Background

On November 30, 1995, OHA published HALLEX Temporary Instruction (TI) 5-452 concerning the implementation of relief in the Dixon v. Shalala class action. The TI, which delineates OHA component responsibilities, is based on a relief order issued by the United States District Court for the Southern District of new York on December 22, 1993, and affirmed by the United States Court of Appeals for the Second Circuit on April 19, 1995.

On December 13, 1995, the district court entered an order that resolved the parties' disagreement about SSA's evidence development responsibilities under the 1993 relief order. The court ordered that SSA must follow the requirements set forth in 20 CFR §§ 404.1512(d) - (e) and that SSA must make an initial request for evidence to all physicians and medical care facilities identified by the plaintiff, must make one follow-up request if the first one goes unanswered and must request additional information if the evidence received by SSA is inadequate to make a disability determination. However, the court ruled that SSA is not required to provide consultative examinations, pursuant to 20 CFR §§ 1512(f) and 416.912(f), if its requests for evidence are unsuccessful.

On April 1, 1996, SSA issued an E-mail message (EM-96-34) to inform Agency adjudicators of the court's order. The E-mail message also identified the sections of the Dixon Program Operations Manual System (POMS) instructions which are affected by the court's order (Section DI 12521.015B.6.a., DI 12521.025B.4.b., DI 32521.005C., DI 32521.015B.1.d., and DI 32521.030.1.b.), provided replacement language for those sections and stated that updated POMS will be issued on or before March 15, 1997.

Explanation of Content and Changes

In order to give effect to the court's December 13, 1995 order, we have revised the Dixon TI to reflect SSA's evidence development responsibilities as ordered by the court and set forth in the regulations. SSA will make an initial request for evidence to each physician and medical care facility identified by the class member claimant. SSA will make one follow-up request (either by letter or by telephone) if the first request goes unanswered and will request additional information if the evidence received from the treating source (s) or other medical sources is insufficient for adjudication. However, SSA is not required to obtain a consultative examination if a request for medical evidence is unsuccessful.

Remove

Remove from 5-400, Court Cases:

Pages 3 through 8 of TI 5-452 dated November 30, 1995 (6 pages).

Insert

Insert in 5-400, Court Cases:

Pages 3 through 8-A of TI 5-452, dated November 18, 1996 (7 pages).

Date: November 18, 1996