ISSUED: July 6, 1990
I. Purpose
This Temporary Instruction (TI) contains instructions for implementing the
September 26, 1989, order of the U.S. District Court for the Western
District of Missouri in the Boyd, et al. v. Bowen
class action. This order directs the reopening and readjudication of title
II and XVI disability claims of certain Missouri residents and former
residents which were denied in 1983 and 1984. The
Boyd order requires the Secretary to reopen and
reconsider the claims of most class members at the disability
determination service (DDS) reconsideration level with full appeal rights
to the next level of appeal, i.e., an Administrative Law Judge (ALJ)
hearing. The only Boyd claims which will come
directly to OHA for screening and readjudication are certain cases in
which the claimant has a subsequent claim pending at the OHA level.
Adjudicators throughout the country must be familiar with this TI because
Boyd class members who now reside outside Missouri
must have their claims processed in accordance with the requirements of
the court order.
II. Background
On July 17, 1984, the U.S. Court of Appeals for the Eighth Circuit
accepted settlement language in Polaski, et al. v.
Bowen, 739 F.2d 1320 (1984), regarding the evaluation of pain
and other subjective complaints and ordered that this standard be followed
in all administrative and judicial proceedings within the Eighth Circuit
(including Missouri). The Secretary promptly notified adjudicators of the
court-approved standard, and the court's order remains in effect for all
administrative and judicial proceedings within the Eighth Circuit. The
U.S. District Court for the District of Minnesota issued orders in the
Polaski class action which specified relief for
class members from all states in the Eighth Circuit except Missouri. TI
5-407 Contains OHA's instructions for implementing these orders, as well
as a copy of the Eighth Circuit's July 17, 1984,
Polaski order.
On September 26, 1989, the U.S. District Court for the Western District of
Missouri approved a stipulated judgment submitted by the parties in the
Boyd class action. The judgment outlines the manner
in which the Secretary is to provide relief to certain current and former
Missouri residents whose claims were denied before the Eighth Circuit
issued its July 17, 1984, order in Polaski.
III. Guiding Principles
In its July 17, 1984, order in Polaski, the Eighth
Circuit found the settlement language to be a correct restatement of
Eighth Circuit case law concerning evaluation of pain and other subjective
complaints. ALJs and the Appeals Council (AC) must continue to apply the
court-approved standard in all Eighth Circuit cases, including the
readjudications ordered by the Boyd court and the
adjudication of current claims of Missouri residents.
The court-approved standard, as set forth in the Eighth Circuit's order in
Polaski and quoted in Boyd,
is as follows:
A claimant has the burden of proving that the disability results from a
medically determinable physical or mental impairment Symptoms such as
pain, shortness of breath, weakness, or nervousness are the individual's
own perceptions of the effects of a physical or mental impairment(s).
Because of their subjective characteristics and the absence of any
reliable techniques for measurement, symptoms (especially pain) are
difficult to prove, disprove, or quantify. As a result of this difficulty,
some adjudicators have misinterpreted the Secretary's policies as
enunciated in
SSR-82-58.
In particular, some adjudicators may have misinterpreted Example No. 2 in
SSR-82-58 to allow
allegations of pain to be disregarded solely because the allegations are
not fully corroborated by objective medical findings typically associated
with pain. The example should not be construed to be inconsistent with the
text of SSR-82-58 which
states in part:
The effects of symptoms must be considered in terms of any additional
physical or mental restrictions they may impose beyond those clearly
demonstrated by the objective physical manifestations of disorders.
Symptoms can sometimes suggest a greater severity of impairment than is
demonstrated by objective and medical findings alone.
While the claimant has the burden of proving that the disability results
from a medically determinable physical or mental impairment, direct
medical evidence of the cause and effect relationship between the
impairment and the degree of claimant's subjective complaints need not be
produced. The adjudicator may not disregard a claimant's subjective
complaints solely because the objective medical evidence does not fully
support them.
The absence of an objective medical basis which supports the degree of
severity of subjective complaints alleged is just one factor to be
considered in evaluating the credibility of the testimony and complaints.
The adjudicator must give full consideration to all of the evidence
presented relating to subjective complaints, including the claimant's
prior work record, and observations by third parties and treating and
examining physicians relating to such matters as:
1.
the claimant's daily activities;
2.
the duration, frequency and intensity of the pain;
3.
precipitating and aggravating factors;
4.
dosage, effectiveness and side effects of medication;
The adjudicator is not free to accept or reject the claimant's subjective
complaints solely on the basis of personal observations. Subjective
complaints may be discounted if there are inconsistencies in the evidence
as a whole.
As indicated above, all SSA adjudicators must use this standard when
considering the claims of Eighth Circuit residents involving complaints of
pain or other subjective complaints.
