DI SF11005.085 Prior Claims Activity (TN 81 — 06/2011)

A. Policy

In the San Francisco Region, the Chavez Acquiescence Ruling (AR) requires special Field Office (FO) actions when a claimant files a new disability application. The special actions provide the Disability Determination Services (DDS) with the necessary information to determine if the Chavez AR applies to the current claim.

The Chavez AR applies when there was a prior final Administrative Law Judge (ALJ) or Appeals Council (AC) denial, or a partially favorable decision on the claimant’s previous claim under the same title of the Act. The Chavez AR does not cover fully favorable, withdrawal, abandonment, and other dismissal decisions. There is no limit as to how much time may have elapsed since the last ALJ/AC decision.

B. Procedure

1. Folder Documentation

  1. a. 

    Document OHO Queries

    To provide the DDS with sufficient prior claims activity to determine if the Chavez AR applies, it is regional policy that the FO obtain copies of the Office of Hearings and Appeals Query (OHAQ) and the Case Processing Management System (CPMS) queries on every initial application for disability benefits (DIB, DWB, CDB, and SSI).

    Both the OHAQ and the CPMS query must be included in the disability folder prior to sending the case to the DDS. An OHAQ may be available for ALJ/AC decisions before and after the implementation of CPMS.

    Following instructions below, please include copies of OHAQ/CPMS queries in the Disability Related Development (blue) section of the electronic folder (EF) via an SSA-5002 for certified electronic folder (CEF) cases.

    • For OHAQ query:

      • Select the ODAR DATA INPUTS/QUERIES (#17) from the SSA MAIN MENU in PCOM. On the next screen (OHAM), select OHAQ (#1). On the OHAQ screen complete the selection for Hearing (#2) and enter. Once you receive a reply, choose “Select All" from the edit dropdown menu, and then select Copy. For additional pages, use Copy Append from the edit dropdown menu.

      • Create an SSA-5002 using UniForms in EDCS. Enter a subject of either “OHAQ No Report” or “OHAQ decision dated MM/DD/YYYY”. Place your cursor on the blank subject area of the 5002 and use [Ctrl]-V or select “Paste” from the menu. The OHAQ will appear on the body of the SSA-5002.

      • Use the “Send Form to EF” button at the top to send the SSA-5002 to the EF. Wait for the acknowledgment of the SSA-5002. You can check the Case Documents display in eView to see if your SSA-5002 is received. It may be queued as an Outstanding Request (check the bottom button on the Case Documents page).

    • For CPMS query:

      • Open CPMS, click “Find a Case,” and enter the SSN on the next screen. If the case is NIF, type “CPMS NIF” on the SSA-5002 you will create in EDCS.

      • If the result shows prior claims activity, select the link to Print on the upper right corner. On the Print Popup screen, select “Microsoft Print to PDF” to create a PDF file of the results. Use eFax or an SSA-5002 barcode to fax the PDF file into eView. Enter a remark, “Prior OHO/AC decision dated MM/DD/YYYY.”

    • For EDCS exclusions or if the official folder is paper, print the OHAQ and CPMS queries and include in the blue section of the paper file before sending to the DDS.

    • If the queries indicate a prior OHO decision, please follow DI SF11005.085B.2 to request the prior folder, if the prior folder is not a CEF.

  2. b. 

    Documenting Prior Claims Activity

    The FO should also document any prior claims activity on the SSA-3367 in EDCS. The FO can use the remarks section of the SSA-3367 if additional space is needed.

    Please annotate the prior folder information in the remarks section, such as,

    • “Prior file attached,” or

    • “Prior folder requested on MM/DD/YY – will be forwarded upon receipt,” or

    • “Prior folder not located, copy of decision attached (or will be forwarded upon receipt),” or

    • “Prior folder CEF,” or

    • “Prior folder not located - copy of decision not obtainable.”

2. Requesting Prior Files

When the prior folder is officially a paper folder, and there is a prior ALJ or AC denial or partially favorable decision, the FO must obtain the prior folder. This does not apply to CEF cases.

To determine if the prior folder is available for request, and for instructions on where to request the prior folder, follow the table in DI 11005085B.6. The T2Fld and T16Fld macros included in Query Master and PCOM toolbars can be used locate and request the prior folder.

3. Forwarding Paper Folders to the DDS

  1. The FO must forward both the prior paper folder and the current claim to DDS under the cover of the Court Case flag, see SF 11005.085B.4. If the prior folder is unavailable, the FO must obtain a copy of the ALJ or AC decision. A copy of the ALJ/AC decision may be available in CPMS from the Central Print Summary link within the case Query, or in the Claims File User Interface (CFUI) or eView, if an electronic repository was created for the case. If records of the prior ALJ/AC decisions are not available, contact the claimant, their attorney or authorized representative, or OHO to see if the prior decision can be obtained. If the claimant or his or her attorney or authorized representative cannot provide a copy of the decision, document this in the remarks section of the SSA-3367.

    For AC decisions, the FO should determine if the decision is substantive or merely a decision declining to review the case. If the AC declined to review the ALJ decision, the FO should forward the ALJ decision to DDS.

    It is not necessary to hold the current claim for 30 days while attempting to locate the prior paper folder. However, the FO must document all attempts to locate prior folders on the SSA-3367 and on the Court Case Flag in EDCS.

4. Court Case Flag

Use the Court Case Flag in EDCS to alert the DDS of the Chavez AR situation. EDCS does not have region-specific case flags, such as a flag specifically for the Chavez AR. In the remarks section of the flag enter, “Chavez Case - ALJ (or AC) decision dated MM/DD/YYYY”.

By completing the EDCS Court Case Flag, this information will download into the DDS system and will be viewable in the EF.

For EDCS exclusions, attach a copy of the Chavez flag below along with the SSA-408 Routing Transmittal before sending to the DDS.

5. Chavez screening guide (SSA-509)

The purpose of the screening guide is to help FOs identify Chavez AR cases and allow the DDS to begin appropriate development. Use of the SSA-509 is optional; but it is strongly recommended to determine Chavez applicability. The SSA-509 is available in Uniforms through EDCS.

6. Pending Appeals

For new claims filed while there is a pending appeal in file, consider if SSR 11-1p applies. If a new subsequent claim is under the same title and same benefit type as the pending appeal, follow DI 51051.005.

If SSR 11-1p does not apply, e.g., the new subsequent claim is a different title or different benefit type from the pending appeal, follow DI SF11005.085B to include OHO queries with every new claim filing before sending the case to the DDS or OHO.

For prior paper folders, the appeal office should have requested the folder, and there is no need to request the folder for cases with pending appeals.

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DI SF11005.085 - Prior Claims Activity (TN 81 — 06/2011) - 03/13/2023
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