Background

The attached is a complete revision and updating of the current Chapters I-4-0, I-4-1, I-4-2, I-4-3 and I-4-7. The material also contains a new chapter (I-4-4). The revised and new material provides the procedures for processing and adjudicating claims at the Civil Action level in the Office of Hearings and Appeals. These revised chapters were last updated in June 1994.

The instructions represent the current day-to-day operating procedures the Office of Appellate Operation (OAO) uses to process Civil Action cases. The revisions incorporate procedures to keep pace with the evolving OAO internal claim handling and record keeping practices as well as housekeeping modifications and procedures.

Explanation of Content and Changes

This is a complete update of HALLEX, Volume I, Division 4, Chapters I-4-1 through I-4-3 and I-4-7 that incorporates all previous transmittals and includes major revisions. Chapter I-4-4 is a new chapter that provides procedures for processing ALJ decisions after court remand. All references to the Health Insurance Branch and title XVIII (Medicare) as well as the Office of Civil Actions (OCA) have been removed. Below are synopses of major revisions contained in the various subchapters.

I-4-0 ff.

Updated the organizational structure of the OAO to include the Court Case Preparation and Review Branches (CCPRBs). Eliminated all references to the Office of Civil Actions and Division of Litigation Analysis and Implementation.

I-4-1 ff.

A number of sections were revised to provide updated instructions. All references to “Affidavits” were removed because that type of document is no longer provided. OAO now uses the “Declaration” format exclusively. The process for obtaining claims files was updated to include references to OAO's Mega-site folder storage facility. All references to the Office of the General Counsel (OGC) Answer Unit were removed as this office was closed in April 2003. OAO now provides Certified Administrative Records to OGC Regional Offices or OGC Office of Program Litigation (OPLit).

I-4-2 ff.

A number of sections were revised to provide updated instructions. Instructions regarding procedures for handling subsequent claim allowances were added, as well as a new exhibit on the same subject (Executive Director's memorandum dated October 25, 2002 (I-4-2-101)). Reference to Litigation Staff was changed to Office of Acquiescence and Litigation Coordination (OALC), based on recent reorganization. All references to “super panel” were removed because this term is no longer used by OAO.

I-4-3 ff.

A number of sections were revised to provide updated instructions. Section I-4-3-1 was revised to include reference to Schaefer v. Shalala (509 U.S. 292 (1993)) and the issues concerning sentence 4 and sentence 6 remands. Section I-4-2-3 (Clerical Procedures for Incoming Remand Orders — Cases Referred by CCPRB to OAO Branches) was added because OAO Branches now handle a number of court remands based on requests for voluntary remand. Section I-4-3-31 (CCPRB Determination that Appeals Council Review Not Required) was revised to add instructions on handling subsequent claims. Exhibit I-4-3-100 (Request for Detailed or Summary Earnings Record) replaced the former exhibit HA-534-U3 (Request for Earnings Record Information) because employees now request earnings information directly through the SSA computer system. Exhibits of sample remand orders and decisions were updated based on the new Document Generation System (DGS) document format. Exhibits I-4-3-103 and I-4-3- 104 were added to provide jurisdictional breakdown information for the Office of Appellate Operations. I-4-3-103 will be available through the Intranet and will include the personal telephone numbers of the Branch Chiefs as well as destination codes. I-4-3-104 will be available through the Internet, and will not include the personal telephone numbers of the Branch Chiefs or the destination codes. Exhibit K (Headquarters' Critical Case Procedures Division of Congressional and Public Inquiries) in I-4-399 Exhibits was eliminated because this information is covered in the I-4-3-43. Exhibit Z (Psychiatric Review Technique Form) was also eliminated as this form is no longer required by the regulations at the OHA level.

I-4-4 ff.

This is a new chapter that outlines the procedures for handling ALJ decisions after court remand. Essentially, these sections duplicate the material currently contained in sections I-3-1-80 through I-3-1-92. We plan to eliminate the Division 3 instructions at a future date.

I-4-7 ff.

A number of sections were revised to provide updated instructions. In section I 4-7-5 (Freedom of Information Requests (FOIA)), we eliminated all references to the Division of Litigation Analysis and Implementation (DLAI). FOIA requests are now referred to the Office of Policy, Planning and Evaluation (OPPE). In section I-4-7-21 (Mandamus Action), we eliminated reference to Litigation Staff. Based on a recent reorganization, we now refer Mandamus actions, not pending with OHA, to the Office of Acquiescence and Litigation Coordination (OALC). We also included their current mailing address.

This issuance replaces the previous edition of Volume I, Division 4, Chapters I-4-0; I-4-1; I-4-2; I-4-3; and I-4-7 and adds chapter I-4-4.

Date: September 17, 2003