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

A. Policy

The Chavez Acquiescence Ruling requires special field office (FO) actions when a claimant files a new disability application and the Administrative Law Judge (ALJ) or Appeals Council (AC) denied or made a partially favorable decision on the claimant's previous claim under the same title of the Act. The Chavez ruling 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

It is regional policy that the FO will obtain Office of Disability Adjudication Review (ODAR) queries, Case Processing and Management System (CPMS) and Office of Hearings and Appeals Query (OHAQ) on every initial application for disability benefits (DIB, DWB, CDB, and SSI). A copy of ODAR queries must be in the file the FO sends to Disability Determination Services (DDS). It is the FO's responsibility to determine if the individual currently filing a claim has previously filed for any type of SSA benefit. The FO must document any prior claims activity, or the lack of any prior claims activity, in every claim sent to DDS. This documentation must be included on the prior filing section of the SSA-3367. The field office 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”. The FO must include a copy of CPMS and OHAQ queries in the Disability Related Development (blue) section of the electronic folder (EF) on an SSA-5002. If CPMS or the OHAQ query indicates a prior ODAR decision, please follow DI SF11005.085B.2 for additional Chavez instructions. For EDCS exclusions, include the printed ODAR queries in the paper file sent to DDS.

To add a remark to the SSA-5002, follow these instructions:

1. 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.

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

   Create an SSA-5002 using eForms in EDCS. Enter a subject of either “ODAR No Report” or “ODAR decision dated MM/DD/CCYY”. Place your cursor on the blank subject area of the 5002 and use [Ctrl]-V or select “Paste” from the menu. The OHAQ query will appear on the body of the SSA-5002. If CPMS has appeals listed that are not in the OHAQ query, you must type the decision information (claim(s) title, date, and disposition) on the SSA-5002. This information should be on the same SSA-5002 as the OHAQ.

3. Use the EF button at the top to send the SSA-5002 to the electronic folder. Wait for the acknowledgment of the SSA-5002. You can check the Case Documents display in eView to see if your SSA-5002 arrived. It may be queued as an Outstanding Request (check the bottom button on the Case Documents page).

2. Requesting Prior Files

Whenever there is a prior ALJ or AC denial or partially favorable decision, the FO must obtain the prior folder from most locations. A complete review of all queries is necessary to determine the correct location of any prior file. Files should not be requested from ODAR locations 5012, 5017, nor from AC locations 5801-5824 (DI 11005.085B.7). The Automated Folder Location website is a good source of information about the prior folder(s).

3. Forwarding Files to the DDS

1. The FO must forward both the prior file and the current claim to DDS under cover of the Chavez flag. See DI 81010.085 if the prior file is paper MDF and the current file is EDCS. If the prior file is unavailable, the FO must obtain a copy of the ALJ or AC decision from the claimant or his or her attorney or authorized representative, or ODAR, and forward to the DDS with the current claim under cover of the Chavez flag. If the claimant or his or her attorney or authorized representative cannot provide a copy of the decision, document this in the remarks of the SSA-3367.

2. For AC decisions, the FO must 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 must forward the ALJ decision to DDS.

3. It is not necessary to hold the current claim for 30 days while attempting to locate the prior file, since the search for prior folders can usually be determined in a shorter, more reasonable period. However, the FO must document all attempts to locate prior folders on the SSA-3367 and on the Court Case Flag. Within 30 days, use EDCS update after transfer (UAT) to advise the DDS of your folder search results. (DI 81010.095). Notify DDS using local procedures for EDCS exclusions.

4. Chavez Flag

Use the EDCS Court Case Flag to alert the DDS of the Chavez AR situation. In the remarks section of the flag enter, “Chavez Case - ALJ (or AC) decision dated MM/DD/CCYY”.

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

For EDCS exclusions, attach a copy of the Chavez Flag to the file sent 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 as an eForm through EDCS.

6. Pending Appeals

If an appeal on the prior application is still pending in SSA at the Appeals Council, or in court, do not apply Chavez.

If the appeal is at the AC level, the FO will treat the subsequent claim as a new initial claim and send it to DDS with documentation on the SSA-3367 regarding the pending claim. Notify DDS if the AC or court dismisses or denies the request for review while the subsequent claim is pending at DDS. (DI 12045.027)

If the appeal of a prior disability claim is pending in court, annotate the SSA-3367 with the prior filing information and forward the new claim to DDS. DDS will adjudicate the new claim on its own merits unless it merely duplicates the prior claim, e.g., a title II claim in which the date last insured expired before the ALJ/AC decision on the prior application. (GN 03106.090)