TN 1 (06-01)

A. Introduction -- Reconsideration Role in the Appeals Process

Reconsideration is the first step in the administrative review process. It is provided to an individual who is dissatisfied with the initial determination(s) made on his/her Special Veterans Benefit (SVB) claim, the benefit amount or on continuing entitlement to SVB payments.

B. Policy

1. Description of Reconsideration

Reconsideration consists of a thorough review of the evidence considered in making an initial determination(s), together with any additional evidence SSA receives. The review is conducted by an individual who has had no involvement in the initial determination.

2. Effect of Reconsideration Determination

A reconsidered determination is final and binding at the time it is made, unless:

• the claimant or any other party to the determination requests a hearing within the time period to do so; or

• the Expedited Appeals Process (EAP) is used (see VB 02502.005); or

• the reconsidered determination is revised.

3. Scope of Reconsideration

The scope of reconsideration is not confined to the issues in dispute. It consists of reexamination of all evidence of record (including determinations regarding a claimant's eligibility for Supplemental Security Income (SSI) under title XVI). The decision maker undertakes development if there is a reasonable basis to do so and explores all leads for obtaining evidence.

4. Independent Decision maker

The decision maker must not have made or previously reviewed the initial determination being reconsidered. See VB 02501.020 for a discussion of employees who can make initial determinations.

5. Methods of Reconsideration

There are three types of reconsideration:

• Case review;

• Formal conference; or

• Informal conference.

In SVB cases, the above reconsideration types are applied as follows:

• Reconsideration for initial determinations involving SVB claims -- case review only;

• Reconsideration for initial determinations involving reduction, suspension or termination of SVB payments -- case review, formal conference or informal conference. (Conferences are conducted only in the United States.)

  Payments should continue or be resumed if reconsideration is requested within 10 days of receipt of a reduction, suspension or termination notice (or later if good cause is established). Payment is not continued or resumed if the beneficiary has waived the right to payment continuation in writing.

• Reconsideration for initial determinations to increase or reinstate SVB payments -- case review only.

• Reconsideration for initial determinations involving representative payees (see VB 02501.035B.4.)--case review only.

6. Sources of Information

In addition to the POMS, sources of information used to reconsider initial determinations include:

• The Social Security Act (the Act);

• SSA Regulations;

• Social Security Rulings;

• Operating instructions;

• Commissioner's Decisions;

• Acquiescence Rulings;

• General Counsel Opinions;

• State laws and regulations;

• Other pertinent laws and rulings

C. Process -- Responsibilities for Reconsideration Decisions

1. Field Office (FO) Responsibilities

The FO reconsiders issues arising from SVB initial determinations, including initial qualification for, entitlement to and continuing receipt of SVB payments. The FO also reconsiders nonmedical issues arising from initial determinations of SSI and certain concurrent SVB/SSI claims. Specifically, the FO:

• Gives the individual filing for reconsideration a full explanation of the issues involved;

• Gives the individual a full explanation of his/her right to reconsideration and, if appropriate, continuation of payments;

• Explains the nature of reconsideration, including alternatives where appropriate (case review, formal conference, informal conference);

• Assists in executing a request for reconsideration;

• Accepts any evidence offered;

• Undertakes requested development, including development requested by other components;

• Conducts case reviews and formal and informal conferences;

• Renders nonmedical reconsidered determinations; and

• Determines good cause for late filing of reconsideration requests and good cause for failure to file within the 10-day due-process payment continuation period.

2. Federal Benefits Unit (FBU) in Manila Responsibilities

A number of the individuals filing for and/or receiving SVB payments reside in the Philippines. For this reason the FBU located in Manila will play an important role in assisting SSA in the processing of certain SVB appeals. In helping SVB claimants or beneficiaries in the Philippines who request review of an initial determination, FBU will handle most FO responsibilities shown in VB 02502.001C.1. This includes assisting claimants or beneficiaries who ask to review their files prior to a reconsideration determination. (See VB 02502.015C.2.a.)

The FBU will not have responsibility for the following:

• conducting formal/informal conferences

• rendering reconsideration determinations; or

• determining good cause for late filing of reconsideration requests.

The FBU should forward reconsideration requests and other associated appeals material to the servicing FO or central processing site according to instructions in VB 00901.015B and VB 00901.015C.

3. Program Service Center (PSC) Responsibilities

Applications for SVB contain within their scope claims under title II and Title XVI. In concurrent claims situations, the PSC (including the Office of Earnings International Operations in Central Office) will be responsible for rendering the reconsideration and/or good cause determinations on initial determinations involving the title II issues.

4. Federal Benefits Units Abroad

SVB initial determination notices direct claimants or beneficiaries in foreign countries other than Canada and the Philippines to contact the nearest FBU if they want their case to be reexamined. The FBU are responsible for assisting these individuals in preparing a reconsideration request and submitting it to the proper FO or central processing site. In certain limited situations, an FBU may also be requested to assist a claimant or beneficiary who has asked to review his/her file prior to a reconsideration determination. (See VB 02502.015C.2.b.)