TN 2 (08-08)

DI 81020.120 Subsequent Claim Filed While a Prior Claim or Appeal is Pending at the Appeals Council (AC)

NOTE: If a claimant files a new disability application and has a prior disability claim for the same title and benefit type pending at any level of administrative review, see DI 51501.001- Procedural Change for Subsequent Disability Applications Effective July 28, 2011. However, if the claimant has an appeal pending for a different title or benefit type, process a new disability application according to the following instructions, as applicable.

A. Overview

When a claim is pending at the AC level and an individual files a subsequent claim, whether under the same Title or different Titles, process the subsequent claim:

  • As a new initial claim or reconsideration claim; and

  • Under current claims processing procedures with normal appeals through the filing of a request for an Administrative Law Judge (ALJ) Hearing.

Version 14.0 of EDCS/eView/EFI allows for the electronic processing of a claim pending at the AC level and a new subsequent claim. If the DDS has the necessary case processing system upgrades and receives a new subsequent claim:

  • Receive an Electronic Folder Interface (EFI) download for a subsequent initial claim or reconsideration; and

  • Follow normal case receipt and assignment rules; see DI 81020.015 Electronic Claim Receipt Process.

B. Field office (FO) identifies subsequent claims

The FO is responsible for identifying subsequent claims by adding a “Subsequent Claim” flag to the Certified Electronic Folder (CEF). The CR annotates in the remarks on the “Subsequent Claim” flag:

  • The date the AC review was requested;

  • The Office of Appellate Operations (OAO) branch with jurisdiction of the ALJ decision; and

  • The remark “Claimant has filed a new application and has an appeal of an ALJ decision on a prior application pending at the Appeals Council. See CPMS Query.”

For the complete FO instructions in processing subsequent claims, see DI 81010.155 Processing Subsequent Claims or Appeals Filed While a Prior Claim or Appeal is Pending at the Appeals Council (AC).

C. DDS adjudication of subsequent claims

DDS adjudicates the subsequent claim per normal case processing procedures with specific instructions found in DI 20101.025F New Application Filed or Reconsideration Requested While Hearing, Appeals Council (AC) Review, or Court Action Pending on Prior Application.

1. Favorable determination on the subsequent claim

If the DDS can make a fully favorable or partially favorable determination on the subsequent claim:

  • Enter “onset restricted to MM/DD/YY, AC appeal on prior claim,” in item 34 of the SSA-831 (Disability Determination and Transmittal) unless using the actual onset date (see DI 20101.025F.2.a. New Application Filed or Reconsideration Requested While Hearing, Appeals Council [AC] Review, or Court Action Pending on Prior Application);

  • Add a message without an expiration date to the CEF stating “FAVORABLE – The FO should immediately send an email to the Office of the Appellate Operations (OAO) per DI 12045.027D.1.b. New Claim or Appeal Filed While a Prior Claim or Appeal is Pending Before the Appeals Council (AC) – Title II or Title XVI”; and

  • Return the claim to the servicing FO or Office of Quality Performance (OQR).

NOTE: If the DDS case processing system is at version 14.0, EFI automatically generates a message notifying the AC of the favorable determination, “A favorable determination was made on another case for this SSN (insert SSN).”

2. Unable to make a favorable determination on subsequent claim

If the DDS cannot make a favorable determination on the subsequent claim:

  • Prepare the determination in the usual manner, including the personalized disability notice (PDN);

  • Add a message without an expiration date to the CEF stating “UNFAVORABLE – Process any appeal request”; and

  • Return the claim to the servicing FO or OQR.

NOTE: The AC does not need to be alerted of unfavorable determinations on subsequent claims, therefore, no message is sent to the AC from the DDS.

D. DDS electronic processing issues applicable to subsequent claims

The AC takes action on a pending appeal while a subsequent claim is pending in the DDS or OQR. The following provides instructions for when the claim is or is not selected for OQR review and for the DDS case processing system versions.

1. AC appeal is remanded to the Hearing Office (HO) while the subsequent claim is pending at the DDS or OQR

If the AC appeal is remanded to the HO while a subsequent claim is pending at the DDS or OQR and the HO determines a common issue exists, the HO adds a message to the subsequent claim in eView advising the DDS to “Stop Processing Duplicate Claim.”

If the claim is not selected for OQR review is:

  • Close the claim with a No Determination (ND) with ND reason “Stopped Processing Duplicate Claim”; and

  • Return the claim to the servicing FO.

