I-5-4-11.Johnson, et.al., v. Sullivan
Purpose | |
Background | |
Guiding Principles | |
Definition of Class | |
Determination of Class Membership and Preadjudication Actions | |
Processing and Adjudication | |
Case Coding | |
Reconciliation of Implementation | |
Inquiries | |
Final Judgment Order dated April 3, 1991 | |
JOHNSON COURT CASE FLAG/ALERT | |
Route Slip or Case Flag for Screening | |
Johnson Screening Sheet | |
Route Slip for Routing Class Member Alert (and Prior Claim Folder(s) to ODIO or PSC -- OHA No Longer Has Current Claim | |
Johnson Non-Class Membership Notice | |
Route Slip for Non-Class Membership Cases | |
Acting Associate Commissioner's Memorandum Dated February 21, 1991, Entitled “The Standard for Evaluating 'Not Severe' Impairments.” | |
Johnson Class Member Flag for Headquarters Use (DDS Readjudication) | |
Johnson Cases Member Flag for HO Use (DDS Adjudication) | |
ALJ Dismissal to DDS | |
Notice Transmitting ALJ Order of Dismissal |
Issued: August 6, 1992, Revised March 21, 1997
I. Purpose
This Temporary Instruction (TI) sets forth procedures for implementing the April 3, 1991 order of the United States District Court for the Northern District of Illinois in the Johnson, et al. v. Sullivan class action involving the “not severe” impairment issue.
Adjudicators throughout the country must be familiar with this TI because Johnson class members who now reside outside of Illinois must have their cases processed in accordance with the requirements of the court's order.
II. Background
On December 7, 1983, the United States District Court for the Northern District of Illinois certified a class challenging the Secretary's regulations, policies and practices for evaluating disability claims at step two of the sequential evaluation.
On September 19, 1984, the district court found the Secretary's severity regulations invalid and enjoined the Secretary from using step two of the sequential evaluation. After the court denied the Secretary's motions to vacate the injunction and amend its judgment, the Secretary appealed to the Seventh Circuit.
The Court of Appeals stayed implementation of class relief pending appeal, but affirmed the district court's jurisdictional and substantive rulings on all issues. A panel of circuit court judges denied the Secretary's petition for rehearing and, subsequently, the Court of Appeals denied the Secretary's suggestion for rehearing in banc by an evenly divided vote. In February 1985, the Secretary petitioned the Supreme Court for a writ of certiorari. While the petition was pending, the Supreme Court upheld the facial validity of the severity regulations in Bowen v. Yuckert, 482 U.S. 137 (1987). The Supreme Court then granted the Secretary's petition in Johnson, vacated the Seventh Circuit's judgment and remanded for further consideration in light of Yuckert. On remand, the Seventh Circuit vacated the district court's injunction to the extent that it prohibited the use of step two of the sequential evaluation and remanded the case to the district court.
On October 6, 1988, the district court issued a decision on the merits. The decision found that the issue of the Secretary's misapplication of the severity regulations was not suitable for class action litigation. However, the court also found that the Secretary's pre-December 1, 1984 policy of not considering the combined effect of individual “not severe” impairments violated the Social Security Act. On June 16, 1989, the district court issued a final order that resolved the remaining implementation and jurisdictional issues and relied on the Supreme Court's decision in Bowen v. City of New York, 476 U.S. 467 (1987), to waive administrative exhaustion and toll the 60-day statute of limitations in 42 U.S.C. § 405(g). The final order established the beginning date of the class as February 26, 1979, the date the “combined effect” regulation became effective.
After staying implementation of class relief pending appeal, the United States Court of Appeals for the Seventh Circuit, on December 28, 1990, issued a unanimous in banc decision upholding the district court's earlier ruling that the Secretary's “combined effect” policy violated the Social Security Act. Although the Seventh Circuit also upheld the lower court's ruling that the Secretary waived the 42 U.S.C. § 405(g) 60-day statute of limitations by failing to raise the issue in a timely manner as an affirmative defense at the onset of the litigation, it found the equitable tolling doctrine in City of New York inapplicable to the facts in the case. The Court of Appeals also found City of New York inapplicable with respect to waiver of administrative exhaustion for lapsed claims, i.e., claims no longer pending or appealable at the time the class complaint was filed. Accordingly, the Seventh Circuit instructed the district court to reconfigure (reduce) the Johnson class to exclude claimants who did not exhaust their administrative remedies 60 days prior to the filing date of the class complaint (August 11, 1983).
On April 3, 1991, the district court issued a final judgment order. That order modified the class definition and set forth the terms for the implementation of class relief (Attachment 1).
III. Guiding Principles
Under Johnson, the Commissioner will reopen and readjudicate the claims of those persons who (1) respond to notice informing them of the opportunity for review and (2) are determined to be class members after screening (see Part V below). Regardless of the state of the claimant's current residence, the Illinois Disability Determination Service (DDS) will, in most cases, screen for class membership and perform the court-ordered readjudications at the reconsideration level, regardless of the level of administrative review that last decided the claim. OHA will screen cases and perform readjudications under limited circumstances (see Part V.B. below). Class members who receive adverse readjudication determinations will have full appeal rights (i.e., Administrative Law Judge (ALJ) hearing, Appeals Council and judicial review).
Johnson does not require any change in OHA's current adjudicatory policies or practices because Social Security Ruling (SSR) 85-28 remains the proper standard for adjudicating claims at step two of the sequential evaluation.
