Background

This transmittal amends chapter I-2-1 of the Hearings, Appeals and Litigation Law (HALLEX) manual to update and provide instructions relating to claim(s) files. The updates are necessary to improve internal communications and processing, provide missing instructions, and clarify existing instructions. We also made other formatting and editorial changes.

Explanation of Content and Changes

This transmittal revises chapter I-2-1 as follows:

I-2-1-10 – We retitled the section “Claim(s) File” for consistency with other HALLEX language.

I-2-1-10 A – We changed the title of subsection A to “General” and updated the subsection to incorporate electronic claim processing information. We moved some information formerly in subsection B to subsection A and moved the remaining information to HALLEX I-2-1-11.

I-2-1-10 B – We retitled the subsection “Organization of Claim(s) File,” and incorporated information formerly in HALLEX I-2-1-15.

I-2-1-10 C – We moved the information previously in subsection C to HALLEX I-2-1-13. We retitled subsection C “Routing of Paper Claim(s) File” and incorporated information not previously included in HALLEX.

I-2-1-10 D – We moved the information formerly in subsection D to HALLEX I-2-1-13 and modified the language to mirror that in the Program Operations Manual System (POMS) DI 20505.010. We changed the title of subsection D to “Retention Periods for Claim(s) File” and incorporated information about retention periods not previously included in HALLEX.

I-2-1-10 E – We removed subsection E and incorporated updated instructions in HALLEX I-2-1-11 and I-2-1-12.

I-2-1-11 – We added a new section titled “Non-receipt of Paper Claim(s) File” and incorporated information previously in HALLEX I-2-1-10 B and E. We added hearing office instructions for contacting the Appeals Council when the Appeals Council remands a case involving a paper claim(s) file, but does not send the claim(s) file with the remand order.

I-2-1-12 – We added a new section titled “Reconstructed Paper Claim(s) File” and provided instructions regarding when reconstruction is necessary, how to develop non- medical and medical issues, and follow-up procedures if reconstructed information is not complete.

I-2-1-13 – We added a new section titled “Prior Claim(s) Files,” and incorporated information previously in HALLEX I-2-1-10. We updated the information and more clearly explained that an administrative law judge (ALJ) will make the final decision on whether a prior claim(s) file is required to adjudicate a case. We clarified when a prior claim(s) file is required, when a prior claim(s) file may be necessary, and when a prior claim(s) file is not needed. We added instructions for requesting a prior claim(s) file and how to exhibit evidence from a prior claim(s) file. We also explained when an ALJ will provide a claimant and appointed representative, if any, an opportunity to review a prior claim(s) file. Finally, we explained that when an ALJ relies on information from a prior claim(s) file, the ALJ will make the information part of the record and address the evidence in the written decision.

I-2-1-14 – We added a new section titled “Appeals Council Requests Claim(s) File,” and provided instructions for how a hearing office will communicate with the Office of Appellate Operations regarding a missing claim(s) file.

I-2-1-15 A – We retitled subsection A “General,” removed outdated information, made minor editorial changes, and incorporated helpful references.

I-2-1-15 B – We retitled subsection B “Exhibited Documents,” made minor editorial changes to the existing language, added a reference to the POMS to address information removed from subsections C, G, H and I, and incorporated information formerly in subsections E, J, and K.

I-2-1-15 C – We removed the information formerly in subsection C as the information mirrors POMS DI 70005.005 (which is now referenced in subsection B). We retitled subsection C “Preparing the Exhibits” and incorporated information formerly in subsections F and M.

I-2-1-15 D – We removed the information formerly in subsection D as the information mirrors POMS DI 70005.005 (which is referenced in subsection B). We retitled subsection D “Prior Claim(s) File Exhibits” and added a reference to HALLEX I-2-1-13 D.

I-2-1-15 E – We removed subsection E as the information was incorporated in subsection B.

I-2-1-15 F – We removed subsection F as the information was incorporated in subsection C.

I-2-1-15 G – We removed subsection G as the information is included in POMS DI 70005.005 (which is now referenced in subsection B).

I-2-1-15 H – We removed subsection H as the information is included in POMS DI 70005.005 (which is now referenced in subsection B).

I-2-1-15 I – We removed subsection I as the information is included in POMS DI 70005.005 (which is now referenced in subsection B).

I-2-1-15 J – We removed subsection J as the information was incorporated in subsection B.

I-2-1-15 K – We removed subsection K as the information was incorporated in subsection B.

I-2-1-15 L – We removed subsection L as the information was incorporated in subsection D and HALLEX I-2-1-13.

I-2-1-15 M – We removed subsection M as the information was incorporated in subsection C.

I-2-1-90 – We removed the section in its entirety as the information is outdated.

Date: June 9, 2014