When the AC grants review and exercises its authority to issue
a decision, SSR
13-3p applies to the AC action. Under SSR 13-3p, the AC will adjudicate
a continuing disability review (CDR) case through the date of the
AC's decision.
In light of SSR
13-3p and the AC's limited resources to develop the record,
the AC must carefully consider whether it is appropriate to issue
a decision in a CDR case rather than remanding the case. Careful
consideration is necessary to avoid issuing a decision on an undeveloped
record or un-adjudicated period of time.
Therefore, the analyst will consider the following before
recommending that the AC issue a decision in a CDR case:
a. Length of Time Between
ALJ Decision and AC Action
If the period of time between the date of the ALJ's decision
and the date of the AC action is not extensive, an AC decision may
be appropriate if the record is otherwise fully developed. For example,
if the claimant submits additional evidence one month after the
ALJ's decision that changes the outcome of the prior decision, an
AC decision may be appropriate.
If the claimant submits additional evidence that clearly establishes
disability, the analyst may recommend issuing a favorable AC decision.
If the claimant submits a significant amount of evidence to
the AC, or review of the evidence requires the assistance of an
expert, the analyst will consider whether it may be more appropriate
to recommend remand for an ALJ to review the evidence. The analyst
will then recommend an appropriate action given the circumstances
of the case.
If the claim before the AC is for title II benefits only and
the date last insured expired before the date of the ALJ decision,
the analyst should not take any action to develop the record. Rather,
the analyst will recommend the action deemed appropriate based on
the evidence before the AC.
d. Subsequent Applications
Under SSR
11-1p, Titles II and XVI: Procedures for Handling Requests
to File Subsequent Applications for Disability Benefits, SSA generally
cannot 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.
However, the SSR
11-1p procedures do not apply if the prior application is
a CDR claim. See HALLEX HA 01195.001 B. The claimant may
file a subsequent application at any time while the CDR case is
pending before the AC. Based on the facts of the case and the determined action,
the AC must be sure to apply any applicable provision in HALLEX HA 01195.000.