decision is necessary if:

• A substantive error is discovered or additional evidence is received that precludes a fully favorable OTR decision; or

• The claimant objects to the decision and submits a request to continue with the RH.

Before taking any action to vacate the decision, a NAT AA must confirm that he or she has jurisdiction to vacate the decision (i.e., the Appeals Council is not reviewing the decision on its own motion pursuant to 20 CFR 404.969 and 416.1469).

When vacating a decision due to substantive errors or new evidence, the NAT AA will send a letter to the claimant and representative, if any, indicating the decision was issued in error and will be vacated. The letter will also advise the claimant that the claim will be scheduled for hearing based on the date of the original RH.

When vacating a decision due to an objection by the claimant, the NAT AA will confirm that the claimant sent a request to continue with his or her RH within 60 days of the decision. See 20 CFR 404.942(d) and 416.1442(d).

When it is appropriate to vacate the decision, the NAT administrative team will:

• Select “Reactivate” under the Status and History tab in eView (this auto-establishes a new record in CPMS);

• Add the following message in eView and remark in CPMS: “Terminate effectuation action on this case. It is being set for hearing because ______”;

• Contact the effectuating component(s) by fax, telephone, or mail, to prevent payment; and

• Transfer the case to the appropriate HO for additional processing.

3. Fee Petition Submitted After Fully Favorable Decision Issued

If the representative files a fee petition (usually because a fee agreement was disapproved or there is no fee agreement), the NAT AA will follow the procedures in HALLEX I-1-2-6 B.2., I-1-2-51, I-1-2-53, and I-1-2-57. In general, the NAT AA will:

• Prepare a fee authorization order using DGS templates, replacing “Administrative Law Judge” with “Attorney Adjudicator;”

• Sign the fee authorization in cases where the NAT AA was the decisionmaker;

• Update CPMS to reflect fee petition information; and

• Scan fee petition documents into the B section of the claim(s) file.