The court-approved language refers to
SSR 82-58. However,
that ruling has been superseded by
SSR 88-13.
IV. Definition of Class
As stated in the Boyd court order, potential
Boyd class members are:
all persons residing in Missouri who have applied for Title II or Title
XVI (Supplemental Security Income) benefits, who allege that they are
unable to work in whole or in part as a result of pain or other subjective
complaints, and who have received an adverse administrative decision at
any level in the administrative process between July 15, 1483, and July
17, 1984, inclusive.
The court order also contains a prescribed screening sheet for making
class membership determinations (Attachment A). To be a class member under
the screening sheet criteria, an individual must:
1.
have been a resident of Missouri at the time of filing a claim, and
2.
have had a claim finally denied (either in whole or in part) between July
15, 1983, and July 17, 1984, as follows:
•
at the initial or reconsideration levels, of the Missouri DDS, or
•
at the ALJ hearing level, if the claimant was a Missouri resident at the
time of the ALJ's action, or
•
at the AC level, if the claimant was a Missouri resident at the time of
the AC's action.
Only those individuals who received adverse determinations or decisions
based on medical or medical-vocational grounds can qualify for class
membership. A res judicata dismissal qualifies a
person for class membership so long as all of the other requirements are
met with respect to that dismissal, i.e., it was issued within the
timeframe for class membership, and the prior determination or decision
was based on medical or medical-vocational grounds.
Excluded from class membership are individuals who received adverse
determinations or decisions based on reasons other than medical or
medical-vocational grounds, such as work activity, failure to cooperate,
whereabouts unknown, or technical reasons such as lack of insured
status.
In order to be a class member, the individual must have received a
determination or decision on his or her claim which was issued within the
timeframe for class membership, i.e., between July 15, 1983, and July 17,
1984, and which the final determination or decision of the
Secretary.
Example 1:
A potential Boyd class member received an ALJ
denial decision issued before July 15, 1983. In this instance, neither an
AC denial of review nor a judicial affirmation issued during the timeframe
for class membership would make the person a class member. However, an AC
denial decision issued in this timeframe would make the person a class
member.
If an individual received a determination or decision issued within the
timeframe for class membership, appealed that determination or decision,
and received a final determination or decision issued after July 17, 1984,
that person would not be a Boyd class member.
Example 2:
A potential Boyd class member received an ALJ
decision issued April 17, 1984, that would establish class membership.
However, the claimant requested AC review and the AC issued a final
decision on the merits on July 29, 1984. This claimant would not be a
Boyd class member. However, if the AC had denied
the claimant's request for review on July 29, 1984, rather than issuing a
decision on the merits, the ALJ decision of April 17, 1984, would have
become the final decision of the Secretary and the claimant would be a
Boyd class member.
If an individual received a final determination or decision during the
timeframe for class membership, and SSA, either at the claimant's request
or on its own initiative, reopened and revised that otherwise final
determination or decision after July 17, 1984, then the individual would
not be a class member.
V. Determination of Class Membership and Preadjudication
Actions
In November 1989, SSA sent notices to all potential class members
identified by computer run. Individuals had 30 days from the date of
receipt of the notice to request that SSA review their cases under the
terms of the Boyd court order.
Litigation Staff in the Office of the Deputy Commissioner for Programs is
tracking all of the responses and sending folder alerts to the Office of
Disability and International Operations (ODIO) and Program Service Centers
(PSCs) to use in locating claim files.
1.
ODIO, PSC, DDS and Field Office Actions
ODIO or the PSC will associate the Boyd folder
alert and the claimant's reply card with the claim file and forward the
file to the DDS servicing the responder's current address for
screening.
If ODIO or the PSC determines that a claim file which needs to be screened
for class membership is located In OHA because there is a pending
subsequent claim, it will forward the alert to OHA and request that OHA
screen the case. See Attachment B for a sample Boyd
folder alert.
ODIO and the PSCs will send all untimely responses to the Servicing Social
Security field office to develop good cause for the untimely response. The
field office will deem that good cause exists for a late response if the
claimant alleges a mental impairment or the record reflects a mental
impairment. If a mental impairment is not involved, the field office will
develop good cause for the late response and apply the same regulatory
standard (20 CFR
§§ 404.911 and
416.1411) for
finding good cause as that applied to any other missed deadline for
requesting review. The field office will send a notice to those claimants
who do not show good cause for failing to respond timely to the potential
class membership notice. The notice will explain that SSA will not review
the claim under Boyd because the claimant did not
respond timely. SSA will afford plaintiffs' counsel an opportunity to
review its actions on these untimely filed requests in the same manner as
for any other class membership denial. Section C., below, describes how
plaintiffs' counsel may review class membership denials. If the field
office finds good cause for the late response, it will forward the folder
to the appropriate DDS for class membership screening.
