DI 27516: Refilings for the Same Period (Res Judicata Cases)
TN 15 (09-17)
A. Applicability of res judicata
Before applying res judicata to a subsequent Title II disability claim, consider any changes in the disability evaluation criteria resulting from the Social Security Disability Benefits Reform Act of 1984 (P.L. 98-460) and changes to the Listing of Impairments discussed throughout this section.
B. Multiple impairments are alleged
For multiple impairments (regardless of whether the prior determination was based on a not severe impairment), apply res judicata to a subsequent claim if the subsequent claim does not present any new facts and the prior determination was made through the date the nondisability requirements were last met, i.e.:
the date last insured (DLI),
the ending date of the prescribed period for a disabled widow(er) claim,
the attainment of age 22 for a childhood disability beneficiary (CDB).
See also:
DI 27516.005 For completing the SSA-831-U3 (Disability Determination and Transmittal).
C. Not severe impairments
When the prior claim was denied because the impairment was not severe, apply res judicata to a subsequent claim that was filed after a prior denial made through the date the nondisability requirements were last met if the subsequent claim does not present any new facts. For additional information, see DI 27516.010B, in this section.
See also:
DI 27516.005 Disability Determination Services (DDS) Res Judicata Development and Processing
D. Mental impairments
Prepare a substantive determination on the subsequent claim if the prior claim was denied before January 17, 2017. For processing instructions, see DI 27516.005D.
REMINDER: If the claimant was unrepresented when the prior final determination was made, and the evidence reveals the presence of a mental condition, res judicata and the rules for administrative finality are not applied if the evidence shows that mental incapacity, or other good cause, prevented the claimant from timely appealing the prior determination. (See Social Security Ruling 91-5P.) The field office (FO) makes the good cause determination and, if necessary, forwards the file to the DDS for a medical/vocational determination.
E. Physical impairments
Use the summaries in this section to determine if there has been a less restrictive change in the criteria for evaluating an impairment. For changes to the listing of impairments that affect the application of res judicata, see DI 27516.010F (in this section).
1. Applicable criteria less restrictive
If the listing criteria applicable to the impairment in the prior claim have become less restrictive, prepare a substantive determination on the subsequent claim. For processing instructions, see DI 27516.005D.
2. Applicable criteria not less restrictive
If the listing criteria applicable to the impairment in the prior claim have not become less restrictive, and the prior claim was denied through the date the nondisability requirements were last met, a subsequent claim may be denied based on res judicata, absent any new facts. Prior to making a determination, see the NOTE in DI 27516.010F (in this section) regarding listing criteria that have not become less restrictive.
NOTE: If the subsequent claim presents new facts, prepare a substantive determination.
F. Changes to the listing of impairments that affect the application of res judicata
Subsequent claims involving the listings shown below should not be denied based on res judicata if the determination or decision on the prior claim was made before the date of the listing change.
NOTE: If a listing for a particular impairment is not in the table below, a less restrictive change was not made to the listing of impairments and a subsequent claim involving the impairment may be denied based on res judicata, absent new facts or issues.
Impairments/Listings Involved |
Date of Change |
Explanation and Action |
|---|---|---|
Musculoskeletal System (1.00) |
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All musculoskeletal disorders |
02/19/02 |
We so extensively revised the musculoskeletal listings in 2002 that, while they are not, in general, less restrictive than the prior listings, the issues are different and include the use of functional criteria to indicate listing-level severity. If the prior claim was denied before 02/19/02, prepare a new determination for all subsequent claims involving a musculoskeletal impairment. |
Special Senses and Speech (2.00) |
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All hearing impairments |
08/02/10 |
We revised the listings for hearing impairments by removing the requirement for testing with hearing aids and replacing listings 2.08 and 102.08 with new listings 2.10 and 102.10, respectively. If the prior claim was denied before 08/02/10, prepare a new substantive determination for all subsequent claims involving hearing loss. |
|
Vision |
04/29/13 |
If the prior claim was denied before 04/29/2013, prepare a new substantive determination for all subsequent claims involving vision. |
Respiratory Disorders (3.00) |
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All respiratory disorders |
10/07/16 |
We revised the listings for respiratory disorders. While the listings are not, in general, less restrictive, we added new criteria. If the prior claim was denied before 10/07/16, prepare a new substantive determination for any subsequent claim involving a respiratory impairment. |
Cardiovascular system (4.00) |
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All cardiovascular disorders |
02/10/94 |
We revised the cardiovascular listings so extensively that, while they are not, in general, less restrictive, the issues are different. If the prior claim was denied before 02/10/94, prepare a new determination for all subsequent claims involving a cardiovascular impairment. |
|
Cardiovascular disorders: chronic heart failure; ischemic heart disease; peripheral arterial disease |
04/13/06 |
We revised the adult listings for chronic heart failure (4.02), ischemic heart disease (4.04), and peripheral arterial disease (4.12). While the listings are not, in general, less restrictive, we added new criteria or revised existing criteria to reflect technological improvements. If the prior claim was denied before 04/13/06, prepare a new substantive determination for all subsequent claims involving chronic heart failure, ischemic heart disease, or peripheral arterial disease. |
Digestive System (5.00) |
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Any digestive disorder |
12/18/07 |
If the prior claim was denied before 12/18/07, prepare a new substantive determination for all subsequent claims involving any digestive disorder. |
Hematological Disorders (7.00) |
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All hematological disorders |
05/18/15 |
