Background

This transmittal amends Hearings, Appeals and Litigation Law (HALLEX) manual chapter I-3-2 to clarify the procedures Office of Appellate Operations staff will follow to develop evidence when a claimant informs the Appeals Council (AC) about additional evidence that relates to the period on or before an administrative law judge's (ALJ) decision and was not previously submitted. This transmittal also updates procedures the AC will apply when it receives a recommended decision from an ALJ. These changes are based on the final rule published in the Federal Register at 81 FR 90987 that establishes nationally consistent procedures for case processing and removes the regulations in 20 CFR Part 405. This transmittal also clarifies procedures for the evaluation of medical evidence based on the final rule published in the Federal Register at 82 FR 5844.

Explanation of Content and Changes

HALLEX I-3-2-1 – We remove references to the regulations in 20 CFR Part 405. In subsection A, we explain that hearing offices must send a Notice of Hearing to a claimant at least 75 days before the date set for the hearing. We also clarify that an analyst will review the evidence using the instruction in HALLEX I-3-3-6 when a claimant submits additional evidence. In addition, we correct the reference to HALLEX I-2-1-82, which contains the procedures for when a claimant waives the right to appear at a hearing. We also make minor editorial changes throughout the section.

HALLEX I-3-2-15 – In subsection A, we provide background information to explain when the AC will consider additional evidence submitted with a request for review. We also clarify that the AC will generally attempt to develop additional evidence only if the claimant clearly indicates that the evidence relates to the period on or before the ALJ's decision and the AC finds that the claimant has good cause for not submitting the evidence previously. In Note 1, we update the citations to the rules in 20 CFR 404.1513 and 416.913 based on the final rule for the evaluation of medical evidence. In new Note 2, we explain that the AC will not develop whether the claimant has good cause for not submitting the evidence earlier. We move the information in former Note 2 to new Note 3. We remove the instructions in former Note 3 because the instructions pertain to the former regulations in 20 CFR Part 405. In subsection B.1., we update the instructions in the first bullet based on systems updates associated with the final rule.

HALLEX I-3-2-16 – In subsection B, we explain that the AC will proffer evidence when the AC finds good cause to consider the evidence and intends to add the evidence to the record because it is new, material, related to the period at issue, and there is a reasonable probability that it would change the outcome of the decision. We also clarify when the AC will not proffer any evidence that is substantively the same as or a duplicate of other evidence already in the record. In addition, we make minor editorial changes.

HALLEX I-3-2-50 – In subsection C, we clarify that the AC will apply the rules in 20 CFR 404.935 and 416.1435 and procedures in HALLEX I-2-6-58 and I-2-6-59 when the AC reviews evidence submitted after an ALJ's recommended decision. We also explain that when a claimant submits additional evidence that the AC will consider, the AC will determine whether the preponderance of the evidence, including the additional evidence, would change the ALJ's recommended action, finding, or conclusion. If the AC declines to consider additional evidence, the AC will evaluate whether the preponderance of the evidence in the record before the ALJ would change the ALJ's recommended action, finding, or conclusion. We also clarify that the AC will issue the final decision of the Commissioner based on the preponderance of the evidence. In addition, we make minor editorial changes throughout the section.

Date: May 1, 2017