2.
OHA Actions
If the folder alert shows that a prior claim file which needs to be
screened for class membership is associated with a subsequent claim
pending anywhere in OHA, the PSC will send the folder alert to the Docket
and Files Branch (DFB) in the Office of Appellate Operations (OAO) for
association with the file. If the claim is pending at the AC level, DFB
must forward the folder alert to the OAO Program Review Branch which is
processing the subsequent claim. If the claim file is in OHA Headquarters
but there is no claim actively pending administrative review, i.e.,
Headquarters is holding the file awaiting potential receipt of a request
for review or notification that a civil action has been filed, DFB must
associate the alert with the file and send the file to the Office of Civil
Actions (OCA), Division II, for screening. If the claim is pending in
court, DPB must forward the folder alert to OCA to associate with the
file. If there is a subsequent claim pending at the ALJ level, DFB must
send the folder alert to the hearing office (HO) processing the subsequent
claim.
If OCA receives an alert for a claimant who has a civil action pending,
either on the alerted case or on a subsequent or prior claim, OCA will
associate the alert with the claim folder(s) and flag the case for
screening by the DDS after completion of court action, using the flag in
Attachment C. Additionally, unless the court has remanded the case, OCA
must notify the appropriate component of the Office of General Counsel
that the claimant has been identified as a potential
Boyd class member.
OHA components must screen cases associated with court remands, and
process them in accordance with section V1.B. or V1.C. below, as
appropriate.
If an OHA component receives a folder alert from DPB but does not have the
prior folder, it must annotate the alert that it does not have the file
and send the alert to the Division of Litigation Analysis and
Implementation (DLAI) at the following address:
Office of Civil Actions
Division of Litigation
Analysis and Implementation
P.O. Box 10723
Room
702, Skyline
Arlington, VA 22210
Attn:
Boyd CoordinatorDCAI will return the folder alert to ODIO or the PSC to locate or
reconstruct the prior folder for a class membership determination. The HO
or OAO must not suspend action on the subsequent claim awaiting the prior
claim file.
Similarly, the HO or OAO must continue to process a subsequent claim for
any claimant who is a potential Boyd class member
but for whom the HO or OAO has not yet received a folder alert.
In OCA, operating division staff will make the class membership
determination. In OAO, the analyst to whom the claim is assigned will make
the class membership determination. In the HO, the Supervisory Staff
Attorney, or his or her designee, will make the class membership
determination.
OHA adjudicators must not take any action on a subsequent claim until the
claimant's class membership status is resolved, unless, as indicated
above, the necessary file is not available.
The individual making the class membership determination must use the
Boyd screening sheet at Attachment A. In completing
the sheets, the screener must:
•
Consider all applications denied (including res
judicata denials) during the period covered by the court order
when making the class membership determination.
•
In item 1, enter the Social Security number under which the claim is
filed, not a child's or widow's own account number.
•
In item 2, under “BIC”, enter the same two-character code
shown under the “MFT” column on the
Boyd folder alert. (See Attachment B, second
column.) If the “MFT” column is blank, the screener must not
make any entry under “BIC”.
•
In item 2, enter the date the case is screened.
•
In item 4, enter the screenout code if the responder is not a class
member. If the answer to any question in items 5 through 9 is
“no”, the responder is not a class member. The screenout
codes are listed in item 10.
•
Sign the original screening sheet and file it in the claim file.
Screeners in OHA Headquarters must send a copy of the screening sheet via
interoffice mail to:
Office of the Deputy Commissioner for Programs
Litigation
Staff
Attn: Boyd Coordinator
3-K-26 operations Building
Baltimore
HO screeners must mail a copy of the screening sheet to:
Office of the Deputy Commissioner for Programs Litigation
Staff
Attn: Boyd Coordinator P.O. Box 17729
Baltimore,
Maryland 21235
Litigation Staff will compile the screening sheet data and use this
information to generate reports as required by the court order.
C. Processing Cases Determined Not to be Class Members
Screeners must use Attachment D (title II claims) and Attachment E (title
XVI claims) to notify individuals that they are not class members. In
concurrent claims, screeners must send two separate notices. Screeners
must also send a copy of each notice to the responder's representative, if
any, and file a copy in the claim file.
Send all non-class member claim files to the Kansas City, Missouri field
office using the pre-addressed route slip in Attachment F. If there is a
subsequent class pending, photocopy any material contained in the prior
folder which is pertinent to the subsequent claim and place the copies in
the subsequent claim folder before shipping the non-class member folder to
the field office. After completing these actions, resume processing the
subsequent claim.
