Subject: Appeals Council Review
In March 1992, the Hearings, Appeals and Litigation Law (LEX) Manual (HALLEX), Volume I was issued in a bound edition. Subsequent issues were released annually until June 1994. Although transmittals of Division 3 have been issued to revise individual sections, there has not been a complete issuance of Division 3 since June 1994.
This transmittal reflects the HALLEX release dated July 31, 2001. This is a complete update of Volume I, Division 3 that incorporates all previous transmittals and includes major revisions. All references to the Health Insurance Branch and title XVIII (Medicare) have been removed. Also, specific references to the Appeals Text Guide have been removed as we are currently in the process of a major revision of this resource. Below are synopses of major revisions contained in the various subchapters.
|References to the Mega-Site were incorporated into the case processing system. References to Docket and Files Branch have been removed and most duties handled by that section would now be handled by the OAO Branches. These changes are seen throughout this section. The organizational chart was removed and the Appeals Officer position was added to various sections. The subsequent claim procedures were moved to section I-3-1-21.|
|A number of sections were revised to provide updated instructions. A new section was added regarding handling of subsequent claims, referencing to instructions in HALLEX I-5-3-17. Section I-3-1-25 was extensively revised regarding unfair hearing complaints. A note was added to I-3-1-52 concerning cassette audits. The note refers to the Executive Director's memorandum dated June 20, 1997 (contained at I-3-1-100, Exhibit). Section I-3-1-60, Spanish Language Communication, was updated with current procedures. Sections I-3-1-80 through I-3-1-92 were added. These sections outline the procedures for handling ALJ decisions after Court remand.|
|Section I-3-3-90, Exhibits was deleted and a cross-reference to HALLEX II-1-1-0, OHA Circuit Court Case Reporter was added. Section I-3-3-9 was revised for clarity and to more closely follow current policy (e.g., Social Security Rulings 91-5p, 95-1p, as well as HALLEX I-5-1-12).|
|Section I-3-4-4 was revised to define “substitute party” and “qualified individual” in cases in which a claimant died. Section I-3-4-5 was restructured to delete reference to the Appeals Council dismissing prematurely or erroneously filed requests for review. Section I-3-4-6 was added for dealing with those situations.|
|A NOTE was added to I-3-5-30, along with I-3-590 Exhibit, providing reference to temporary instructions regarding responding to contentions and additional evidence. Section I-3-5-40 D. was revised concerning the use of Spanish language correspondence. Section I-3-5-40 E. was revised to include reference to Appeals Officers.|
|Section I-3-6-1 B.3. was deleted as revised mental impairment regulations eliminated mandatory completion of Psychiatric Review Technique form. Sections I-3-6-50 — I-3-6-55 were revised to update these sections with current procedures.|
|A note was added to I-3-7-11 C., explaining that Medical Support Staff comments were advisory in nature and generally are not entered into the record. The note also contains a cross-reference to I-3-8-6. Reference to Acquiescence Rulings was added to I-3-7-14 D.|
|The Drug Addiction and Alcoholism criteria, in I-3-8-3, were revised. Section I-3-8-12 was revised to add the requirement to consider State Agency medical source opinions. Section I-3-8-13 E. was added for routing instructions where a fee agreement is in file. Section I-3-8-20 was revised with reference to Administrative Appeals Judge review of fee agreements.|
|Section I-3-9-6 A.6. was revised to better parallel regulations. Section I-3-9-10 B. was deleted, as AR 87-2(11) has been rescinded. Section I-3-9-50 was revised to show that retention date for all claims files will be 150 days (180 days for Puerto Rico cases). Notes were added to section I-3-9-50, the first concerning AR 92-4(11), and the second concerning obtaining supervisory concurrence when releasing claims files prior to end of retention period.|
This issuance, dated July 31, 2001, replaces the previous bound edition of Volume I, Division 3. Prior editions should be discarded upon receipt of this transmittal.
Date: July 31, 2001