Identification Number:
DI 12045 TN 6
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Special Situations
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 120 – Appeals Processing
Subchapter 45 – Special Situations
Transmittal No. 6, 08/04/2020

Audience

PSC: CS, DE, DEC, DTE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, ERE, FCR, FDE, RECONE, RECONR, RECOVR;
OCO-ODO: BET, CR, CST, CTE, CTE TE, DE, DEC, DS, PETE, PETL, RCOVTA, RECONE, RECOVR;
ODD-DDS: REF;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;
OHO/OAO: OHAAC, OHACO (SAWDY), OHAHOs, OHAROs;

Originating Component

ODP

Effective Date

Upon Receipt

Background

We are issuing this transmittal to improve readability of the section. This is a Quick Action Transmittal and the changes do not introduce new policy or procedure.

Summary of Changes

DI 12045.025 Different Determinations or Decisions for the Same Period in Separate Claims

The word "and" was added to the third sentence in DI 12045.025B.2.

DI 12045.025 Different Determinations or Decisions for the Same Period in Separate Claims

A. Introduction

The field office (FO) may discover that adjudicators issued different determinations or decisions for the same period in claims for benefits under different titles of the Social Security Act even when there is a common issue, see DI 12045.005. The components involved must resolve the conflict.

NOTE: Any adverse reopening resulting from this procedure is subject to administrative finality considerations and due process procedures.

B. Procedure for components to resolve conflict

1. Change in medical-vocational rules or vocational profile

The Disability Determination Services (DDS) may issue conflicting determinations when collateral estoppel does not apply to a subsequent claim and, after completing development of the claim, the DDS issues a denial. Review the SSA-831 to identify why collateral estoppel did not apply to these claims. The claims carry one of the following list codes in item 26 of the SSA-831:

  • 586 (Adoption does not apply due to changes in the listings),

  • 588 (Adoption does not apply due to change in medical-vocational rules), or

  • 581 (Adoption does not apply due to changed vocational profile).

These determinations are appropriate and should not be returned to the DDS for resolution, see DI 27515.001D through DI 27515.001G.

For a complete inventory of disability-related list codes, see DI 33530.005.

When a potential collateral estoppel situation was not properly considered or addressed, the FO must take the following actions.

a. Both determinations were made at the initial or reconsideration level

The FO must forward the claims for resolution to the DDS that made the last determination.

b. At least one decision was made by an administrative law judge (ALJ) or the Appeals Council (AC)

  • The FO must forward the claims to the regional office (RO), explaining the conflict on the routing slip.

  • The RO Programs Coordinator works with the Office of Hearings Operations (OHO) to coordinate the processing of the claim(s) that are with OHO.

  • The Regional Office Programs Coordinator works with the Office of Appellate Operations (OAO) to coordinate the processing of the claim(s) that are with the AC.

2. Substantial gainful activity (SGA) issue in conflict

The FO is responsible for resolving conflicts of substantial gainful activity (SGA) findings between determinations for the same period(s) in different claims at the initial or reconsideration levels.

The FO cannot reopen a decision of an ALJ or the AC. For reopening and revising a determination or decision, see DI 27501.005.

When at least one of the claims was adjudicated at OHO or OAO and material evidence was not available for consideration at the time of the decision, the FO must forward the claims to the office that had jurisdiction at the time of the decision; and explain the conflict on the routing slip and allow for additional review.


DI 12045 TN 6 - Special Situations - 8/04/2020