The Kansas City, Missouri field office will hold all non-class member
claim files for 120 days pending review by the plaintiffs' counsel and
will serve as a contact point for Class membership issues. Upon review of
the files, plaintiffs' counsel will contact the Office of the General
Counsel directly if there is any class membership dispute.
The district court will resolve any disputes that the parties are unable
to resolve. OHA personnel must refer any inquiries from claimants or
representatives concerning non-class membership determinations to DLAI at
the address shown on page seven.
D. Processing Cases Determined to be Class Members
1.
Hearing Office
After determining that an individual is a class member, HO personnel must
follow the instructions in section VI.B., below.
2.
Headquarters
After determining that an individual is a class member, Headquarters
personnel must follow the instructions in sections V1.A. or VI.C., below,
as appropriate.
VI. Processing and Adjudication
A. No Subsequent Claim Pending
If the 120-day retention period for holding the claim file after the ALJ's
or AC's action has expired, OCA must send the claim file to the DDS
servicing the claimant's current address (see Attachment G for a sample
route slip). If less than 120 days has elapsed, OCA must attach a
Boyd class member flag to the outside of the
combined folders (see Attachment H), to direct the case to the appropriate
DDS after expiration of the retention period. OCA must:
•
return unappealed ALJ affirmations and dismissals to DFB, and
•
return unappealed AC denials to the appropriate OAO mini-docket.
B. Subsequent Claim Pending at ALJ Level
1.
Request for Hearing Cases in Which a Hearing Has Been Scheduled or Held,
and All Remand Cases
If a Boyd class member has a request for hearing
pending on a subsequent claim and the ALJ has scheduled a hearing, the ALJ
must consolidate the Boyd review with action on the
subsequent claim. The ALJ must also consolidate claims if the
Boyd class member's subsequent claim is before the
ALJ on remand from the AC or a court.
The ALJ must not consolidate the claims if
•
the subsequent claim and the Boyd review claim have
no issues in common, or
•
a court remand contains a court-ordered time limit and it will not be
possible to meet the time limit if the claims are consolidated.
If the ALJ does not consolidate the claims, the HO staff must flag the
Boyd claim for DDS review after completion of all
administrative actions on the subsequent claim (see Attachment H).
If the Boyd review claim raises any additional
issues not raised by the subsequent claim, the ALJ must give proper notice
of the new issue(s) as required by
20 CFR §§
404.946(b) and
416.1446(b). If
the AL3 has already held a hearing and the Boyd
review claim raises additional issues, the ALJ must offer the claimant a
supplemental hearing unless the ALJ is prepared to issue a decision which
is wholly favorable with respect to the Boyd
claim.
Because the Boyd court order requires the Secretary
to reopen fully the claims of class members, the issue in a title II
Boyd review claim is whether the claimant was
disabled a any time from the alleged onset date through the present (or,
if the claimant is no longer insured, through the date the claimant last
met the insured status requirements). If a title II
Boyd claim involves an earlier alleged onset date
than the subsequent claim, the Boyd claim would
raise an additional issue of disability between the two alleged onset
dates. Similarly, consolidation of a title XVI Boyd
review claim with a subsequent title XVI claim will always raise a new
issue of disability between the dates the claims were filed.
In all instances, the ALJ must issue one decision which addresses both the
issues raised by the current request for hearing and those raised by the
Boyd review.
2.
Request for Hearing Cases — Hearing Not Scheduled
If a Boyd class member has a request for hearing
pending on a subsequent claim and the HO has not scheduled a hearing, the
ALJ must remand the subsequent claim to the DDS servicing the claimant's
current address for consolidation with the Boyd
review claim unless one of the exceptions listed below applies. The ALJ
must use the language in Attachment I to remand the claim to the DDS.
Attachment J is a covering notice transmitting the ALJ's remand
order.
The ALJ must not remand the subsequent claim if
•
the subsequent claim and the Boyd review claim have
no issues in common; or
•
the reason a hearing has not been scheduled is that the claimant has
waived his or her right to an oral hearing and the case is ready for a
decision; or
•
(the ALJ is prepared to act fully favorably on the subsequent claim.
If the ALJ does not remand for consolidation of the claims and does not
issue a decision which is wholly favorable with respect to all issues
raised by the Boyd claim, the HO staff must flag
the Boyd claim for DDS review after completion of
all administrative actions on the subsequent claim (Attachment H).
If the ALJ proposes to issue a fully favorable decision on the subsequent
claim, and this decision would be fully favorable with respect to all
issues raised by the application which makes the claimant a
Boyd class member, the ALJ must consolidate the
claims. The ALJ must reopen the final determination or decision on the
Boyd claim and issue a decision which considers
both applications. The ALJ's decision must clearly indicate that the ALJ
considered the Boyd claim pursuant to the
Boyd court order.
