Effective Dates: 05/01/2017 - Present Previous | Next

Last Update: 5/1/2017 (Transmittal I-3-154)

HA 01330.006 Additional Evidence

Renumbered from HALLEX section I-3-3-6

A. General

Generally, claimants must inform the Social Security Administration (SSA) about or submit written evidence to SSA no later than five business days before the date of the scheduled hearing. See 20 CFR 404.935 and 416.1435. When the Appeals Council (AC) acts on a request for review, the AC usually considers only the evidence that was before the administrative law judge (ALJ). See 20 CFR 404.970 and 416.1470.

If a claimant or representative submits additional evidence in association with a request for review, the AC must determine if the claimant meets one of the good cause exceptions set forth in 20 CFR 404.970(b) and 416.1470(b). If the AC finds that the claimant meets a good cause exception, the AC will evaluate the additional evidence with the entire record. The AC will grant review or take own motion review of the case if the additional evidence is new, material, and relates to the period on or before the date of the hearing decision, and if there is a reasonable probability that the additional evidence will change the outcome of the decision. See 20 CFR 404.970(a)(5) and 416.1470(a)(5). For further information about when to apply these provisions, see subsection D below.

NOTE: 

Under Social Security Ruling (SSR) 11-1p, Titles II and XVI: Procedures for Handling Requests to File Subsequent Applications for Disability Benefits, the agency will not accept a new disability application if the claimant has a prior disability claim for the same title and benefit type pending at any level of administrative review, unless the prior claim is pending at the AC and the claimant has evidence of a new critical or disabling condition with an onset after the date of the hearing decision. See also POMS DI 51501.000. For more information on how SSR 11-1p applies when additional evidence is submitted, see Hearings, Appeals and Litigation Law (HALLEX) manual HA 01350.020.

When the AC evaluates a decision that is not based on an application for benefits and involves title XVI of the Social Security Act (Act) (e.g., age 18 redeterminations, continuing disability reviews, or terminations), the AC considers the evidence in the hearing record and any additional evidence it believes is material to an issue being considered. See 20 CFR 416.1470(b). However, the AC will only grant review or take own motion review of the case if the additional evidence is new, material, and relates to the period on or before the date of the hearing decision, and if there is a reasonable probability that the additional evidence will change the outcome of the decision. See 20 CFR 404.970(a)(5) and 416.1470(a)(5). For further information about when to apply these provisions, see subsection D below.

B. Determining Whether to Consider Additional Evidence

Generally, the AC will only consider additional evidence as a basis for granting review if the claimant meets one of the good cause exceptions set forth in 20 CFR 404.970(b) and 416.1470(b); the additional evidence is new, material, and relates to the to the period on or before the date of the hearing decision; and there is a reasonable probability that the additional evidence will change the outcome of the decision.

However, when the AC evaluates a decision that is not based on an application for benefits and involves title XVI of the Act (e.g., age 18 redeterminations, continuing disability reviews (CDRs), or terminations), the AC considers the evidence in the hearing record and any additional evidence it believes is material to an issue being considered. See 20 CFR 416.1470(b).

NOTE: 

If the AC receives additional evidence that a hearing office developed, the AC will not evaluate good cause. In this circumstance, the AC will consider the additional evidence if it is new, material, and relates to the period on or before the date of the hearing decision, and if there is a reasonable probability that the additional evidence will change the outcome of the decision. For instructions about whether to proffer additional evidence received by the AC, see HALLEX HA 01320.016.

1. Good Cause Exceptions

The AC will find that a claimant meets a good cause exception if the claimant shows that he or she did not inform SSA about or submit the evidence earlier because:

  • •

    SSA's action misled the him or her;

  • •

    The claimant has a physical, mental, educational, or linguistic limitation(s) that prevented him or her from informing SSA about or submitting the evidence earlier; or

  • •

    Some other unusual, unexpected, or unavoidable circumstance beyond the claimant's control prevented him or her from informing SSA about or submitting the evidence earlier.

NOTE 1: 

The AC has broad discretion when evaluating whether a claimant meets a good cause exception. However, the AC will not infer good cause for missing the deadline to timely submit evidence solely because a claimant is unrepresented. When an unrepresented claimant submits additional evidence, the AC will consider all factors present in the record and any statements from the claimant.

