TN 4 (11-88)

GN 04040.020 Collateral Estoppel

A. Policy Principle

Collateral estoppel provides that an issuewhich has already been decidedin a previous determination or decision in a claim involving the same parties but arising under a different title of the Act or under the Federal Coal Mine Health and Safety Act, will not be considered againunless there are reasons to believe that it was wrong.

EXAMPLE:If a claimant is found disabled for title II, based on collateral estoppel, we will find him disabled for title XVI.

B. Operating Policy—When We Can Have Different Determinations Under Different Titles

  • If in processing the later claim on one title we discover that the determination on the earlier claim under a different title was incorrect, we do not have to adopt the erroneous determination when we process the new claim.

  • We can only change the incorrect determination on the first claim if it can be reopened and revised under the rules of administrative finality.

C. Operating Policy—Disability Determinations

1. WHEN COLLATERAL ESTOPPEL APPLIES

A prior title XVI disability determination or decision will be adopted in any new title II disability claim (and a prior title II disability determination or decision will be adopted in any new title XVI disability claim) provided:

  1. The same criteria are used; and

  2. The same period is involved; and

  3. There is no reason to question the prior determination (see DI 11010.120, DI 27505.001 and DI 27515.001 - DI 27515.050).

NOTE: Collateral estoppel of medical denials is not possible by field offices (see DI 11011.001).

2. ESTABLISHING EARLIER ONSET

The DDS or processing center may have to establish an earlier onset date in the title II determination, as an earlier onset date prior to the month of filing will generally not have been considered in the title XVI determination. (See DI 27505.001 and DI 27515.001 - DI 27515.050.)

D. Example

A claimant filed for RSI benefits. We established 1924 as her date of birth (DOB) and entitled her. She did not appeal the DOB. Two years later, when she filed for SSI aged benefits, she was denied at the initial and reconsideration levels because, based on a 1924 DOB, she was not age 65. However, the ALJ established 1923 as her DOB, which made her age 65. If the ALJ DOB decision was based on new and material evidence or if there was an error on the face of the evidence on the RSI claim, the processing center can reopen and revise the DOB in the RSI claim. However, if the ALJ decision was based on the same evidence which was used to establish the DOB in the RSI claim, the case should be referred to the AC since the ALJ decision violates the doctrine of collateral estoppel. The 1924 DOB in the RSI case would not be changed and would be used in the SSI claim.

E. Reference

See