C. Subsequent Claim Pending at the AC
Disposition of the Boyd claim depends on the action
the AC takes on the subsequent claim. Therefore, OAO must keep the claim
files together until the AC completes its action on the subsequent claim.
The AC will act on the Boyd review claim as
follows.
1.
AC dismisses, denies review, or issues a denial decision
OAO staff must attach a Boyd flag (Attachment H) to
the combined folders of a class member. If the claimant does not file a
civil action, at the end of the retention period OAO staff will forward
both files to the DDS servicing the claimant's current address. If the
claimant does file a civil action, the Boyd flag
(Attachment H) directs the component with the claim file to forward it to
the servicing DDS after completion of court action.
2.
AC issues a favorable decision — no Boyd
issues remain
If the AC proposes to issue a fully favorable decision on a subsequent
claim, and this decision would-be fully favorable with respect to all
issues raised by the application which makes the claimant a
Boyd class member, the Council must consolidate the
claims. The AC must reopen the final determination or decision on the
Boyd claim and issue a decision which considers
both applications. The AC's decision must clearly indicate that the AC
considered the Boyd claim pursuant to the
Boyd court order.
3.
AC issues a favorable decision — Boyd issues
remain
If its decision is not fully favorable with respect to all issues raised
by the Boyd review claim, the AC must request the
effectuating component to forward the claim files to the DDS servicing the
claimant's current address after the AC's decision is effectuated. OAO
staff must include the following language on the transmittal sheet used to
forward the case for effectuation: “Boyd review needed —
forward both claim files to the ___________ DDS after
effectuation.”
4.
AC Remands
In its remand order, the AC must direct the ALJ to consolidate the
Boyd review with action on the subsequent
claim.
The AC must not direct the ALJ to consolidate the claim if
•
the subsequent claim and the Boyd review claim have
no issues in common, or
•
a court remand contains a court-ordered time limit and it will not be
possible to meet the time limit if the claims are consolidated.
D. OHA Adjudication of Class Member Claims
The following sections apply both to consolidation cases in which the AL3
or AC conducts the initial Boyd readjudication and
to DDS readjudication cases in which the claimant requests a hearing or AC
review.
1.
General Considerations
All decisions in Boyd class member claims, as well
as all other decisions within the jurisdiction of the Eighth Circuit, must
indicate that we have applied Polaski v. Bowen, 739
F.2d 1320 (8th Cir. 1984), when deciding claims involving allegations of
pain or other subjective complaints. The decision rationale must reflect
careful consideration of all pertinent facts in accordance with the pain
standard enunciated in Polaski.
Pursuant to the Boyd court order, we must fully
reopen the claim of each class member to determine whether the claimant
was disabled at any time from the date of onset alleged in the
Boyd review claim through the present (or, in title
II cases in which the claimant is no longer insured, through the date last
insured). Under the terms of the court order, the ALJ must ensure that the
medical record is fully documented for the entire period at issue, using
treating physicians when possible and employing consultative examiners
when necessary. The ALJ must fully elicit and consider the subjective
complaints of class members.
Except as noted herein, HOs and the AC must process
Boyd review claims according to all other current
adjudicatory practices and procedures including coding, scheduling,
developing evidence, adjudicating, routing, etc. The ALJ and the AC must
use current medical listings and other current criteria when adjudicating
class member claims.
2.
Effect of a Previously Decided Subsequent Claim
SSA may have made a final determination or decision on a subsequent claim
by a Boyd class member before the DDS or OHA
reopens and readjudicates the Boyd review claim.
Under the terms of the court order, SSA, in reopening and issuing new
determinations or decisions on Boyd review member
claims, must apply the normal rules, SSA, in reopening and issuing new
determinations or decisions on Boyd class member
claims, must apply the normal rules of administrative res
judicata as described in the regulations with respect to any
final determinations or decisions made after July 17, 1984.
Examples
A claimant received a March 1984 ALJ hearing decision which qualifies him
for Boyd relief. The ALJ's decision ruled on the
period from the alleged onset data in July 1982 through the date of the
decision in March 1984. The claimant filed a new application in August
1984, alleging the same onset date; a second ALJ considered the entire
period from the alleged onset date in July 1982 through the date of the
decision in July 1986. A third ALJ now has a request for hearing following
DDS action on the first claim pursuant to the Boyd
court order. If the claimant has submitted no additional evidence which
changes the facts of the case, and all other conditions res
judicata dismissal are present, the request for hearing on the
Boyd class member claim can be dismissed entirely
for res judicata because the entire period has
already been considered under the Polaski
standard.