IV. Definition of Class
Except as noted below, the Johnson class includes all persons who resided in Illinois during the following timeframes and:
whose disability benefits were denied or terminated at step two of the sequential evaluation at any administrative level on or after June 12, 1983, through May 1, 1985; or
whose disability benefits were denied or terminated at step two on or after August 20, 1980, through June 11, 1983, and who exhausted their administrative remedies (i.e., pursued their claims through the Appeals Council level of review); or
whose disability benefits were denied or terminated at step two between February 26, 1979, and August 19, 1980, inclusive, and who exhausted their administrative remedies (i.e., pursued their claims through the Appeals Council level of review), and who were listed under “code 922” by the Illinois DDS. (This code appears on the SSA-831-U3 or 833-U3 and identifies step two denial or cessation claims adjudicated at the initial or reconsideration levels.)
EXCEPTION:
A person is not a class member if:
(1) the last administrative denial or termination the individual received on the Johnson claim was not based on step two of the sequential evaluation; or
(2) the last administrative denial or termination the individual received on the Johnson claim was issued after May 1, 1985; or
(3) the individual had a subsequent claim denied after May 1, 1985, and the onset date alleged in connection with the subsequent claim is on or before the onset date alleged in connection with the Johnson claim.
V. Determination of Class Membership and Preadjudication Actions
A. Non-OHA Actions
1. Notification
On June 3, 1991, SSA sent notices to all potential class members identified by computer run. Individuals had 60 days from the date of receipt of the notice to request that SSA readjudicate their claims under the terms of the Johnson court order.
Notices returned as undeliverable will be mailed a second time. The Office of Disability and International Operations (ODIO) and the Program Service Centers (PSCs) will send all untimely responses to the servicing Social Security field office to develop good cause for the untimely response. Good cause determinations will be based on the standards in 20 CFR §§ 404.911 and 416.1411.
2. Alerts and Folder Retrieval
Litigation Staff in the Office of Policy and Planning is tracking all response forms and sending alerts to ODIO and the PSCs to use in locating claim files. Alerts will be generated first for termination cases. See Attachment 2 for a sample Johnson alert. In most instances, ODIO or the PSCs will associate the Johnson alert and the claimant's response form with the claim file(s) and forward the file to the Illinois DDS for screening and readjudication.
3. Alerts Sent to OHA
If ODIO or the PSCs determine that a current claim, i.e., either a potential class member claim or a subsequent claim, is pending appeal or stored at OHA, it will forward the alert to OHA, along with any prior claim file(s) not in OHA's possession, for screening, consolidation consideration and readjudication (if consolidated).
ODIO or the PSCs will send all alerts potentially within OHA jurisdiction, and related prior claim files, if any, to the Office of Appellate Operations (OAO) at the following address (case locator code 5007):
Office of Hearings and AppealsOffice of Appellate Operations
One Skyline Tower, Suite 701
5107 Leesburg Pike
Falls Church, VA 22041-3200
ATTN: OAO Class Action Coordinator
NOTE:
The OAO Class Action Coordinator is responsible for controlling and reconciling the disposition of class alerts shipped to OHA Headquarters for association with pending or stored claims. The OAO Class Action Coordinator will maintain a record of all alerts received and the location, if any, to which they are transferred. This information will be necessary to do the final class membership reconciliation.
4. Folder Reconstruction
Generally, ODIO or the PSCs will initiate any necessary reconstruction of prior claim files through the servicing FO. Consequently, OHA requests for reconstruction of potential Johnson class member cases should be rare. Prior to requesting reconstruction, OHA will determine whether available systems data or other information provides satisfactory proof that the claim would not confer class membership.
However, if it becomes necessary for OHA to request reconstruction, the OHA component (the Hearing Office (HO) or the OAO Branch) will forward the alert and any accompanying claim file(s) (if the claim file(s) is not needed for adjudication purposes) to the servicing FO, along with documentation of attempts to locate the file and a covering memorandum requesting that the reconstructed file be forwarded to OHA. HOs will route any reconstruction requests directly to the servicing FOs. The OAO branch will also route reconstruction requests directly to the servicing FOs and send copies of the cover memorandums concerning all reconstruction requests to the OAO Class Action Coordinator. For CATS purposes, HO personnel and the OAO Class Action Coordinator will forward a copy of the reconstruction request memorandum to Litigation Staff at the following address:
Litigation StaffOffice of Policy and Planning
3-K-26 Operations Building
6401 Security Boulevard
Baltimore, MD 21235
ATTN: Johnson Coordinator
The HO or OAO will not delay action on a pending claim when a prior claim is being reconstructed for screening purposes, unless the prior claim is needed for the adjudication of the pending claim. If OHA completes action on the pending claim prior to the receipt of the reconstructed file, the HO or OAO, as appropriate, will forward the class action material, including the alert, unneeded claim files, if any, and the reconstruction request to the OAO Class Action Coordinator, along with a copy of the action on the pending claim (see V.B.2.a. below). For additional information on reconstruction procedures, see the Generic Class Action Implementation Instructions, Hallex I-1-7-5C.
5. Class Membership Denials
The Chicago, Illinois district office, located at 175 West Jackson Boulevard, will hold all non-class member claim folders pending review by class counsel. Upon review of the folders, class counsel will contact the Office of the General Counsel (OGC) directly to resolve class membership disputes.
