TN 13 (11-11)
GN 01010.800 Resolving Policy and Legal Issues in Adjudication
A. Background on resolving policy and legal issues
The Social Security Act as amended, Regulations, Social Security Rulings (SSR), and the POMS provide the basic guides for adjudication and review of Social Security claims. Policy and legal issues that arise in the adjudication process are usually resolved by reference to POMS guidelines. Issues not addressed in POMS are resolved through use of SSA's precedent process or SSA's policy resolution process.
1. Precedents of General Applicability
SSRs are policy statements relating to the programs administered by SSA and published under the authority of the Commissioner of Social Security. An SSR is a precedential decision made available to adjudicators and the public or provides an interpretation of current policy. SSRs may be based on case decisions made at all administrative levels of adjudication, federal court decisions, Commissioner's decisions, office of general counsel (OGC ) opinions, and policy interpretations of the law and regulations.
Although SSRs do not have the same force and effect as the statute or regulations, they are binding on all components of the Social Security Administration, in accordance with 20 CFR 402.35(b), and are to be relied upon as precedents in adjudicating cases, unless superseded, rescinded, or modified by another ruling.
SSRs are effective upon publication in the Federal Register , unless otherwise mentioned in the SSR.
2. Precedents of Regional Applicability
An Acquiescence Ruling (AR) is also a precedential policy interpretation published in the “Notices” Section of the Federal Register. ARs are also effective upon publication and binding unless superseded, rescinded or modified. An AR explains how we apply the holding of a United States Court of Appeals to adjudication of claims within that judicial circuit when the holding of the court is at variance with our national policies interpreting the federal law. An AR is only binding within the applicable judicial circuit(s).
3. Precedents of Fact
Precedents of fact are decisions made on a factual issue by the field office (FO) on a previously filed claim, which may be used as a precedent decision on subsequent claims requiring determinations on substantially the same factual situation. See GN 01010.805.
4. Legal Precedent Opinions
Legal precedent opinions interpret or clarify a principle of law to advise SSA as to how the relevant law would probably be interpreted by the courts in a particular factual situation. See GN 01010.810.
OGC may provide a legal opinion on questions regarding either Federal laws or the laws of foreign countries.
Regional Chief Counsels (RCCs) may provide a legal opinion interpreting the laws of the States within a respective region to resolve issues relating to coverage, initial SSA or SSI eligibility and continuing entitlement.
5. Change of position (COP)
COP occurs when a policy, precedent or statutory requirement changes because of subsequent court decisions, legislation, precedents or new policy considerations.
Before adjudicating the claim, fully document the file with the effect of the COP in reference to the new claim. Include any specific information or limitations on retroactivity.
C. Documentation requirements
The adjudicator is responsible for documenting the claim with all the required information when adjudicating a claim involving a precedent of fact or SSR. Formal determinations are required to cite authority in the Act or regulations along with details of facts that lead to the conclusion. Refer to GN 01010.365 for formal determinations instructions.
GN 01010.365 Formal and Informal Determinations – Adjudication
GN 01010.375 Payment Center (PC) Responsibilities in Preparing or Reviewing Special Determinations
GN 04001.001 Reopening – General Statement
GN 04001.100 Reopening – Change in Ruling or Legal interpretation – Change of position