If, instead, the second ALJ had dismissed the request for hearing with
respect to the issue of disability during the previously adjudicated
period from July 1982 through March 1984 on the basis of res
judicata, an ALJ currently conducting the
Boyd review must reopen the first claim and
consider the period from July 1982 to March 1984 because the second ALJ
did not issue a decision on the merits with respect to the period prior to
the March 1984 decision. However, the request for hearing with respect to
the issue of disability after March 1984 can be dismissed on the basis of
res judicata (if all other conditions for a
res judicata dismissal are present) because that
period has already been considered under the
Polaski standard.
3.
Substantial Gainful Activity Denials
The court order directs that no class member shall be denied benefits on
the-basis of substantial gainful activity unless the record conclusively
shows that the person actually engaged in substantial gainful activity for
the entire period of his or her alleged disability or for such a period as
would preclude him or her from establishing a 12-month period of
disability.
4.
Class Member is Deceased
If a class member is deceased, the usual survivor and substitute party
provisions and existing procedures for determining distribution of any
potential underpayment apply.
VII. Inquiries
HO personnel may call the Regional Office. Regional Office personnel may
call the Division of Field Practices and Procedures in the Office of the
Chief Administrative Law Judge on FTS 756-5022.
|
BOYD SCREENING SHEET
|
|
1.
|
SOCIAL SECURITY NUMBER
____ ____ ____ - ____ ____ - ____ ____ ____ ____
|
|
2. |
BIC
____ ____
|
DATE
____ ____ - ____ ____ - ____ ____
|
_ MEMBER(J)
_ NONMEMBER (F)
|
|
3. |
NAME
|
|
4. |
SCREENOUT CODE
_____ _____ (See Item 10 for screenout codes.)
|
|
5.
|
Was the responder a resident of the State of Missouri at the time of filing a claim.
|
____ YES ____ NO
(If No go to 10).
|
|
6.
|
Did the responder have a claim denied at any level of administrative review between 7/15/83 and 7/17/84 by Missouri DDS/OHA? For purpose of this class action, a denial includes a determination or dismissal based on res judicata).
|
____ YES ____ NO
(If No go to 10).
|
|
7.
|
Did any of the determinations or decisions made between 7/15/83 and 7/17/84 inclusive become final? (That is, there was not a determination or decision on the same claim made after 7/17/84, either as a result of any appeal or reopening.)
|
____ YES ____ NO
(If No go to 10).
|
|
8.
|
Were any of the determinations or decisions that meet the above requirements made on medical or medical-vocations grounds? (For res judicata caes was the determination or decision on the prior claim based on a medical or medical-vocational grounds?)
|
____ YES ____ NO
(If No go to 10).
|
|
9.
|
Did the responder allege pain or other subjective complaints e.g., shortness of breath, numbness, weakness, dizziness, nervousness, or my other problem that may not show up in x-rays, blood tests, or similar tests? (NOTE: If the responder did not make such allegations on the application, you must review the medical evidence of record for allegations. If there are such allegations in the medical evidence answer “Yes” to this question.)
|
____ YES ____ NO
(If No go to 10).
|
|
10.
|
IF ANY ANSWER IS 'NO' THE RESPONDER IS NOT A CLASS MEMBER. ENTER THE SCREEN OUT CODE IN ITEM 4 AS FOLLOWS:
ENTER 05 IF QUESTION 5 WAS ANSWERED 'NO'
ENTER 06 IF OUESTION 6 WAS ANSWERED 'NO'
ENTER 07 IF OUESTION 7 WAS ANSWERED 'NO'
ENTER 08 IF QUESTION 8 WAS ANSWERED 'NO'
ENTER 08 IF QUESTION @ WAS ANSWERED 'NO'
|
|
|
SIGNATURE OF REVIEWER
|
DATE
|
Attachment B. - Boyd Court Case Flag/Alert
BOYD
COURT CASE
FLAG/ALERT
SHIP-TO PSC MFT DOC ALERT
DATE DSTN
CD
X XX XXX XX-XX-XX X
FUN NAME
XXX-XX-XXXX _________________
SSN
OR RUN PESP
DTE TOE
XXX-XX-XXXX XX-XX-XX 840
FOLDER
LOCATION
INFORMATION
TITLE CFL CFL
DATE ACN PAYEE
ADDRESS
_____ XXX XX-XX-XX ____ _____________
_____________
_____________
Attachment C. - Boyd Case Flag For Screening
Potential Boyd Class Member
SCREENING
NECESSARY
Claimant's Name: __________________________________________
SSN: __________________________________________
State of Current Residence: _______________________________
After completion of court action, forward claim file(s) to the DDS
servicing the claimant's current address for screening.
