ISSUED: June 24, 1987
This temporary instruction (TI) applies only to cases involving persons
residing in Massachusetts. It is being issued nationally for informational
purposes only.
I. Background
HA 01540.021 dated
September 3, 1986, described the order issued on July 17, 1986 by the U.S.
Circuit Court of Appeals for the First Circuit in the
McDonald case. The circuit court reversed the
district court's decision of December 19, 1985 insofar as it enjoined the
Secretary from applying the “not severe” regulations.
However, the circuit court upheld the district court's supplemental order,
issued on March 10, 1986, requiring the Secretary to consider the combined
effect of multiple nonsevere impairments when readjudicating claims of
class members who received final decisions of the Secretary prior to
December 1, 1984. This TI sets out procedures for readjudicating cases
under the McDonald court order. SSA will
readjudicate the claims of all class members who exhausted their
administrative remedies and who were denied benefits based on the policy
of not considering the combined effects of multiple nonsevere impairments
(the policy which was in effect through November 30, 1984).
II. Definition of Class
For purposes of this TI, the McDonald class
consists of Massachusetts title II and title XVI disability claimants who
were denied benefits because they did not have a severe impairment(s)
and:
a.
who exhausted their administrative remedies (i.e., had an AC decision or
AC denial of the request for review of an ALJ decision) between 6/28/84
and 11/30/84; and
b.
whose claims were denied without consideration of the combined effect of
multiple nonsevere impairments.
III. Implementation of Court Order
A. Identification of Class Members
Identification of the class members began January 5, 1987 with the receipt
in OHA Headquarters of a computer-generated list of Appeals Council
actions and decisions. The Litigation Staff, Office of the Deputy
Commissioner for Programs (ODCP), has sent OHA Headquarters an updated
list of file locations of potential class member cases. The Division of
Support Services, OAO, will retrieve files from OHA components, State
agencies and Social Security field offices. ODCP Litigation Staff will
arrange for the retrieval of files located in the Federal Records Center
and Processing Centers (including the Office of Disability Operations
(ODO)). All located files will be sent to OAO Review Branch 3 which is
responsible for screening and processing the
McDonald cases. (OGC has provided notice of class
relief in all pending court cases. Accordingly, OHA will not have to take
any action to identify class members with cases pending before the
courts.)
B. Notification of Class Members
OAO should prepare and send a letter and option form (Attachment 1), with
a self-addressed franked envelope, to each identified class member. The
claimant should complete and return the option form within 20 days from
the date of the letter and the analyst should establish a control diary
for 30 days. If the claimant affirmatively replies to the letter or does
not return the option form, the Appeals Council or ALJ must readjudicate
the case. If the claimant returns the form stating he or she does
not want another Appeals Council
review, it is not necessary for the Appeals Council to readjudicate the
case. Since these cases involve implementation of a court order, all cases
must receive expeditious handling.
IV. Adjudication of Cases
The Appeals Council will readjudicate the McDonald
cases under SSA's current policy, in effect since December 1, 1984, of
considering the combined effect of multiple nonsevere impairments. Current
policy is described in detail in
SSR 85-28
The Appeals Council should issue a decision in the case if possible, or,
if not, remand the case to an ALJ for a new hearing and decision. (See
sample remand order in Attachment 2.)
V. Questions
Hearing Office personnel may call the Regional Office. Regional Office
personnel may call the Division of Field Practices and Procedures in the
Office of the Chief Administrative Law Judge on FTS 305-0022. Headquarters
personnel may call DLAI on 305-0708.
Attachment 1. OPTION FOR APPEALS COUNCIL REVIEW
SSN
Name and
Address of Claimant
Dear
The Appeals Council notified you on _______________________ of its
[action] [decision] in your case. The United States District Court for the
District of Massachusetts has issued an order in the case of
Claire McDonald et al. v. Bowen requiring the
Social Security Administration to take another look at certain claims and
consider the combined effect of multiple “nonsevere”
impairments in determining whether an individual claimant is or was
disabled.
You now have the opportunity to have your claim reviewed again by the
Appeals Council and to receive a new decision because of the
McDonald court order.
If you choose to have the Appeals Council review your claim again, you
should complete the enclosed option form. You may submit additional
evidence and/or a written statement as to the facts and law in your case.
The option form and any additional evidence and/or a written statement
should be submitted by mail to the Appeals Council
within 20 days from the date of this letter.
Please mail the material in the enclosed self-addressed envelope which
requires no postage. If you need more time to submit additional evidence,
you should advise the Appeals Council, by mail, within the 20-day time
period, when it may be expected.
If you should have any questions about this letter, you may contact any
Social Security office. Most questions can be handled by telephone or
mail. If you visit an office, please take this letter with you.
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Sincerely, |
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________________________ |
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Administrative Appeals Judge |
Enclosures:
Option Form
Self-addressed Envelope
cc:
(Representative, if any)
Enclosure for Attachment 1
OPTION FOR ANOTHER AC REVIEW
OPTION FORM FOR MCDONALD CASE
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_________________________
Claimant's Name
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_________________________
Social Security Number
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(Please check appropriate box)
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I request that the Appeals Council review mycase under the terms of the McDonald court order. I understand that if it is determined that I am not disabled, I will be notified of my appeal rights.
I plan to submit additional evidence/arguments (please check one)
Yes______
No ______
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____ |
I do not wish to have my case reviewed by the Appeals Council.
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_________________________
Signature
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_________________________
Date
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Current Address:
______________________
______________________
_______________________
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Telephone:
(___)_____________________
Area/Number
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Department of
HEALTH AND HUMAN SERVICES
Social Security Administration
Office of Hearings and Appeals
ORDER OF APPEALS COUNCIL
REMANDING CASE TO ADMINISTRATIVE LAW JUDGE
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In the case of
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Claim for
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____________________________
(Claimant)
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____________________________
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____________________________
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____________________________
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(Wage Earner) (Leave blank if same as above)
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(Social Security Number)
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The United States District Court for the District of Massachusetts, in
McDonald et al. v. Bowen, (applicable to residents
of the State of Massachusetts), has directed the Social Security
Administration to readjudicate cases involving “nonsevere”
impairments where the combined effect of multiple “nonsevere”
impairments was not considered.
[Insert statement of additional reasons for remand.]
Therefore, the Appeals Council under authority of section 404.977 and/or
416.1477 of Social Security Administration Regulations Nos. 4 and/or 16
(20 CFR 404.977
and 416.1477,
respectively), vacates the prior decision of the Administrative Law Judge
[or Appeals Council] dated _______________, and remands this case to an
Administrative Law Judge for further proceedings, including a
(new) hearing and decision.
The Administrative Law Judge should give consideration to the specific
issues raised in the March 10, 1986 order of the United States District
Court for the District of Massachusetts in McDonald et al. v.
Bowen, and shall afford the claimant the opportunity to
present further evidence on these issues0.
[Specify development if needed.]
The Administrative Law Judge may take any (additional) action not
inconsistent with this Order.
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APPEALS COUNCIL
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____________________________
Administrative Appeals Judge
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____________________________
Administrative Appeals Judge
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Form HA-517