B. OHA Actions
1. Pre-Screening
Actions
a. Current
Claim in OHA
As provided in Part V.A.3. above, if there is a current claim pending or
stored at OHA, the OAO Class Action Coordinator will receive the alert and
related Johnson claim file(s). The OAO Class Action Coordinator will
determine OHA jurisdiction for screening and forward as follows.
If the current claim is in an HO, the Coordinator will use Attachment 3 to
forward the alert and the prior claim file(s) to the HO for screening.
(Part V.B.2.a. below provides instructions to the HOs regarding the action
to be taken if they receive an alert package but no longer have a current
claim pending.)
If the current claim is before the Appeals Council, or is located in an
OAO branch mini-docket or in the OAO Docket and Files Branch, the
Coordinator will use Attachment 3 to forward the alert and prior claim
file(s) to the appropriate OAO branch for screening. (Part V.B.2.a. below
provides instructions to the OAO branches regarding the action to be taken
if they receive an alert package from the OAO Class Action Coordinator
but no longer have a current claim pending.)
If the Coordinator (or designee) is unable to locate the current claim
file within OHA, the Coordinator (or designee) will broaden its claim file
search and arrange for alert transfer or file reconstruction, as
necessary.
b. Current
Claim Pending in Court
If the OAO Class Action Coordinator receives an alert for a claimant who
has a civil action pending, either on the alerted case or on another
claim, the Coordinator will forward the alert and any accompanying claim
file(s) to the appropriate Court Case Preparation and Review Branch
(CCPRB) for screening using Attachment 3. See Part V.B.2.b. below for
special screening instructions when a civil action is involved.
a. Current Claim in OHA
As provided in Part V.A.3. above, if there is a current claim pending or stored at OHA, the OAO Class Action Coordinator will receive the alert and related Johnson claim file(s). The OAO Class Action Coordinator will determine OHA jurisdiction for screening and forward as follows.
If the current claim is in an HO, the Coordinator will use Attachment 3 to forward the alert and the prior claim file(s) to the HO for screening. (Part V.B.2.a. below provides instructions to the HOs regarding the action to be taken if they receive an alert package but no longer have a current claim pending.)
If the current claim is before the Appeals Council, or is located in an OAO branch mini-docket or in the OAO Docket and Files Branch, the Coordinator will use Attachment 3 to forward the alert and prior claim file(s) to the appropriate OAO branch for screening. (Part V.B.2.a. below provides instructions to the OAO branches regarding the action to be taken if they receive an alert package from the OAO Class Action Coordinator but no longer have a current claim pending.)
If the Coordinator (or designee) is unable to locate the current claim file within OHA, the Coordinator (or designee) will broaden its claim file search and arrange for alert transfer or file reconstruction, as necessary.
b. Current Claim Pending in Court
If the OAO Class Action Coordinator receives an alert for a claimant who has a civil action pending, either on the alerted case or on another claim, the Coordinator will forward the alert and any accompanying claim file(s) to the appropriate Court Case Preparation and Review Branch (CCPRB) for screening using Attachment 3. See Part V.B.2.b. below for special screening instructions when a civil action is involved.
2. Screening
a. General
Instructions
The screening component will associate the alert, if any, and any prior
claim file(s) with the claim file(s) in its possession and then complete
the screening sheet (see Attachment 4) as follows:
consider all applications denied (including res judicata
denials/dismissals) during the Johnson timeframe;
follow all instructions on the screening sheet;
sign and date the original screening sheet, place it in the claim file(on
the top right side of the file); and,
if the screening component is an OHA Headquarters component, forward a
copy of the screening sheet to the OAO Class Action Coordinator at the
address in Part V.A.3. above. (The Coordinator will enter information from
the screening sheet into a database and forward a copy of the screening
sheet to the Division of Litigation Analysis and Implementation (DLAI). If
the screening component is an HO, forward a copy of the screening sheet
directly to DLAI at the following address:
Office of Hearings and Appeals
Division of Litigation Analysis
and
Implementation
One Skyline Tower, Suite 702
5107 Leesburg
Pike
Falls Church, VA 22041-3255
HO personnel may also forward material by telefax to DLAI at (703)
305-0655. (DLAI will retain a copy of each screening sheet and forward a
copy to the OAO Class Action Coordinator and to Litigation Staff.)
If the HO receives an alert only, or an alert associated with a prior
claim file(s) for screening and no longer has the current claim file, it
will return or forward the alert and the prior claim file(s) to the OAO
Class Action Coordinator (see address in Part V.A.3. above) and advise the
Coordinator of what action was taken on the current claim and its
destination. The Coordinator will determine the current claim file
location and, if it is located in OHA Headquarters, will forward the alert
and any accompanying prior claim file(s) to the responsible OAO branch
for screening, using Attachment 3. If the file(s) is no longer in OHA,
the Coordinator will use Attachment 5 to send the alert and any
accompanying prior claim file(s) to the non-OHA location and request that
the file(s) be forwarded to the Illinois DDS for screening.
If the OAO branch receives an alert only, or an alert associated with a
prior claim file(s), and the branch no longer has the current claim file
(and it is not located in an OAO branch mini-docket or in the OAO DFB), it
will determine the location of the current claim file. If the current
claim file is located within OHA, the OAO branch will use Attachment 3 to
forward the alert and any accompanying prior claim file(s) to the current
OHA location. If the file(s) is no longer in OHA, the OAO branch will use
Attachment 5 to forward the alert and any accompanying prior claim file(s)
to the non-OHA location and request that the file(s) be forwarded to the
Illinois DDS for screening. The OAO branch will also advise the OAO Class
Action Coordinator of its actions.