Examples of unusual, unexpected, or unavoidable circumstances include, but are not limited to:

  • •

    The claimant was seriously ill, and his or her illness prevented him or her from contacting SSA in person, in writing, or through a friend, relative, or other person.

  • •

    There was a death or serious illness in the claimant's immediate family.

  • •

    Important records were destroyed or damaged by fire or other accidental cause.

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    The claimant actively and diligently sought evidence from a source, and the evidence was not received or was received less than five business days before the date set for hearing.

NOTE 2: 

The AC will determine that the claimant actively and diligently sought evidence from a source when any evidence suggests that the documents were timely requested. The AC will not investigate the issue or require a showing of proof that the claimant actively and diligently sought the evidence.

  • •

    The claimant received a hearing level decision on the record, and the AC reviewed the decision.

NOTE 3: 

A hearing level decision is “on the record” when a hearing level adjudicator issues the decision without holding a hearing. See 20 CFR 404.948 and 416.1448.

2. New, Material, and Relates to the Period On or Before the Hearing Decision

Additional evidence is new if it is not part of the claim(s) file as of the date of the hearing decision.

Additional evidence is material if it is relevant, i.e., involves or is directly related to issues adjudicated by the ALJ.

Additional evidence relates to the period on or before the date of the hearing decision if the evidence is dated on or before the date of the hearing decision, or the evidence post-dates the hearing decision but is reasonably related to the time period adjudicated in the hearing decision.

NOTE: 

The AC does not apply a strict deadline when determining whether post-dated evidence relates to the period on or before the date of the hearing decision. There are circumstances when evidence dated after the hearing decision relates to the period on or before the date of the hearing decision. For example, a statement may relate to the period on or before the date of the hearing decision when it postdates the decision but makes a direct reference to the time period adjudicated in the hearing decision. This may be especially important in a claim involving an expired date last insured (DLI) when a statement from a medical source dated after the hearing decision specifically addresses the time period before the DLI.

Common examples of evidence that is not related to the period on or before the date of the hearing decision include evidence that shows:

  • •

    A worsening of the condition after the expiration of a DLI in a title II disability insurance benefits claim.

  • •

    A worsening of the condition after the last day of the prescribed period in a widow(er)'s insurance benefits claim based on disability.

  • •

    A worsening of the condition after the claimant attained age 22 in a child's insurance benefits claim based on disability.

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    A worsening of the condition or onset of a new condition after the date of the hearing decision.

For procedures on considering additional evidence, see HALLEX HA 01350.020.

3. Reasonable Probability that the Additional Evidence Will Change the Outcome

The AC will evaluate the entire record along with the additional evidence to determine whether there is a reasonable probability that the additional evidence will change the outcome of the decision.

C. Determining Whether to Grant Review Based on Additional Evidence

The AC will consider the entire record and any additional evidence that meets the criteria outlined in subsection B above. If, considering the entire record, the AC finds that the additional evidence is new, material, and relates to the to the period on or before the date of the hearing decision, and that there is a reasonable probability that the additional evidence will change the outcome of the decision, the AC will grant review or take own motion review of the case and take appropriate action. See 20 CFR 404.970(a)(5) and 416.1470(a)(5).

D. Determining When the Good Cause Provisions Apply

The good cause provisions that limit the AC's consideration of additional evidence, 20 CFR 404.970(b) and 416.1470(b), apply to:

  • •

    Title II claims based on an application filed after June 30, 1980;

  • •

    Title XVI claims based on an application filed after April 30, 1986; and

  • •

    Title II claims not based on an application (e.g., cessation or termination cases), effective with requests for review filed on or after February 9, 1987.

However, in title XVI claims not based on an application (e.g., age 18 redeterminations, CDRs, or terminations), the AC considers the evidence in the hearing record and any additional evidence it believes is material to an issue being considered. See 20 CFR 416.1470(b).

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HA 01330.006 - Additional Evidence (I-3-3-6) - 05/01/2017
Batch run: 04/20/2025
Rev:05/01/2017