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Office of Disability Adjudication and Review

Volume I

Transmittal No. I-3-154

Chapter: I-3-3

Subject: Substantive Review


This transmittal amends Hearings, Appeals and Litigation Law (HALLEX) manual chapter I-3-3 to clarify the policy for the consideration of additional evidence at the Appeals Council (AC) level based on the final rule published in the Federal Register at 81 FR 90987. This final rule establishes nationally consistent procedures for case processing and removes the regulations in 20 CFR Part 405. The 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-3-3-1 – We update the instructions pertaining to the consideration of evidence for consistency with the final rules. We also update the regulatory references. We also make minor editorial changes.

HALLEX I-3-3-4 – We remove the reference to the “weight of the evidence” standard for consistency with updates to HALLEX I-3-3-6. We also make a minor editorial change.

HALLEX I-3-3-6 – We re-title the section “Additional Evidence” and update the instructions for consistency with the regulatory language, remove references to regulations in 20 CFR Part 405, and make minor editorial and formatting changes throughout the section. In subsection A, we provide general information about the standard for considering evidence and reviewing the case. In subsection B, we update the instructions for determining when the AC will consider additional evidence. We clarify that these instructions apply in appeals of all claims under title II of the Social Security Act and in appeals of claims based on an application for benefits under title XVI. In subsection B, we add a Note to explain that the good cause requirement does not apply when a hearing office develops evidence. We create additional sub-subsections to define further the requirements for when the AC will consider additional evidence. In new B.1., we provide instructions for determining whether a claimant has good cause for not submitting the evidence earlier. In new B.2., we incorporate existing definitions and examples of evidence that is new, material, and related to the period at issue. In the Note in B.2., we replace the term “treating source” with “medical source” based on the final rules for the evaluation of medical evidence. In new B.3., we clarify that the AC will evaluate the entire record including the additional evidence to determine whether there is a reasonable probability that the additional evidence would change the outcome of the decision. In subsection C, we clarify that when the AC considers additional evidence, the AC considers it with the entire record. We re-title subsection D “Determining When the Good Cause Provisions Apply” and clarify that the good cause provisions apply to all title II claims and to title XVI claims based on an application. We also make minor editorial changes.

Date: May 1, 2017