NOTE:
Final determinations or decisions made after May 1, 1985, on a claim filed
by a potential Johnson class member may adjudicate the same timeframe
covered by the Johnson claim. Instead of applying the doctrine of
administrative res judicata to the Johnson claim, these claims should be
denied class membership.
b. Special
OAO Screening Instructions if a Civil Action Is Involved
As noted in Part V.B.1. above, the CCPRB will screen for Johnson class
membership when a civil action is involved. The CCPRB's class membership
determination will dictate the appropriate post-screening action.
If the current claim pending in court was adjudicated in accordance with
SSR
85-28 and resolved all Johnson issues, the claimant is not a Johnson
class member. The CCPRB will follow the instructions in Part V.B.3.a.
below for processing non-class member claims.
If the current claim pending in court was adjudicated in accordance with
SSR
85-28, but a Johnson issue remains unresolved, e.g., there is a prior
(inactive) Johnson claim and the current claim does not include the
entire period covered by the Johnson claim, the CCPRB will forward the
Johnson claim to the Illinois DDS for separate review. The CCPRB will
modify the case flag in Attachment 9 to indicate that the pending court
case does not resolve all Johnson issues and that the Johnson class
member claim is being forwarded for separate processing. The CCPRB will
notify the OAO Class Action Coordinator of this action.
If the final administrative decision on the claim pending in court was not
adjudicated in accordance with
SSR
85-28 or is legally insufficient for other reasons, the CCPRB will
initiate voluntary remand proceedings and consolidate the claims.
NOTE:
The CCPRB will immediately notify OGC if the pending court case is a
Johnson class member claim so that OGC can notify the claimant of the
option to have the case remanded for readjudication.
a. General Instructions
The screening component will associate the alert, if any, and any prior claim file(s) with the claim file(s) in its possession and then complete the screening sheet (see Attachment 4) as follows:
consider all applications denied (including res judicata denials/dismissals) during the Johnson timeframe;
follow all instructions on the screening sheet;
sign and date the original screening sheet, place it in the claim file(on the top right side of the file); and,
if the screening component is an OHA Headquarters component, forward a copy of the screening sheet to the OAO Class Action Coordinator at the address in Part V.A.3. above. (The Coordinator will enter information from the screening sheet into a database and forward a copy of the screening sheet to the Division of Litigation Analysis and Implementation (DLAI). If the screening component is an HO, forward a copy of the screening sheet directly to DLAI at the following address:
Office of Hearings and Appeals
Division of Litigation Analysis and
Implementation
One Skyline Tower, Suite 702
5107 Leesburg Pike
Falls Church, VA 22041-3255
HO personnel may also forward material by telefax to DLAI at (703) 305-0655. (DLAI will retain a copy of each screening sheet and forward a copy to the OAO Class Action Coordinator and to Litigation Staff.)
If the HO receives an alert only, or an alert associated with a prior claim file(s) for screening and no longer has the current claim file, it will return or forward the alert and the prior claim file(s) to the OAO Class Action Coordinator (see address in Part V.A.3. above) and advise the Coordinator of what action was taken on the current claim and its destination. The Coordinator will determine the current claim file location and, if it is located in OHA Headquarters, will forward the alert and any accompanying prior claim file(s) to the responsible OAO branch for screening, using Attachment 3. If the file(s) is no longer in OHA, the Coordinator will use Attachment 5 to send the alert and any accompanying prior claim file(s) to the non-OHA location and request that the file(s) be forwarded to the Illinois DDS for screening.
If the OAO branch receives an alert only, or an alert associated with a prior claim file(s), and the branch no longer has the current claim file (and it is not located in an OAO branch mini-docket or in the OAO DFB), it will determine the location of the current claim file. If the current claim file is located within OHA, the OAO branch will use Attachment 3 to forward the alert and any accompanying prior claim file(s) to the current OHA location. If the file(s) is no longer in OHA, the OAO branch will use Attachment 5 to forward the alert and any accompanying prior claim file(s) to the non-OHA location and request that the file(s) be forwarded to the Illinois DDS for screening. The OAO branch will also advise the OAO Class Action Coordinator of its actions.
NOTE:
Final determinations or decisions made after May 1, 1985, on a claim filed by a potential Johnson class member may adjudicate the same timeframe covered by the Johnson claim. Instead of applying the doctrine of administrative res judicata to the Johnson claim, these claims should be denied class membership.
b. Special OAO Screening Instructions if a Civil Action Is Involved
As noted in Part V.B.1. above, the CCPRB will screen for Johnson class membership when a civil action is involved. The CCPRB's class membership determination will dictate the appropriate post-screening action.
If the current claim pending in court was adjudicated in accordance with SSR 85-28 and resolved all Johnson issues, the claimant is not a Johnson class member. The CCPRB will follow the instructions in Part V.B.3.a. below for processing non-class member claims.
If the current claim pending in court was adjudicated in accordance with SSR 85-28, but a Johnson issue remains unresolved, e.g., there is a prior (inactive) Johnson claim and the current claim does not include the entire period covered by the Johnson claim, the CCPRB will forward the Johnson claim to the Illinois DDS for separate review. The CCPRB will modify the case flag in Attachment 9 to indicate that the pending court case does not resolve all Johnson issues and that the Johnson class member claim is being forwarded for separate processing. The CCPRB will notify the OAO Class Action Coordinator of this action.
