Chapter: I-3-0, I-3-1, I-3-3, I-3-4, I-3-5, I-3-6, I-3-7, I-3-8, I-3-9
Subject: Appeals Council Review
In July 2001, the Hearings Appeals and Litigation Law (LEX) Manual (HALLEX), Volume I, Division 3 (Appeals Council Review) was completely reviewed and updated. Although transmittals of Division 3 have been issued to revise individual sections, there has not been a complete issuance of Division 3 since July 2001.
This transmittal reflects a complete review, and where appropriate, revision of all chapters in Division 3. All references to Title II and Title XVI of the Social Security Act have been capitalized. All references to “cassettes” and/or “tapes” have been revised to “recording” because the Office of Hearings and Appeals is moving from recording oral hearings on cassette tapes to digital compact disks. We also revised references to “appeals assistants” to “branch staff” because this position was eliminated and all support operations for the Appeals Council are performed by branch staff. In addition, we have made a number of minor editorial/typographical revisions/corrections.
Below are synopses of other revisions contained in the various chapters:
Added “Deputy Chair” to individuals who may preside at en banc Appeals Council meetings.
Revised to indicate that claims files are requested through the Mega-site Information Management System (MIMS).
Revised Note to indicate that claims files are requested through the Mega-site Information Management System (MIMS).
Revised the process for obtaining recordings when they are not housed with the claims files. In this regard, OAO uses the Mega-site Information Management System (MIMS) to control and request recordings. Moreover, the Cassette Computer Library was disbanded with its functions incorporated in the OAO Mega-site.
Deleted this exhibit. As noted above, OAO controls and processes requests for recordings through the MIMS system.
The list of Folder Finding Team members was revised.
This section was updated to provide current earning, insured status, and benefit computation query information. We deleted references to Earnings Estimate (ES) and Primary Insurance Amount Estimate (PIAEST) queries as these no longer exist. We added reference to the Informational/Certified Earnings Records System (ICERS) as well as the Disability Insured Status Calculation Online (DISCO), which is an OQA toolbar icon.
This section was updated to remove all references to the Special Counsel Staff because this entity was disbanded and the staff incorporated into the Office of the General Counsel. In addition, all referrals regarding unfair hearing allegations are now routed to the Office of the Chief Administrative Law Judge (OCALJ) through the Executive Director, OAO.
The Office of the Director of Operations staff no longer controls Bureau Protest cases.
Revised section to remove definition of “inordinate delay.” OAO processes its workload based through Differential Case Management (DCM), therefore “average processing times” are not an accurate method for determining when a case has been “inordinately delayed.” We added note to describe process used by OAO, in consultation with the Division of Congressional and Public Inquiries (DCPI) staff, to determine when a case is “inordinately delayed.” This timeframe is subject to change, based on a review of OAO's current workloads.
Revised the Note to include a statement that although the June 1997 memorandum refers only to cassette tapes, its provisions include all recordings.
Revised the definition of “abuse of discretion” in keeping with revisions to Black's Law Dictionary.
Removed references to HALLEX II-1-1, OHA Circuit Court Case Reporter because this section was deleted from HALLEX in its entirety on June 25, 2005.
This section was revised to include a reference to POMS DI 27516.010. This POMS section contains the “official” guide to determining the applicability of res judicata. It also contains summaries of less restrictive changes to listing of impairments and listing of impairment changes affecting application of res judicata. Because they were covered in POMS, we deleted most of the list in HALLEX. However, we retained four items from our original list because they were not covered in POMS.
Revised reference to who OAO notifies when request for review is prepared prematurely or erroneously prepared. Both the claimant and representative must be notified, if a representative is involved.
Added this section to describe the procedures used when a request for exhibits and/or recording(s) is received prior to the Appeals Council action, but not associated until after the action is released. These procedures were announced in a memorandum issued by the Executive Director, OAO on April 24, 2002.
Revised this section for clarity. The revised section specifically state that the AAJs sign the notice, that it is dated before release and the file is returned to the OAO branch to be placed in diary.
Did not remove the first bullet concerning National Random Sample cases even though the Appeals Council has not conducted this type of review for a number of years. We left this section in HALLEX because the National Random Sample could be reinstituted at any time. We removed references to the OM Review Data Sheet when discussing OQA Referral and Bureau Protest cases because OAO completes that document only in National Random Sample cases.
See sentence above, OAO does not complete OM Review Data Sheet in OQA or Bureau Protest cases.
Added a Note to this section. The Note reminds staff that they should use the terms “if available” or “if possible” when ordering testimony from a medical expert with a specific specialty (See Executive Director's memorandum dated February 14, 2002).
Added a note to this section to remind analyst that they must prepare payment status request and transmittal documents, through DGS, when preparing remands in Title XVI or concurrent Title II and Title XVI medical cessation cases.
Added sentence informing analyst that they must prepare an Appeals Council Decision Coding Sheet.
Revised first Note, removed references to HALLEX II-1-1, OHA Circuit Court Case Reporter. This section of HALLEX was deleted on June 25, 2005.
Revised section to include reference to coding responsibilities of support staff. Added instructions to input Regulation Basis Code(s) and Impairment Code(s) to all fully and partially favorable AC decisions. Instructed support staff to obtain codes from AC Decision Coding Sheet, which will be completed by analyst.
Added instructions that analyst will complete Regulation Basis Code(s) and Impairment Code(s) on AC Decision Coding Sheet for all fully and partially favorable AC decisions.
Revised AC Decision Coding Sheet to include Regulation Basis Code(s) and Impairment Code(s).
Date: September 9, 2005