Last Update: 8/18/2015 (Transmittal I-3-126)
HA 01320.022 Evaluating Whether
Reviewing a Prior Claim(s) File Is Necessary
Renumbered from HALLEX section I-3-2-22
Generally, if an administrative law judge (ALJ) was required
to review a prior claim(s) file when adjudicating a claim (see Hearings,
Appeals and Litigation Law (HALLEX) manual HA 01210.013), the Appeals Council
(AC) will need the prior claim(s) file when adjudicating the claim.
For instructions on how Office of Appellate Operations (OAO) staff
requests a paper claim(s) file, see HALLEX HA 01310.023.
This means the AC will usually need a copy of the prior claim(s)
file when the claim before the ALJ involved:
•
A continuing disability
review (CDR);
•
A collateral estoppel issue;
•
A reopening issue when the ALJ did not make a finding;
•
Findings of an ALJ or the AC on a prior claim(s)
to comply with an Acquiescence Ruling (AR); or
If the AC exercises its authority
to issue a decision, it will use the same criteria in HALLEX HA 01210.013 to
determine whether it needs a prior claim(s) file. If the AC finds
it necessary to reference documents from the prior claim(s) file,
it will use the same general principles in HALLEX HA 01210.013 in
regard to exhibiting any evidence from a prior claim(s) file.
If an ALJ was required to obtain
a prior claim(s) file but the file is missing, the AC will determine
the appropriate action on a case-by-case basis. For example, if the
record clearly shows the ALJ made all reasonable attempts to obtain
and reconstruct a prior claim(s) file in a CDR case, there may be
circumstances where the AC determines the facts of the case do not
present a basis for granting review. In other circumstances, the
AC may determine a finding that there has been no medical improvement
is more appropriate, and the newly developed claim(s) file (see HALLEX HA 01210.012)
may become the comparison point decision for a later CDR. See 20 CFR 404.1579(c)(3) and 416.994(b)(2)(iv)(E).
If an ALJ makes specific references to evidence in the prior
claim(s) file in his or her decision, but does not associate the
referenced documents with the current claim(s) file, the analyst
will need to review the prior claim(s) file. In evaluating the issue,
the analyst will determine whether the ALJ appropriately applied
HALLEX HA 01210.013 in
regard to exhibiting evidence (or citing exhibited evidence) and
will recommend appropriate corrective action, if necessary.
It is important that the analyst
ensures that the ALJ followed the appropriate procedures and that
evidence is properly associated with the record. If the case proceeds
to Federal court, the AC must ensure the certified administrative
record is a full and accurate record of the proceedings. As explained
in HALLEX HA 01420.030 B.4.,
missing exhibits that pertain to the current claim can compromise
certification of the record.
Further, if the issue of reopening is before the AC, the analyst
will make all reasonable attempts to obtain a prior claim(s) file.
See HALLEX HA 01390.080.
When an analyst reviews a prior claim(s) file, the analyst
will include in his or her analysis and recommendation to the AC
appropriate references to the prior claim(s) file, and will ensure
the prior claim(s) file is available for the AC when it reviews
the analyst's recommendation.
For information about how the AC
handles evidence in a subsequent claim(s) file, see HALLEX HA 01195.020.