If the final administrative decision on the claim pending in court was not adjudicated in accordance with SSR 85-28 or is legally insufficient for other reasons, the CCPRB will initiate voluntary remand proceedings and consolidate the claims.
NOTE:
The CCPRB will immediately notify OGC if the pending court case is a Johnson class member claim so that OGC can notify the claimant of the option to have the case remanded for readjudication.
3. Post-Screening
Actions
a. Non-Class
Member Cases
If the screening component determines that the individual is not a class
member, the component will:
notify the individual, and representative, if any, of non-class membership
using Attachment 6 (modified as necessary to fit the facts and posture of
the case when there is a current claim);
retain a copy of the notice in the claim file;
send a copy of the notice to:
John Bouman, Attorney
Poverty Law Project
National Clearinghouse for
Legal Services
205 West Monroe, 2nd Floor
Chicago, Illinois
60606
Attn: Johnson
send the non-class member claim file(s) to the Chicago, Illinois district
office using the pre-addressed route slip in Attachment 7.
NOTE:
Photocopy any material contained in the prior file that is relevant to the
current claim and place it in the current claim file before shipping the
prior file.
An individual who wishes to appeal a determination of non-class membership
may do so only through class counsel, as explained in the notice
(Attachment 6).
b. Cases
Determined to Be Class Members
If the screening component determines that the individual is a class
member, it will proceed with processing and adjudication in accordance
with the instructions in Part VI below.
a. Non-Class Member Cases
If the screening component determines that the individual is not a class member, the component will:
notify the individual, and representative, if any, of non-class membership using Attachment 6 (modified as necessary to fit the facts and posture of the case when there is a current claim);
retain a copy of the notice in the claim file;
send a copy of the notice to:
John Bouman, Attorney
Poverty Law Project
National Clearinghouse for Legal Services
205 West Monroe, 2nd Floor
Chicago, Illinois 60606
Attn: Johnsonsend the non-class member claim file(s) to the Chicago, Illinois district office using the pre-addressed route slip in Attachment 7.
NOTE:
Photocopy any material contained in the prior file that is relevant to the current claim and place it in the current claim file before shipping the prior file.
An individual who wishes to appeal a determination of non-class membership may do so only through class counsel, as explained in the notice (Attachment 6).
b. Cases Determined to Be Class Members
If the screening component determines that the individual is a class member, it will proceed with processing and adjudication in accordance with the instructions in Part VI below.
VI. Processing and Adjudication
A. Cases Reviewed by the DDS
The Illinois DDS will conduct the first Johnson review except for cases consolidated at the OHA level (see Part VI.D. below). The DDS determination will be a reconsideration determination, regardless of the administrative level at which the class member's claim(s) was previously decided, with full appeal rights (i.e., ALJ hearing, Appeals Council and judicial review). Except as otherwise noted in this instruction, ALJs should process and adjudicate requests for hearing on Johnson DDS review cases in the same manner as for any other case.
B. Payment Reinstatement for Cessation Cases
If the Johnson claim involves a title II or title XVI cessation, the class member may elect to have disability benefits reinstated pending readjudication. In general, the servicing Social Security field office has responsibility for:
contacting the class member who may have reinstatement rights;
completing the election forms;
verifying non-disability factors; and
making a good faith effort to reinstate benefits within 45 days after retrieval or reconstruction of the Johnson claim file.
NOTE:
For OHA jurisdiction cases, the screening component will:
(1) identify Johnson claims involving title II or title XVI cessations;
(2) immediately notify the servicing field offices by telephone of the pending Johnson claims that may be eligible for benefit reinstatement and document the file accordingly; and
(3) provide the servicing field office with identifying information and any other information requested.
C. OHA Adjudication of Class Member Claims
The following instruction applies to both consolidation cases in which the ALJ or Appeals Council conducts the Johnson readjudication and to DDS readjudication cases in which the claimant requests a hearing or Appeals Council review. Except as noted herein, HOs and Headquarters will process Johnson class member cases according to all other current practices and procedures including coding, scheduling, developing evidence, routing, etc.
1. Type of Review and Period to Be Considered
Pursuant to the Johnson order, regardless of whether the claim under review is an initial claim or cessation case, the type of review to be conducted is a reopening. The claim of each class member must be fully reopened to determine whether the claimant was disabled at any time from the onset date alleged in the Johnson claim through the present (or, in title II cases in which the claimant is no longer insured, through the date last insured).
2. Step Two of the Sequential Evaluation
Johnson does not require any change in OHA's current adjudicatory policies or practices with respect to step two of the sequential evaluation. Effective with enactment of the 1984 Amendments to the Social Security Act, OHA's adjudicators have considered the combined effects of individual “not severe” impairments in evaluating disability claims at step two. ALJs and the Appeals Council may, if appropriate, continue to deny or cease the disability claims of Illinois residents in accordance with 20 CFR §§ 404.1520(c), 404.1521, 416.920(c) and 416.921, as well as SSR 85-28. The then Acting Associate Commissioner's memorandum, dated February 21, 1991 (Attachment 8), regarding the proper standard for adjudicating claims at step two, remains in effect.
3. Class Member Is Deceased
If a class member is deceased, the usual survivor and substitute party provisions and existing procedures for determining distribution of any potential underpayment apply.
