Background

This transmittal amends the Hearings, Appeals and Litigation Law (HALLEX) manual Chapter I-3-5 to clarify how an analyst handles additional evidence when analyzing a claim and when preparing a denial notice for the Appeals Council (AC). For consistency with our long- standing business processes, we also updated instructions on addressing contentions.

These changes were necessary for consistency with regulatory language, and to incorporate processing changes due to Social Security Ruling 11-1p: Titles II and XVI: Procedures for Handling Requests to File Subsequent Applications for Disability Benefits. Additionally, we anticipate that these changes will result in improved consistency within the AC and reduce inconsistent results and application in the Federal courts.

Explanation of Content and Changes

This transmittal revises I-3-5-20 to provide instructions on handling additional evidence when a denial is appropriate. This transmittal also revises I-3-5-30 to clarify that an analyst should acknowledge receipt of but not specifically address contentions in a denial notice.

I-3-5-20 (Introductory Paragraph) — We modified the language to adhere more closely to the regulatory language, and added a brief explanation of when each section applies.

I-3-5-20 A. — We modified subsection A to provide detailed instructions on handling additional evidence when it is not new, material, or does not relate to the period at issue. We incorporated information previously included in subsections B, C, and D, and deleted information that is now included in HALLEX I-3-3-6. We clarified the importance of including protective filing date language in the denial notice, in light of SSR 11-1p. We also provided detailed instructions regarding returning evidence and explained that the evidence should not be exhibited.

I-3-5-20 B. — We created a new subsection B to provide instructions on handling evidence that is new and material, and relates to the period at issue, but does not provide a basis for granting review. Most significantly, we explained the analyst must exhibit this evidence.

I-3-5-20 C. — We deleted this subsection as it was incorporated into new subsection A.

I-3-5-20 D. — We deleted this subsection. The policy statements were incorporated into HALLEX I-3-3-6, and the procedures were incorporated in other subsections.

I-3-5-30 A. — We added subsection A to retain a brief history of prior AC business practices.

I-3-5-20 B. — We added subsection B to incorporate current AC business procedures, and removed the requirement to include specific responses to contentions in a denial notice.

Date: December 27, 2012