Basic (01-01)

VB 02503.010 Administrative Law Judge Hearings Under Title VIII – Special Veterans Benefits — Process

A. Policy

1. Overview of the Hearing Process

An individual who is dissatisfied with one of the determinations or decisions in VB 02503.010A.2. may request a hearing before an Administrative Law Judge (ALJ). At the hearing, the individual may appear in person, submit new evidence, examine the evidence used in making the determination or decision or review, and present and question witnesses. If no oral hearing is held, the ALJ will make a decision based on evidence that is in the file and any new evidence that may have been submitted for consideration.

All title VIII requests for hearing will be handled by the Office of Disability Adjudication and Review (ODAR) San Francisco Regional Office, regardless of where the claimant lives (within the U.S. or abroad) or the issue(s) being appealed.

Qualification for and entitlement to SVB are two separate determinations. However, until an individual qualifies for SVB, SSA will not make a determination on entitlement. Appeal rights attach to each determination so that the individual may have the right to more than one hearing on the same application. (See VB 00901.000 ff. for procedures on adjudicating SVB claims.)

On actions to suspend, reduce, or terminate SVB, the individual has the right to advance notice before SSA implements the adverse action. The reconsideration notice provides 60 days from the date of receipt to file a request for hearing and for benefit continuation if the individual's requests is made within 10 days of the reconsideration notice (or later if “good cause” is established).

2. When to Hold a Hearing

An individual may request a hearing before an ALJ if SSA has made:

  • A reconsidered determination;

  • A reconsideration of a revised determination of an initial or reconsidered determination that involves a suspension, reduction, or termination of current benefits;

  • A revised initial determination or revised reconsidered determination that does not involve a suspension, reduction, or termination of benefits; or

  • A revised hearing decision based on evidence not included in the record on which the prior hearing decision was based.

3. Who May Request a Hearing

  • The individual or his or her authorized representative may request a hearing if the procedural prerequisites of VB 02503.010A.2. are met.

  • If the beneficiary is deceased and the issue is the existence, amount, or waiver of an overpayment for which his or her estate may be responsible, anyone authorized to act on behalf of the estate may pursue the request for hearing.

4. Issues Before the ALJ

a. General

The issues before the ALJ are all of the issues brought out in the initial, reconsidered, or revised determination that were not decided entirely in the individual's favor. However, if evidence is presented before or during the hearing that causes the ALJ to question an issue previously decided in the individual's favor, the ALJ will notify the individual that he or she will consider the issue in making his or her decision on the case.

b. New Issues

The ALJ may consider a new issue at the hearing if he or she notifies the individual about the new issue any time after receiving the hearing request and before mailing notice of the hearing decision.

Either the ALJ or the individual may raise a new issue. An issue may be raised even though it arose after the request for a hearing was filed and even though it has not been considered in an initial or reconsidered determination. A new issue that the ALJ decides is not an initial determination.

c. Notice of a New Issue

The ALJ will notify the individual if he or she will consider any new issue(s). If an oral hearing will be held, the ALJ will provide advance notice of the time and place of the hearing on the new issue(s), unless the individual has stated in writing that he or she does not wish to receive advance notice. If no oral hearing will be held, the ALJ will notify the individual that he or she plans to consider the new issue(s)and allow the individual time to provide additional evidence or pertinent legal argument addressing the new issue(s).

5. Effect of the ALJ's Decision

The ALJ's decision is binding unless:

  • The individual requests review of the decision by the Appeals Council (AC) within the stated time period and the AC decides to review the case; or

  • The individual requests AC review of the decision within the stated time period, the AC denies the request for review, and the individual seeks judicial review of the case by filing an action in Federal district court; or

  • The ALJ or AC reopens and revises the decision (see VB 02507.000);

  • The ALJ issued a recommended decision; or

  • The individual, with SSA's concurrence, uses the expedited appeals process; or

  • A Federal court remands the case and the AC assumes jurisdiction. (See VB 02504.010).

6. Where Hearings Are Held

SSA holds hearings within United States, which title VIII defines as the 50 States, the District of Columbia, and the Northern Mariana Islands.

For individuals residing outside the U.S., the ALJ will not schedule a hearing unless the individual tells us he or she wishes to appear. For individuals residing abroad who travel to the U.S. for a hearing, the hearing will be scheduled at the hearing office or remote hearing site nearest to the individual's port of entry into the U.S. There are no provisions in title VIII for SSA to pay travel expenses. Although SSA may pay for some travel expenses for individuals residing within the U.S. who have concurrent title II/title VIII or title XVI/title VIII claims, SSA does not pay travel expenses for individuals residing abroad.

B. Process

1. Notice of the Hearing

For an individual residing in the U.S., the ALJ will set the time and place of the hearing unless the individual has waived his or her right to a hearing. If a U.S. resident waives his or her right to a hearing, obtain an HA-4608, Waiver of Your Right to Personal Appearance Before an Administrative Law Judge.

When an oral hearing will be held, the Notice of Hearing will be mailed to the individual at his or her last know address, or given by personal service, unless the individual has waived in writing the right to receive notice. The notice will be mailed or served at least 20 days before the hearing and will contain:

  • A statement of the specific issues to be decided;

  • A statement informing the individual of the right to appoint a person to represent him or her if the individual is not already represented;

  • An explanation of the procedures for requesting a change in time or place of the hearing; and

  • A reminder that if the individual or his or her representative fail to appear at the scheduled hearing, and the ALJ does not find good cause for failure to appear, the ALJ may dismiss the hearing request.

2. Acknowledgment by Individual and/or Representative

If neither the individual nor his or her representative acknowledges receipt of the notice of hearing, hearing office staff will attempt to contact the individual or his or her representative for an explanation. If the individual or the representative says that the notice was not received, the hearing office will send an amended notice by certified mail. In limited circumstances, the hearing office may request FO assistance in attempting to contact the individual.

SSA considers a notice to be “received” if either the individual or the representative receives it.

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VB 02503.010 - Administrative Law Judge Hearings Under Title VIII – Special Veterans Benefits — Process - 08/13/2012
Batch run: 08/13/2012