D. Claim at OHA But No Current Action Pending
If a claim file (either a class member or a subsequent claim file) is located in OHA Headquarters but there is no claim actively pending administrative review, i.e., Headquarters is holding the file awaiting potential receipt of a request for review or notification that a civil action has been filed, OAO will associate the alert with the file and screen for class membership.
If the 120-day retention period for holding a claim file after an ALJ decision or Appeals Council action has expired, OAO will attach a Johnson class member flag (see Attachment 9) to the outside of the file and send the claim file(s) to the Illinois DDS for review of the Johnson class member claim.
If less than 120 days has elapsed, OAO will attach a Johnson class member flag to the outside of the folder (see Attachment 9) to ensure the case is routed to the Illinois DDS after expiration of the retention period. Pending expiration of the retention period, OAO will also:
return unappealed ALJ decisions and dismissals to DFB, OAO; and
return unappealed Appeals Council denials to the appropriate OAO minidocket.
The respective OAO component will monitor the retention period and, if the claimant does not seek further administrative or judicial review, route the file(s) to the Illinois DDS in a timely manner.
E. Processing and Adjudicating Class Member Claims in Conjunction with Current Claims (Consolidation Procedures)
1. General
If a class member has a current claim pending at any administrative level and consolidation is warranted according to the guidelines below, the appropriate component will consolidate all Johnson class member claims with the current claim at the level at which the current claim is pending.
2. Current
Claim Pending in the Hearing Office
a. Hearing
Has Been Scheduled or Held, and All Remand Cases
Except as noted below, if a Johnson class member has a request for hearing
pending on a current claim, and the ALJ has either scheduled or held a
hearing, and in all remand cases, the ALJ will consolidate the
Johnson case with the appeal on the current
claim.
EXCEPTIONS:
The ALJ will not consolidate the claims if:
the current claim and the Johnson claim do not
have any issues in common, or
a court remand contains a court-ordered time limit and it will not be
possible to meet the time limit if the claims are consolidated.
If the claims are consolidated, follow Part VI.E.2.c. below. If the claims
are not consolidated, follow Part VI.E.2.d. below.
b. Hearing
Not Scheduled
Except as noted below, if a Johnson class member
has an initial request for hearing pending on a current claim and the HO
has not yet scheduled a hearing, the ALJ will not consolidate the
Johnson claim and the current claim. Instead, the
ALJ will dismiss the request for hearing on the current claim and forward
both the Johnson claim and the current claim to
the DDS for further action (see Part VI.E.2.d. below).
EXCEPTION:
If the hearing has not been scheduled because the claimant waived the
right to an in-person hearing, and the ALJ is prepared to issue a fully
favorable decision on the current claim, and this decision would also be
fully favorable with respect to all the issues raised by the application
that makes the claimant a Johnson class member,
the ALJ will consolidate the claims.
If the claims are consolidated, follow Part VI.E.2.c. below. If the claims
are not consolidated, follow Part VI.E.2.d. below.
c. Actions
if Claims Are Consolidated
Because the Johnson court order requires the
Secretary to reopen fully the claims of class members, the issue in title
II Johnson claims is whether the claimant was
disabled at any time from the onset date alleged in the
Johnson claim through the present (or, if the
person is no longer insured, through the date the claimant last met the
insured status requirements). If a title II
Johnson claim involves an earlier alleged onset
date than the current claim, the Johnson court order requires the ALJ to
consider the additional issue of whether the claimant became disabled at
any time between the two alleged onset dates. Similarly, consolidation of
a title XVI claim will always raise the issue of whether a claimant
became disabled between the dates the claims were filed.
If the ALJ decides to consolidate the current claim with the
Johnson claim(s), the HO will:
give proper notice of any new issue(s) as required by
20 CFR
§§ 404.946(b) and
416.1446(b),
if the Johnson claim raises any additional
issue(s) not raised by the current claim;
offer the claimant a supplemental hearing if the ALJ has already held a
hearing and the Johnson claim raises an
additional issue(s), unless the ALJ is prepared to issue a fully
favorable decision with respect to the Johnson
claim;
issue one decision that addresses both the issues raised by the current
request for hearing and those raised by the
Johnson claim (the ALJ's decision will clearly
indicate that the ALJ considered the Johnson
claim pursuant to the Johnson court order);
and
send copies of the consolidated hearing decision to both:
Office of Hearings and Appeals
Division of Litigation Analysis
and
Implementation
One Skyline Tower, Suite 702
5107 Leesburg
Pike
Falls Church, VA 22041-3255
ATTN:
Johnson Coordinator
and
Litigation Staff
Office of Policy and Planning
P.O. Box
17729
Baltimore, Maryland 21235
ATTN:
Johnson Coordinator
d. Action
if Claims Not Consolidated
If common issues exist but the ALJ decides not to consolidate the current
claim with the Johnson claim because the hearing
has not yet been scheduled, the HO will:
dismiss, without prejudice, the request for hearing on the current claim,
using the language in Attachment 11 and the covering notice in Attachment
12;
send both the Johnson claim and the current claim
to the Illinois DDS for consolidation and further action.
