Effective Dates: 12/18/2024 - Present Previous | Next

TN 22 (12-24)

DI 27516.001 Field Office Res Judicata Development and Processing

Citations: Social Security Act, sections 205(a) and (b)(3) ;

Regulation - 20 C.F.R. 404.957(c)(1),

SSR 91-5p  Titles II and XVI: Mental Incapacity and Good Cause for Missing the Deadline to Request Review

SSR 95-1p  Title II And Title VI: Finding Good Cause For Missing The Deadline To Request Administrative Review Due To Statements In The Notice of Initial or Reconsideration Determination Concerning The Right To Request Administrative Review And The Option To File A New Application

A. Definition of res judicata

Our administrative policy of res judicata provides that once an issue is decided it does not need to be decided again. We apply res judicata at all levels of the claims adjudication process to avoid deciding an issue that we have previously decided based on the same facts, same issues, same parties, and same adjudicative period.

B. Applying res judicata to deny a subsequent Title II claim

1. When to apply res judicata

The field office (FO) has jurisdiction to deny a subsequent Title II claim based on res judicata when the following apply:

a. A previous determination or decision denying the prior Title II claim meets the following criteria:

  • •

    it has become final (i.e., there was no timely appeal)

  • •

    it adjudicated the prior claim through the date the non-disability requirements for entitlement were last met (i.e., the date last insured (DLI) for disability insurance benefits (DIB); the end of the prescribed period for disabled widow's or widower's benefits (DWB); or attainment of age 22 for childhood disability benefits (CDB)); and

  • •

    it considered the same facts, issues, and period.

b. AND none of the exceptions in DI 27516.001B2 in this section applies.

2. Res judicata exceptions

If any of the following conditions apply, do not apply res judicata:

a. Mental incapacity

The claimant alleges or the evidence supports failure by the claimant to timely appeal the previous adverse determination or decision, because of the claimant’s mental incapacity, that is their lack of mental capacity to understand the procedures for requesting review. In determining whether the claimant lacked the mental capacity to understand the procedures for requesting review, the adjudicator must consider the following factors as they existed at the time of the prior adverse determination or decision:

  • •

    inability to read or write;

  • •

    lack of facility with the English language;

  • •

    limited education;

  • •

    any mental or physical condition which limits their ability to do things for themselves.

For additional information, see SSR 91-5p.

b. Misinformation

The claimant demonstrates they failed to timely appeal the adverse prior initial or reconsideration Title II determination because of good faith reliance on incorrect, incomplete, or misleading information given by the Social Security Administration (SSA) or the Disability Determination Service (DDS).  To make a finding about misinformation, follow procedures in GN 03101.120C.

c. Change in law or policy

The applicable law or policy has changed. That is either:

  • •

    The relevant medical criteria have changed since the prior final determination or decision, see DI 27516.010;

    or

  • •

    There has been a different change that makes the applicable law or policy less restrictive (i.e. more favorable to the claimant), see DI 27516.010. 

d. New fact or issue

The subsequent claim presents a new fact(s) or issue(s) that was not considered in making the prior determination or decision.  Examples include:

  • •

    An unadjudicated period

  • •

    There is an allegation of a new impairment with an onset that began during the previously adjudicated period

  • •

    New and material evidence

C. Processing an initial res judicata denial in the FO

If all of the conditions in section DI 27516.001B1 are met, the claim is in the FO's jurisdiction. When res judicata applies to the subsequent Title II claim in the FO:

  1. 1. 

    Enter the “S1” denial code on the Benefit Continuity Factors (BECF) screen in the Modernized Claim System (MCS);

  2. 2. 

    Enter the decision status of “03” and the listing code of “243” on the Decision Input (DECI) screen; and

  3. 3. 

    Process via Earnings Computation (EC). Process via the Manual Adjustment Credit and Award Data Entry system (MACADE). If the S1 denial will not process through EC, see SM 00380.000.

D. Processing res judicata exception cases

DDS has jurisdiction for res judicata exception claims where one of the factors in DI 27516.001B2 is established.

The FO will:

  1. 1. 

    Transfer electronic claims for which the DDS has jurisdiction to the DDS for a determination, see DI 81010.085.

  2. 2. 

    Annotate the prior filing information section of the SSA-3367 Disability Report – Field Office, with the pertinent facts regarding the prior filing, specifying the identified exception(s) to FO res judicata processing

  3. 3. 

    Add a message (without an expiration date) to the certified electronic folder (CEF) stating: “DDS jurisdiction: potential denial on basis of res judicata. DDS review necessary.” For instructions on posting messages to the CEF, see DI 81020.090.

  4. 4. 

    Obtain the prior claim folder(s) if the prior filing is an official paper folder housed in a Modular Disability Folder (MDF).

  5. 5. 

    Document the claims folder to show any Supplemental Security Income (SSI) involvement, including the location of the SSI folder.

For additional information on documenting prior claims activity, see DI 11005.085. If the prior title II folder cannot be located, do not reconstruct the folder. Obtain a new application, SSA-3368, and SSA-827(s).

For information on the electronic process for unable-to-locate (UTL) folders, see DI 81010.242. If the search is unsuccessful, complete the UTL Report of Contact and include a copy in the current folder.

NOTE: When the prior claim is pending at the Appeals Council (AC), and the subsequent claim needs a DDS medical determination because res judicata does not apply, add the “subsequent claim” flag, see DI 81010.080B to the case prior to transferring it to the DDS. Social Security Ruling 11-1p may apply if the subsequent claim is under the same title of the Social Security Act and for the same benefit type. Follow the appropriate instructions to process the subsequent claim, see DI 51501.001 or DI 12045.027.

E. Processing reconsideration of an initial res judicata denial

The notice in a res judicata case informs the claimant that the final determination or decision reached on the prior application applies and that the only appeal available is on the question of whether the same person, facts and issues were present for the same period in both the prior and subsequent claims.

  • •

    If the FO made the initial res judicata determination and the claimant appeals the determination, the FO has jurisdiction to make the reconsideration determination.

  • •

    If the DDS made the initial res judicata determination and the claimant appeals the determination, the DDS has jurisdiction to make the reconsideration determination. See DI 275601.005.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427516001
DI 27516.001 - Field Office Res Judicata Development and Processing - 12/18/2024
Batch run: 12/18/2024
Rev:12/18/2024