If the claimant lives in Missouri, send files to:
Section of Vocational Rehabilitation
Disability
Determination Services
9140 Ward Parkway
Kansas
City, Missouri 64114
Attachment D. - Class Membership Denial Notice — Title II
Social Security Administration
Retirement, Survivors and Disability Insurance
Important Information
Date:
Claim Number:
This notice is about your Social Security disability benefits.
Read it carefully.
You asked us to review your case under the terms of the Boyd v.
Sullivan court decision. We have reviewed your case and have
decided that you are not a Boyd class member. This
means that we will not review our earlier decision to deny you benefits.
The reason you are not a class member under the
Boyd court order is checked below.
Why You Are Not A Class Member
You are not a Boyd class member because:
|
_________ |
Your residence was not in the State of Missouri.
|
|
_________ |
As a Missouri resident, you did not receive a decision denying you disability benefits at any administrative level between July l5, 1983 and July 17, 1984, inclusive.
|
|
_________ |
You appealed the decision denying you disability benefits, and the appeal was decided after July 17, 1984.
|
|
_________ |
Pain or other subjective complaints were not involved in your claim.
|
|
_________ |
Your benefits were denied for some reason other than your medical condition. The reason was
____________________________________________________
____________________________________________________
|
We Are Not Deciding If You Are Disabled
It is important for you to know that we are not making a decision about
whether you are disabled. We are deciding only that you are not a
Boyd class member.
If You Art Disabled Now
If you think you are disabled now, you should fill out a new application
at any Social Security office.
If You Have A Representative
If a representative is handling your Social Security claims and he or she
is identified in your record, we have sent a copy of this letter to him or
her. However, you might want to tell him or her about this letter
anyway.
If You Have Any Questions Or Disagree With This Determination
Call or visit any Social Security office. If you do not have a
representative, or if you disagree with the determination that you are not
a class member contact:
Legal Aid Of Western Missouri
600 Lathrop Building
1005
Grand Ave
Kansas City MO 64106-2216
(816)
474-6750
If you visit an office, please bring this letter with you. It will help to
answer your questions.
Attachment E. - Class Membership Denial Notice — Title XVI
Social Security Administration
Supplemental Security Income
Important Information
Date:
Claim Number:
This notice is about your Supplemental Security Income disability
payments. Read it carefully.
You asked us to review your case under the terns of the Boyd v. Sullivan
court decision. We have reviewed your case and have decided that you are
not a Boyd class member. This means that we will not review our earlier
decision to deny you payments. The reason you are not a class member under
the Boyd court order is checked below.
Why You Are Not A Class Member
You are not a Boyd class member because:
|
_________ |
Your residence was not in the State of Missouri.
|
|
_________ |
As a Missouri resident, you did not receive a decision denying you disability payments at any administrative level between July 15, 1983 and July 17, 1984, inclusive.
|
|
_________ |
You appealed the decision denying you disability payments and the appeal was decided after July 17, 1980.
|
|
_________ |
Pain or other subjective complaints next not involved in your claim.
|
|
_________ |
Your payments were denied for some reason other than your medical condition. The reason was
____________________________________________________
____________________________________________________
|
We Are Not Deciding If You Are Disabled
It is important for you to know that we are not making a decision about
whether you are disabled. We are deciding only that you are not a
Boyd class member.
If You Art Disabled Now
If you think you are disabled now, you should fill out a new application
at any Social Security office.
If You Have A Representative
If a representative is handling your Social Security claims and he or she
is identified in your record, we have sent a copy of this letter to him or
her. However, you might want to tell him or her about this letter
anyway.
If You Have Any Questions Or Disagree With This Determination
Call or visit any Social Security office. If you do not have a
representative, or if you disagree with the determination that you are not
a class member contact:
Legal Aid Of Western Missouri
600 Lathrop Building
1005
Grand Ave
Kansas City MO 64106-2216
(816)
474-6750
If you visit an office, please bring this letter with you. It will help to
answer your questions.
Attachment F. - Route Slip for Non-Class Member Cases
|
ROUTING AND TRANSMITTAL SLIP |
DATE: |
|
TO: (Name, office symbol, room number, building, Agency/Post) |
INITIALS |
DATE |
|
1. Social Security Office |
|
|
|
2. 1624 East 63rd St. |
|
|
|
3. Kansas City, MO 64110 |
|
|
|
4. Kansas City, Missouri |
|
|
|
5. |
|
|
|
XX |
ACTION |
|
FILE |
|
NOTE AND RETURN |
|
|
APPROVAL |
|
FOR CLEARANCE |
|
PER CONVERSATION |
|
|
AS REQUESTED |
|
FOR CORRECTION |
|
PREPARE REPLY |
|
|
CIRCULATE |
|
FOR YOUR INFORMATION |
|
SEE ME |
|
|
COMMENT |
|
INVESTIGATE |
|
SIGNATURE |
|
|
COORDINATION |
|
JUSTIFY |
|
|
REMARKS
BOYD CASE
Claimant: ___________________________
SSN: ________________________________
Please find attached:
___Title II Claim File ___Title XVI Claim File
We have determined that this claimant is not a Boyd class member. (See
screening sheet and copy of non-class membership notices in the claim
file.)