If the ALJ decides not to consolidate the current claim with the
Johnson claim because: 1) the claims do not have
any issues in common, or 2) there is a court-ordered time limit, the ALJ
will:
flag the Johnson claim for DDS review using
Attachment 10, immediately route it to the Illinois DDS for adjudication
and retain a copy of Attachment 10 in the current claim file; and
take the necessary action to complete the record and issue a decision on
the current claim.
a. Hearing Has Been Scheduled or Held, and All Remand Cases
Except as noted below, if a Johnson class member has a request for hearing pending on a current claim, and the ALJ has either scheduled or held a hearing, and in all remand cases, the ALJ will consolidate the Johnson case with the appeal on the current claim.
EXCEPTIONS:
The ALJ will not consolidate the claims if:
the current claim and the Johnson claim do not have any issues in common, or
a court remand contains a court-ordered time limit and it will not be possible to meet the time limit if the claims are consolidated.
If the claims are consolidated, follow Part VI.E.2.c. below. If the claims are not consolidated, follow Part VI.E.2.d. below.
b. Hearing Not Scheduled
Except as noted below, if a Johnson class member has an initial request for hearing pending on a current claim and the HO has not yet scheduled a hearing, the ALJ will not consolidate the Johnson claim and the current claim. Instead, the ALJ will dismiss the request for hearing on the current claim and forward both the Johnson claim and the current claim to the DDS for further action (see Part VI.E.2.d. below).
EXCEPTION:
If the hearing has not been scheduled because the claimant waived the right to an in-person hearing, and the ALJ is prepared to issue a fully favorable decision on the current claim, and this decision would also be fully favorable with respect to all the issues raised by the application that makes the claimant a Johnson class member, the ALJ will consolidate the claims.
If the claims are consolidated, follow Part VI.E.2.c. below. If the claims are not consolidated, follow Part VI.E.2.d. below.
c. Actions if Claims Are Consolidated
Because the Johnson court order requires the Secretary to reopen fully the claims of class members, the issue in title II Johnson claims is whether the claimant was disabled at any time from the onset date alleged in the Johnson claim through the present (or, if the person is no longer insured, through the date the claimant last met the insured status requirements). If a title II Johnson claim involves an earlier alleged onset date than the current claim, the Johnson court order requires the ALJ to consider the additional issue of whether the claimant became disabled at any time between the two alleged onset dates. Similarly, consolidation of a title XVI claim will always raise the issue of whether a claimant became disabled between the dates the claims were filed.
If the ALJ decides to consolidate the current claim with the Johnson claim(s), the HO will:
give proper notice of any new issue(s) as required by 20 CFR §§ 404.946(b) and 416.1446(b), if the Johnson claim raises any additional issue(s) not raised by the current claim;
offer the claimant a supplemental hearing if the ALJ has already held a hearing and the Johnson claim raises an additional issue(s), unless the ALJ is prepared to issue a fully favorable decision with respect to the Johnson claim;
issue one decision that addresses both the issues raised by the current request for hearing and those raised by the Johnson claim (the ALJ's decision will clearly indicate that the ALJ considered the Johnson claim pursuant to the Johnson court order); and
send copies of the consolidated hearing decision to both:
Office of Hearings and Appeals
Division of Litigation Analysis and
Implementation
One Skyline Tower, Suite 702
5107 Leesburg Pike
Falls Church, VA 22041-3255
ATTN: Johnson Coordinatorand
Litigation Staff
Office of Policy and Planning
P.O. Box 17729
Baltimore, Maryland 21235
ATTN: Johnson Coordinator
d. Action if Claims Not Consolidated
If common issues exist but the ALJ decides not to consolidate the current claim with the Johnson claim because the hearing has not yet been scheduled, the HO will:
dismiss, without prejudice, the request for hearing on the current claim, using the language in Attachment 11 and the covering notice in Attachment 12;
send both the Johnson claim and the current claim to the Illinois DDS for consolidation and further action.
If the ALJ decides not to consolidate the current claim with the Johnson claim because: 1) the claims do not have any issues in common, or 2) there is a court-ordered time limit, the ALJ will:
flag the Johnson claim for DDS review using Attachment 10, immediately route it to the Illinois DDS for adjudication and retain a copy of Attachment 10 in the current claim file; and
take the necessary action to complete the record and issue a decision on the current claim.
3. Current Claim Pending at the Appeals Council
The action the Appeals Council takes on the current claim dictates the disposition of the Johnson claim. Therefore, OAO must keep the claim files together until the Appeals Council completes its action on the current claim. The following sections identify possible Appeals Council actions on the current claim and the corresponding action on the Johnson claim.
a. Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision on the Current Claim -- No Johnson Issue(s) Will Remain Unresolved.
This will usually occur when the current claim duplicates the Johnson review claim, i.e., the Johnson claim raises an issue of disability for a period covered by the current claim, and the current claim has been adjudicated in accordance with the provisions of SSR 85-28 and the current severity regulations, i.e., 20 CFR §§ 404.1520(c), 404.1521, 404.1523, 416.920(c), 416.921 and/or 416.923. In this instance, the Appeals Council will consolidate the claims and proceed with its intended action.
The Appeals Council's order, decision or notice of action will clearly indicate that the ALJ's or Appeals Council's action resolved or resolves both the current claim and the Johnson claim.
b. Appeals Council Intends to Dismiss, Deny Review or Issue a Denial Decision on the Current Claim — Johnson Issue(s) Will Remain Unresolved.
