Last Update: 2015-07-27 TN-012-145)

HA 01290.006 Administrative Law Judge Believes Claimant Is Disabled During Time Adjudicated in Appeals Council Decision

When, during a current case adjudication, an administrative law judge (ALJ) believes new evidence establishes the claimant was disabled during a time period adjudicated in a prior Appeals Council (AC) decision, the ALJ's action in the current claim will depend on whether the time period for reopening the prior decision has expired. For information about computing the time period for reopening, see Hearings, Appeals and Litigation Law (HALLEX) manual HA 01290.020.

If the time period for reopening has expired, the ALJ will include the following information in the decision:

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  The claimant is disabled as of the date established by the evidence, but is only entitled to benefits based on the current application; and

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  If the claimant explicitly requested reopening (see HALLEX HA 01290.010A), an explanation of why reopening is not possible.

If the time period for reopening has not expired, the ALJ will:

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  Issue a decision finding the claimant disabled as of the day after the date of the AC decision, and find entitlement based on the current application only;

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  State in the decision that the AC decision on the prior application is final and binding; and

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  Email Adjudication Practices and Procedures (APP) in Disability Compliance at |||DA DICompliance APP explaining the situation. The email should indicate whether any of the involved claim(s) is non-electronic. However, no paper folders will be forwarded to the Appeals Council unless specifically requested.

When warranted, APP will immediately notify the AC at ^DA ApplsReqReview General and request that the AC consider reopening its decision.