NOTE: EFI automatically adds a new document, SSA-5058 Subsequent Application Duplicate, to the red section of the electronic folder (EF), stating “Processing Stopped because the claim became a duplicate claim on (MM/DD/YYYY), at the request of the Appeal Council or Hearing Office.”

If the claim is selected for OQR review:

  • Annotate “Do Not Process” next to the SSA-831 in eView [see GN 04440.237 Determination Forms Technical Corrective Action (TCA)];

  • Close the claim with an ND with ND reason “Stopped Processing Duplicate Claim”; and

  • Send the claim to OQR or to the servicing FO.

A message is automatically posted to the Actions Page notifying the FO of the ND.

NOTE: EFI automatically adds an SSA-5058 to the red section of the EF stating, “Processing Stopped because the claim became a duplicate claim on (MM/DD/YYYY), at the request of the Appeals Council or Hearing Office.”

2. The AC makes a fully favorable decision on an appeal while the subsequent claim is pending at the DDS

If the AC makes a fully favorable decision on an appeal and a subsequent claim is pending at the DDS, a message is automatically sent to the subsequent claim notifying the DDS of the decision, “AC made a fully favorable decision on an earlier filed application for this SSN (insert SSN). Stop Processing Subsequent Application.”

If the claim is not selected for OQR review:

  • Close the claim with an ND with ND reason “Stopped Processing Duplicate Claim”; and

  • Return the claim to the servicing FO.

NOTE: EFI automatically adds an SSA-5058 to the red section of the EF stating, “Processing Stopped because the claim became a duplicate claim on (MM/DD/YYYY), at the request of the Appeals Council or Hearing Office.”

If the claim is selected for OQR review:

  • Annotate “Do Not Process” next to the SSA-831 in eView [see GN 04440.237 Determination Forms Technical Corrective Action (TCA)];

  • Close the claim with an ND with ND reason “Stopped Processing Duplicate Claim”;

  • Send the claim to OQR or to the servicing FO.

NOTE: EFI automatically adds an SSA-5058 to the red section of the EF stating, “Processing Stopped because the claim became a duplicate claim on (MM/DD/YYYY), at the request of the Appeals Council or Hearing Office.”

3. The AC makes a partially favorable decision on an appeal while the subsequent claim is pending at the DDS

If the AC makes a partially favorable decision on an appeal and a subsequent claim is pending at the DDS, a message is automatically sent to the subsequent claim notifying the DDS of the decision, “AC made a (insert decision) on an earlier filed application for this SSN (insert SSN).”

If the established onset date (EOD) in the AC decision is earlier than the alleged onset date in the subsequent claim pending at the DDS:

  • Prepare a fully favorable determination; and

  • Send the claim to OQR or to the servicing FO.

If the EOD in the AC decision is later than the alleged onset date in the subsequent claim:

  • Continue current case processing;

  • Review the AC decision and determine what issues, if any, remain to be resolved with respect to the subsequent claim;

  • Prepare a determination; and

  • Send the claim to OQR or to the servicing FO.

If the AC decision is a closed period allowance:

  • Continue current case processing;

  • Review the AC decision and determine what issues, if any, remain to be resolved with respect to the subsequent claim or what effect the AC’s decision has on the pending claim;

  • Prepare a determination; and

  • Send the claim to OQR or to the servicing FO.

4. The AC makes an unfavorable decision on an appeal while the subsequent claim is pending at the DDS

If the AC makes a decision to dismiss or to deny an appeal when a subsequent claim is pending at the DDS, a message is automatically sent to the subsequent claim notifying the DDS of the decision, “AC made a (insert decision) on an earlier filed application for this SSN (insert SSN)”:

  • Continue current case processing;

  • Prepare a determination; and

  • Send the claim to OQR or to the servicing FO.

5. The AC makes a favorable decision on an appeal while an informal remand (IR) subsequent claim is pending at the DDS

If the AC makes a favorable decision on an appeal while an IR subsequent claim is pending at the DDS and the DDS case processing system is at version 14.0, a message is automatically sent to the subsequent claim notifying the DDS of the decision, “AC made a fully favorable decision on an earlier filed application for this SSN (insert SSN). Stop Processing Duplicate Application”:

  • Close the claim with a ND, with ND reason “Hearing Office Recalls Claim (HORC)”; and

  • Return the claim to the originating HO that requested the IR.


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DI 81020.120 - Subsequent Claim Filed While a Prior Claim or Appeal is Pending at the Appeals Council (AC) - 01/25/2017
Batch run: 01/25/2017
Rev:01/25/2017