The DDS has jurisdiction of a subsequent claim filed after a prior claim has been denied through the date the nondisability requirements were last met and any one of the other conditions required for applying res judicata in DI 27516.001B. is not met.

NOTE: Due to revised evaluation criteria, the DDS has jurisdiction when the determination or decision denying the prior claim was made before January 6, 1986, and denied the claim through the date the nondisability requirements were last met. For information about revised evaluation criteria, see DI 27516.010.

Review the prior and subsequent claims following the guides in DI 27516.010 – Disability Determination Services (DDS) Medical Evaluation Criteria to Determine Applicability of Res Judicata, to determine if the disability criteria applied to decide the prior claim have become less restrictive. Determine if new facts, which were not present in making the prior determination, are present.

NOTE: For complete DDS electronic processing instructions see DI 81020.000 – DDS Procedures - Electronic Processing.

Follow instructions in DI 27516.005B. (in this section), noting the following exceptions:

1. a. 

   Check block 25 (Revised Det) and 25 A. B. (Recon); and

2. b. 

   Enter “Recon Affirmation -- Res judicata applies” in item 34 (Remarks).

Prepare a substantive medical/vocational determination per usual procedures if:

• •

  the disability criteria have become less restrictive since the prior denial determination (For changes to the listings of impairments that affect the applicability of res judicata, see DI 27516.010); or

• •

  the subsequent claim presents new facts which were not present in the prior claim.

Then, annotate the SSA-831 as follows:

• •

  Item 26 (List No.) - “243” (subsequent claim -- prior claim medically denied through date nondisability factors last met); and

• •

  Item 34 (Remarks) - “Res judicata not applicable.”

  NOTE: If you cannot determine the applicability of res judicata because the prior folder was not located, enter “Res judicata not applied -- prior claim not located” in item 34. Also, enter listing code 243 in item 26 for cases where the prior folder is not available.

If a basis for reopening and revising the final determination on the prior claim exists (new and material evidence, error on the face, etc.), see DI 27505.001 – Conditions for Reopening a Final Determination or Decision.

NOTE: Only if it is within 12 months from the date of notice of the initial determination on a claim can a final determination or decision be reopened and revised for any reason (including a change in the criteria).

After reopening the prior determination or decision, forward the case to the appropriate component:

• •

  If the ALJ, AC, or court issued a prior decision and the rules for reopening apply, forward the prior and subsequent claims to the Office of Disability Operations (ODO) per DI 27505.010B.2.

• •

  If a Disability Hearing Officer made the determination on the prior claim and the determination can be reopened under the rules for reopening, forward both the prior and subsequent claims to the Disability Hearing Unit (DHU).

• •

  When a change in disability criteria warrants establishment of disability on the current application, i.e., claimant now meets disability criteria before nondisability requirement last met, prepare a substantive determination on the new claim before referring to ODO or the DHU.

  NOTE: This means going into the period previously adjudicated even though the time periods for reopening have not expired. This action is permissible because the determination on the new claim is based on a change in the disability criteria, and does not reopen the decision on the prior claim.

Make a new initial determination if:

• •

  the rules for reopening the final prior determination, ALJ, AC, or court decision do not apply; and

• •

  a favorable determination within the prior adjudicated period is warranted because the disability criteria have changed or new and material evidence is submitted since the prior determination or decision. For information on subsequent applications, see DI 27510.005.

  NOTE: Since the determination or decision on the prior claim cannot be reopened, benefit rights flow only from the new application.