HOLD the claim file(s) for 120
days.
SEE POMS
DI 12532.015
Attachment
DO NOT use this form as a RECORD of
approvals, concurrences, disposals, clearances, and similar actions.
|
FROM: (Name, org, symbol, Agency/Post)
|
Room No. - Building
|
|
Phone Number
|
Attachment G. - Route Slip for Class Member Cases
|
ROUTING AND TRANSMITTAL SLIP |
DATE: |
|
TO: (Name, office symbol, room number, building, Agency/Post) |
INITIALS |
DATE |
|
1. Section of Vocational Rehabilitation |
|
|
|
2. Disability Determination Services |
|
|
|
3. 9140 Ward Parkway |
|
|
|
4. Kansas City, Missouri |
|
|
|
5. |
|
|
|
XX |
ACTION |
|
FILE |
|
NOTE AND RETURN |
|
|
APPROVAL |
|
FOR CLEARANCE |
|
PER CONVERSATION |
|
|
AS REQUESTED |
|
FOR CORRECTION |
|
PREPARE REPLY |
|
|
CIRCULATE |
|
FOR YOUR INFORMATION |
|
SEE ME |
|
|
COMMENT |
|
INVESTIGATE |
|
SIGNATURE |
|
|
COORDINATION |
|
JUSTIFY |
|
|
REMARKS
BOYD CASE
Claimant: ___________________________
SSN: ________________________________
Please find attached the class member claim file:
___Title II Claim File ___Title XVI Claim File
We have determined that this Missouri resident is a Boyd class member,
(See screening sheet in the claim file.)
Process this case in accordance with the instructions contained in POMS
DI 32532.015
ff.
Attachment
DO NOT use this form as a RECORD of
approvals, concurrences, disposals, clearances, and similar actions.
|
FROM: (Name, org, symbol, Agency/Post)
Office of Civil Actions
Office of Hearings and Appeals
|
Room No. - Building
|
|
Phone Number
|
Attachment H. - Boyd Class Member Flag (for reopening)
BOYD Class Member Case
BOYD REVIEW NECESSARY
Claimant's Name: ___________________________________________
SSN: ___________________________________________
State of current residence: _____________________________
This claimant is a Boyd class member. After
expiration of the retention period, forward the claim file(s) to the DDS
servicing the claimant's current address.
If the claimant has filed a civil action, forward the claim file(s) to the
servicing DDS after completion of court action.
If the claimant lives in Missouri, send files to:
Section of Vocational Rehabilitation
Disability
Determination Services
9140 Ward Parkway
Kansas
City, Missouri 64114
ORDER OF ADMINISTRATIVE LAW JUDGE
|
______________________________
|
______________________________
|
|
______________________________
|
______________________________
|
This case is before the Administrative Law Judge pursuant to a request for
hearing filed on ________________.
In accordance with an order of the United States District Court for the
Western District of Missouri in the case of Boyd, et al. v,
Bowen, the claimant has requested reopening and revision of
the final (determination/decision) on a
prior claim filed on _______________. Because the claimant's current claim
raises certain issues in common with the prior claim, this case is
remanded to the disability determination service for consolidation with
the prior claim.
Pursuant to the order of the court, the disability determination service
will reopen the determination which serves as the basis for class
membership and issue a consolidated determination on both claims.
The disability determination service will notify the claimant of its new
determination and of the claimant's right to file a new request for
hearing.
|
|
______________________________
|
|
|
Administrative Law Judge
|
Date:
Attachment J. - Notice Transmitting ALJ Order of Remand
Department of
HEALTH AND HUMAN SERVICES
Social Security
Administration
Office of Hearings and Appeals
Name and Address of Claimant
NOTICE OF ORDER OF ADMINISTRATIVE LAW JUDGE
Enclosed is my order remanding your case to the disability determination
service which makes disability determinations for the Social Security
Administration. Please read this notice and the order carefully.
What This Order Means
•
I have sent your current claim and your Boyd class member claim back to
the disability determination service. In the enclosed order, I explain why
I did this.
The Next Action on Your Claim
•
The disability determination service processing your claim will contact
you to tell you what you need to do.
•
If you do not hear from the disability determination service within 30
days, you may contact your local hearing office or your local Social
Security office. You may also contact either of these offices if you have
any questions.
This notice and enclosed order of remand
mailed __________________________
cc: Representative, if any
Social Security Office (City, State)