This will usually occur when the current claim does not duplicate the Johnson claim, e.g., the current claim raises the issue of disability but does not cover the entire period adjudicated in the Johnson claim . For example, the Johnson claim raises the issue of disability for a period prior to the period adjudicated in the current claim. In this instance, the Appeals Council will proceed with its intended action on the current claim in accordance with the provisions of SSR 85-28.
OAO staff will attach a Johnson case flag (Attachment 9) to the Johnson claim, immediately route it to the Illinois DDS for adjudication, and retain a copy of Attachment 9 in the current claim file. OAO will modify Attachment 9 to indicated that the Appeals Council action on the current claim does not resolve all Johnson issues and that the Johnson class member claim is being forwarded for separate processing. OAO staff will include copies of the ALJ or Appeals Council decision or order on the current claim and the exhibit list used for the ALJ or Appeals Council decision.
c. Appeals Council Intends to Issue a Favorable Decision on the Current Claim -- No Johnson Issue(s) Will Remain Unresolved.
If the Appeals Council intends to issue a fully favorable decision on a current claim, and this decision would be fully favorable with respect to all issues raised by the application that makes the claimant a Johnson class member, the Appeals Council will proceed with its intended action. The Appeals Council will consolidate the claims, reopen the final determination or decision on the Johnson claim and issue a decision that adjudicates both applications. The Appeals Council's decision will clearly indicate that the Appeals Council considered the Johnson claim pursuant to the Johnson court order. For class action reporting purposes, the Appeals Council will send copies of its decision to the Johnson coordinators listed in Part VI.E.2.c. above.
d. Appeals Council Intends to Issue a Favorable Decision on the Current Claim -- Johnson Issue(s) Will Remain Unresolved.
If the Appeals Council intends to issue a favorable decision on a current claim and this decision would not be fully favorable with respect to all issues raised by the Johnson claim, the Appeals Council will proceed with its intended action. In this instance, the Appeals Council will request the effectuating component to forward the claim files to the Illinois DDS after the Appeals Council's decision is effectuated. OAO staff will include the following language on the transmittal sheet used to forward the case for effectuation: “Johnson court case review needed — following effectuation forward the attached combined files to Department of Rehabilitation Services, Bureau of Disability Determination Services, 100 N. First Street, Springfield, Illinois 62702.”
e. Appeals Council Intends to Remand the Current Claim to an ALJ.
If the Appeals Council intends to remand the current claim to an ALJ, it will proceed with its intended action unless one of the exceptions below applies. In its remand order, the Appeals Council will direct the ALJ to consolidate the Johnson claim with the action on the current claim pursuant to the instructions in Part VI.E.2.a. above.
EXCEPTIONS:
The Appeals Council will not direct the ALJ to consolidate the claim if:
the current claim and the Johnson claim do not have any issues in common, or
a court remand contains a court-ordered time limit and it will not be possible to meet the time limit if the claims are consolidated.
If the claims do not share a common issue or a court-ordered time limit makes consolidation impractical, OAO will forward the Johnson class member claim to the Illinois DDS for separate review.
The case flag in Attachment 10 should be modified to indicate that the Appeals Council, rather than an ALJ, is forwarding the Johnson class member claim for separate processing.
F. Copy Requirements
For all cases in which OHA is the first level of review for the Johnson claim (i.e., the Appeals Council or an ALJ consolidates the Johnson claim with action on a current claim or a class member only claim is pending at OHA), HO, OAO or OCA personnel, as appropriate, must send a copy of any OHA decision to the Johnson coordinators at the addresses listed in Part VI.E.2.c. above.
VII. Case Coding
HO personnel will code prior claims into the Hearing Office Tracking System (HOTS) and the OHA Case Control System (OHA CCS) as “reopenings.” If the prior claim is consolidated with a current claim already pending at the hearing level (see Part VI above), HO personnel should not code the prior claim as a separate hearing request. Instead, HO personnel will change the hearing type on the current claim to a “reopening.” To identify class member cases in HOTS, HO personnel will code “JN” in the “Class Action” field. No special identification codes will be used in the OHA CCS.
VIII. Reconciliation of Implementation
At an appropriate time, Litigation Staff will request SSA components to reconcile their screening activity and disposition of class member claims with information available on CATS. Within OHA, the OAO Class Action Coordinator is responsible for maintaining a personal computer-based record of OHA implementation activity (e.g., a record of alerts processed by OHA, and a record of cases screened and consolidated by OHA), as reported by HOs and OAO to the Coordinator. See Part V.B.2.a. and HALLEX I-1-7-12 with respect to their reporting requirements
IX. Inquiries
HO personnel should direct any questions to their Regional Office. Regional Office personnel should contact the Division of Field Practices and Procedures in the Office of the Chief Administrative Law Judge at (703) 305-0022.
Attachments:
Final Judgment Order Dated April 3, 1991
Johnson Court Case Flag/Alert
Route Slip or Case Flag For Screening
Johnson Screening Sheet
Route Slip for Routing Class Member Alert (and Prior Claim Folder(s)) to ODIO or PSC -- OHA No Longer Has Current Claim
Johnson Non-Class Membership Notice
Route Slip for Non-Class Membership Cases
Acting Associate Commissioner's Memorandum Dated February 21, 1991, Entitled “The Standard for Evaluating 'Not Severe' Impairments”
Johnson Class Member Flag for Headquarters Use (DDS Readjudication)
Johnson Class Member Flag for HO Use (DDS Readjudication)
ALJ Dismissal Order to DDS
Cover Notice for ALJ Dismissal Order