We so extensively revised the hematological disorders listings in 2015 that, while they are not, in general, less restrictive than the prior listings, the issues are different and include the use of functional criteria to indicate listing-level severity. If the prior claim was denied before 05/18/15, prepare a new determination for all subsequent claims involving a hematological disorder impairment. |
Skin Disorders (8.00) |
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All skin disorders |
07/09/04 |
We revised the listings for evaluation of skin disorders. We added new listings and included a specific time requirement for most listings, which is less restrictive. If the prior claim was denied before 07/09/04, prepare a new substantive determination for all subsequent claims involving skin disorders. |
Congenital Disorders That Affect Multiple Body Systems (10.00) |
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Non-mosaic Down syndrome in an individual age 18 or older |
6/19/00 |
We added listing 10.06 for non-mosaic Down syndrome. If the prior claim was denied before 06/19/00, prepare a substantive determination for all subsequent claims involving an individual age 18 or older with non-mosaic Down syndrome. |
Neurological Disorders (11.00) |
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Amyotrophic lateral sclerosis (ALS) |
08/28/03 |
We revised the listing criteria for evaluating ALS under listing 11.10. We will find disability with medical evidence showing that the claimant has ALS. If the prior claim was denied before 08/28/03, prepare a new substantive determination for all subsequent claims involving ALS. |
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All neurological disorders except for ALS |
09/29/16 |
We comprehensively revised the listings for evaluating neurological disorders. We added new listings, removed 3 listings and included new functional criteria for most listings. If the prior claim was denied before 09/29/16, prepare a new substantive determination for all subsequent claims involving a neurological disorder other than ALS. |
Mental Disorders (12.00) |
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Mental Disorders |
01/17/17 |
We extensively revised the mental disorders listings. While these listings are not, in general, less restrictive, we extensively revised the areas of mental functioning considered in the severity criteria. If the prior claim was denied before 01/17/17, prepare a new substantive determination for all subsequent claims involving a mental disorder. |
Cancer (13.00) |
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Malignant neoplastic disease of the esophagus |
01/06/86 |
We revised the listing for evaluating tumors located in the lower half of the esophagus (13.16) to remove the requirement for metastatic disease. If the prior claim was denied before 01/06/86, prepare substantive determination on subsequent claim involving a tumor located in the lower half of esophagus if the prior claim was denied before 01/06/86. |
|
Malignant neoplastic disease of the gallbladder |
01/06/86 |
We revised the criteria for evaluation of carcinoma of the bile ducts to require less extension of the tumors. This change is less restrictive. If the prior claim was denied before 01/06/86, prepare a substantive determination on the subsequent claim involving carcinoma of the bile ducts if the prior claim was denied before 01/06/86. |
|
Malignant neoplastic disease of the penis |
01/06/86 |
We added new listings to provide standards for tumors of the penis and vulva. (The listing for tumors of the penis was 13.29 from 01/06/86 to 07/08/04. It was renumbered to 13.26 beginning 07/09/04.) If the prior claim was denied before 01/06/86, prepare a substantive determination on the subsequent claim involving tumors of the penis. |
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12/15/04 |
We revised the listings for these disorders (13.02C, 13.02E, 13.03A, 13.03B2, 13.06, 13.07, 13.10A, 13.11D, 13.14A, 13.17A, 13.21A, 13.23, 13.27, and 13.28). While these listings are not, in general, less restrictive, we added criteria to recognize the length and debilitating effects of treatment for some malignancies. We also:
If the prior claim was denied before 12/15/04, prepare a new substantive determination for all subsequent claims involving these malignant neoplastic diseases. |
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Malignant neoplastic diseases of: skin; thyroid gland; breast; lungs; female genital tract |
11/5/09 |
We have revised the listings for these disorders (13.03B, 13.09C, 13.10B, 13.14C, 13.23C). While these listings may not, in general, be less restrictive, we added criteria to recognize the length and debilitating effects of treatment for some malignancies. We also added criteria for evaluating malignant neoplastic diseases of the skin, thyroid gland, and breast. If the prior claim was denied before 11/5/09, prepare a new substantive determination for all subsequent claims involving these malignant neoplastic diseases. |
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Cancer |
07/20/15 |
We have revised the listings and added some new listings for these disorders (13.02, 13.03, 13.05, 13.06, 13.10, 13.12, 13.13, 13.15, 13.16, 13.17, 13.18, 13.20, 13.22, 13.23, 13.24, 13.29). While these listings may not, in general, be less restrictive, we added criteria to recognize the unfavorable prognoses and length and debilitating effects of treatment for some malignancies. If the prior claim was denied before07/20/15, prepare a new substantive determination for all subsequent claims involving these malignant neoplastic diseases. |
Immune System Disorders (14.00) |
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All immune system disorders except human immunodeficiency virus (HIV) infection |
06/16/08 |
We revised the listings for these disorders by either making them less restrictive or making major changes that result in the listing criteria being significantly different. For example, in some listings, we added functional criteria to indicate listing-level severity. If the prior claim was denied before 06/16/08, prepare a new substantive determination for all subsequent claims involving these immune system disorders listings. |
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Human immunodeficiency virus (HIV) Infection |
01/17/17 |
We revised the listing used to evaluate human immunodeficiency virus (HIV) infection. While the new listing is not, in general, less restrictive, we have made a number of significant changes. We have removed many criteria and added new criteria to reflect medical advances and changes in expected outcomes for individuals with HIV infection. If the prior claim was denied before 01/17/17, prepare a substantive determination for all subsequent claims involving symptomatic HIV infection. |