Background

This transmittal adds section I-2-5-15 to the Hearings, Appeals and Litigation Law (HALLEX) manual to incorporate instructions for handling evidence from excluded medical sources of evidence identified in sections 223(d)(5)(C) and 1614(a)(3)(H)(i) of the Social Security Act, as amended by section 812 of the Bipartisan Budget Act of 2015.

Explanation of Content and Changes

HALLEX I-2-5-15 is organized as follows:

I-2-5-15 – We titled the section “Excluded Medical Sources of Evidence.”

I-2-5-15 A – We titled the subsection “General Policy” and explained the requirements of 20 CFR 404.1503b and 416.903b. We also added a NOTE explaining how a medical source furnishes evidence.

I-2-5-15 B – We titled the subsection “Identifying Excluded Medical Sources of Evidence.” We added a sub-subsection titled “Written Statement of Exclusion Requirement” and explained that excluded medical sources of evidence must provide a written statement of exclusion each time they furnish evidence. We added another sub-subsection titled “Finding the Written Statement of Exclusion” and provided guidance on how to locate the written statement.

I-2-5-15 C – We titled the subsection “Annotating the Claim(s) File” and provided instructions on how to annotate electronic and paper claim(s) files that contain evidence from an excluded medical source of evidence.

I-2-5-15 D – We titled the subsection “Evaluating Evidence from Excluded Medical Sources of Evidence.” We added a sub-subsection titled “Evidence Falls within a Good Cause Exception” and explained the five good cause exceptions. We added another sub-subsection titled “Evidence Considered at a Prior Administrative Level or Continuing Disability Review (CDR)” and provided guidance on how to evaluate evidence from an excluded medical source of evidence depending on when the evidence was furnished and whether it was considered at a prior administrative level.

I-2-5-15 E – We titled the subsection “Addressing Evidence from Excluded Medical Sources of Evidence in a Dismissal Order or Hearing Decision” and included three sub-subsections titled “When All Evidence Has Been Excluded,” “When All Evidence Has Been Considered,” and “When Some Evidence Has Been Excluded and Some Evidence Has Been Considered.” We explained how evidence from an excluded medical source of evidence that is included or excluded must be addressed in the dismissal order or hearing decision.

I-2-5-15 F – We titled the subsection “Reopening Due to Incorrect Inclusion or Exclusion of Evidence” and explained that a determination or decision may be reopened, if a previous adjudicator incorrectly considered evidence from an excluded medical source of evidence or incorrectly excluded evidence from a source that the adjudicator misidentified as an excluded medical source of evidence.

Date: November 8, 2016