TN 12 (07-08)

DI 27520.030 Conflicting Determinations or Decisions in Disability/Blindness Common Issue Claims

A. Introduction

The Disability Determination Services (DDS) has primary responsibility for resolving conflicting determinations in common issue claims. For example, if the DDS discovers an error made on an initial claim while attempting to adopt the decision for another title, the DDS would resolve onset issues associated with the claims.

This concurs with the policy on adoption of prior claims and refilings for the same period per “Collateral Estoppel – General” DI 27515.001 and “Refilings for the Same Period (Res Judicata Cases” DI 27516.001.

B. Operating Policy

1. Determinations on Both Claims Were Made by the DDS at Initial or Reconsideration Level

The DDS must resolve the determinations. Apply the Rules for Reopening DI 27505.000 and Due Process DI 27525.000 in reopening and reversal situations.

EXCEPTION: DDS issues a favorable reconsidered determination on one title and an unfavorable initial or revised initial determination on the other title. If the DDS finds a favorable determination to be erroneous, the Disability Hearing Officer (DHO) resolves the conflict.

NOTE: In the event two DDSs are involved, the DDS that made the most recent determination maintains jurisdiction in resolving the conflict.

2. Determination or Decision on One Claim Made at the DHO, Administrative Law Judge (ALJ), or Appeals Council (AC) Level

If the claimant does not provide new and material evidence, the DDS gives priority to the determination made at the higher level and prepares a revised determination. Identify the conflict and show the reasons for referral on the SSA-408 (Route Slip).

a. Exceptions

Use the following guidelines for exceptions to this rule (for additional information, see “Good Cause for Reopening” DI 27505.010B.2.b.):

  • IF the DDS issued a favorable reconsidered determination on one title, and DHO issued an unfavorable determination on the other title, then the DHO is responsible for resolving the conflict.

  • IF the DDS issued a favorable reconsidered determination on one title and the ALJ or AC issued an unfavorable decision on the other title, then the ALJ or AC is responsible for resolving the conflict. If this situation arises, forward the claims to Office of Disability Adjudication and Review’s (ODAR) per instructions in “How to Protest ALJ Decisions” GN 03103.260, “Processing Appeals Council (AC) Decisions — Title II or Title XVI” GN 03104.400B.4., and “Questionable SSI Hearing Decisions” SI 04030.060.

  • IF the DDS issued a favorable initial or revised initial determination on one title and the ALJ or AC issued an unfavorable determination on the other title, then the ALJ or AC is responsible for resolving the conflict. If this situation arises, forward the claims to ODAR per instructions in “Processing Appeals Council (AC) Decisions — Title II or Title XVI” GN 03104.400B.4., and “Questionable SSI Hearing Decisions” SI 04030.060.

b. New and Material Evidence

If there is new and material evidence, which was not available to the DHO, ALJ or AC, take the following actions:

  • Route conflicting DDS-DHO determinations to the Disability Hearing Unit (DHU).

  • Route conflicting DDS-ALJ (or AC) decisions to the Assistant Regional Commissioner, Management and Operations Support (ARC, MOS) if the ALJ (or AC) decision was favorable. The ARC, MOS will coordinate with the ODAR Regional Office, or as necessary through the Office of Disability (OD) with the ODAR Central Office, as to which component (DDS or ODAR) should resolve the decisions.

  • Route conflicting DDS - ALJ (or AC), decisions to ODAR per instructions in “Processing Appeals Council (AC) Decisions — Title II or Title XVI” GN 03104.400B.4., and “Questionable SSI Hearing Decisions” SI 04030.060 if the ALJ (AC) decision was unfavorable.

3. Pending DHO Hearing on Either Claim

If the DDS has made a favorable initial or reconsideration determination on one claim and the claimant requests a DHO hearing on a less favorable determination on another claim, the DHO is responsible for resolving the conflict. When this occurs:

  • The DDS phones the DHU or ODAR