Basic (01-01)

VB 02503.040 The SVB Hearing Decision

A. Policy — Fully Favorable Decision Without Hearing

If the evidence in the hearing record supports a decision in favor of the individual on every issue, the ALJ may issue a decision without oral hearing. Even when a fully favorable decision is issued, the notice of decision will inform the individual of his or her right to appear at a hearing and to examine the evidence on which the ALJ based the decision.

The determination as to whether an individual is qualified for SVB and whether he or she is entitled to SVB will, if the individual resides in the U.S., are two separate determinations. Until an individual qualifies for SVB, the determination on entitlement (residence outside the U.S. within four calendar months of being notified that he or she qualifies for SVB payments) is not made. Appeal rights attach to each determination, so that the individual may have the right to more than one hearing on the same application.

B. Policy — After The Hearing

1. Distribution After Hearing

Unless the hearing request is withdrawn or dismissed, the ALJ will usually make a decision or, if appropriate, send a recommended decision to the AC after the hearing. Depending on the component having jurisdiction for the SVB claim (i.e., FO or CPS), the ALJ will return the claims folder, with a copy of the favorable decision, to that component for appropriate action (see VB 00901.015).

2. Favorable Hearing Decision — Reopening of Prior Determination or ALJ Decision

If the individual has received an unfavorable determination or decision on a prior application and the ALJ decides to rule favorably on the current application, the ALJ may reopen and revise the prior determination or decision subject to the rules of administrative finality. However, the ALJ may issue a favorable decision on a current application but inadvertently not reopen a prior denial.

During the effectuation, the existence of all the following conditions will require reopening and revising the denial of a prior SVB determination on an application or reduction, suspension or termination of SVB:

  • The ALJ establishes that a factor of eligibility was met continuously on or before the date of the prior initial denial notice; and

  • The prior denial and the current hearing decision involve the same factor of qualification and/or eligibility; and

  • In the decision on the current application, the ALJ did not state t hat he or she was not reopening the prior denial; and

  • There is no AC or court decision on the prior denial (only the AC or the court can reopen a decision issued at that level of appeal); and

  • The date of initial denial notice for the prior application is within 2 years before the date the individual filed the subsequent application.

3. Favorable Hearing Decision — Reopening When There Are Intervening Months of Nonpayment

a. Nonappealed Issue

For factors of qualification and/or entitlement other than the issue(s) appealed, the individual need not be entitled to SVB in every month since the date of the prior application.

b. Appealed Issue

The ALJ's decision may indicate entitlement on or earlier than the date of the prior denial. However, other evidence may indicate the individual is not entitled for one or more month(s), between the date of the prior application and the date of the current application.

In this case, the prior denial must not be reopened since the criterion in VB 02503.040B.2. (a factor of entitlement must be met continuously on or before the date of the prior initial denial notice) is not established. The ALJ or the Appeals Council must review and reopen the ALJ's decision, as appropriate.

4. Favorable Hearing Decision — ALJ Reopens Prior Denial

a. 2-Year Rule

If the ALJ reopens a prior denial made more than 2 years before the current application, the resulting ALJ decision is final if it is not appealed timely or if the AC does not review on its own motion. The hearing decisions in such cases must be effectuated.

b. AC “Own Motion” Review

To review a decision on its “own motion”, the AC must decide to review the decision within 60 days after the date of the hearing decision. Therefore, any case in which it appears the ALJ may have erroneously reopened a prior application or post-entitlement issue, the case should be referred to the AC as quickly as possible, following the procedures in VB 02504.000 ff.

C. Procedure

1. Effectuating Hearing Decisions

a. Read the entire ALJ decision to determine if the individual's payment status should be changed or adjustments should be made, including whether continuing payments should be terminated.

b. If the decision is on a post-entitlement issue, query the system for payment status and make any required systems updates.

NOTE: It is important to post the information to the SVB Intranet site and make all appropriate systems inputs when effectuating any ALJ decision.

2. Effectuating Affirmations and Dismissals

The ALJ will send either the appropriate notice (decision or dismissal order) to the individual. No FO action is necessary.

NOTE: In denial decisions and dismissal, the HO will send the folder to ODAR Headquarters to hold pending possible receipt of a request for review.

3. Favorable Hearing Decision — Request For AC Review

FO Discovers ALJ Decision Improperly Reopening Prior Denial

Follow the procedures in SI 04030.050C.8. when an ALJ decision improperly reopens a prior denial.

4. Notice to Individual of Action on ALJ Decision

Prepare and send an award notice using an SSA-L8165-U2 (Important Information). See POMS NL 00802.010 through NL 00802.015 for instructions on preparing an award notice. Also, see the SVB initial notices menu of the Field Office Notice Software (FONS) for model language.

5. Individual Dissatisfied With ALJ Decision

  • If the individual expresses dissatisfaction with the decision in a letter, send the letter to the AC after preparing an HA-520-U6 (Request for Review of Hearing Decision/Order) (see GN 03104.300 and SI 04040.020C.6. for instructions on completing Form HA-520-U6). Until a revised HA-520-U6, which includes title VIII, is issued, annotate the form to show ”SVB or” title VIII”.

  • If the individual orally expresses dissatisfaction with the ALJ's decision, find out if he or she wants an AC review. If so, assist him or her in completing an HA-520-U6 and send the completed form with any material obtained to the AC. (See SI 04040.020 C., Exhibit 9 for instructions.)

6. Additional Information and Evidence Received After Hearing

Evaluate new information received in the FO after a hearing decision.

a. If the Evidence is Pertinent and Bears on the Same Issue and Period Ruled on By the ALJ

Forward to the ALJ if:

  • No request for AC review of the ALJ's decision was filed and the AC did not review the decision on its own motion; or

  • A request for review was filed but the AC dismissed it for any reason other than the death of the individual; or

  • A request for review was filed but the AC denied it and the 60-day period for filing a civil action has expired; or

  • The ALJ dismissed the hearing request, the dismissal has not been vacated, and material relates to the reason for dismissal.

Forward the entire folder, including the new evidence, to the AC if:

  • It issued the decision; or

  • It dismissed a request for review because of the death of the individual; or

  • It denied a request for review but the 60-day period for filing a civil action has not expired; or

  • The individual or representative is filing a civil action after the 60-day time limit and brings or sends to the FO information and a statement to establish good cause for late filing.

b. The Material is Substantive But Does Not Bear On the Issues Decided By the ALJ

Evaluate the evidence and determine the appropriate action (e.g., redetermination, notification for payment suspension, etc.).

c. The Material is Extraneous or Duplicative

Associate it with the folder.

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VB 02503.040 - The SVB Hearing Decision - 08/13/2012
Batch run: 08/13/2012