POMS Reference

GN 03104: Appeals Council Review (Title II and Entitlement Under Title XVIII)

TN 4 (04-01)

A. Procedure -- both titles

  1. If the subsequent application results in a favorable initial or reconsideration determination, immediately FAX a copy of the notice of award to OAO:

    Subsequent Application Coordinator
    Office of Appellate Operations (OAO)
    Fax number (703) 605-7101

    For a subsequent favorable claim that is electronic, see DI 12045.027D.2.b.

    This will provide the AC with advance notice that a subsequent favorable determination is on the way.

  2. If the subsequent claim is allowed, forward the folder to the AC.

  3. If the subsequent claim is denied and the claimant appeals, process through normal appeal procedures. See GN 03104.380D.

  4. If the determination on the subsequent claim was favorable, the date of eligibility/entitlement can be no earlier than the day after the date of the ALJ decision. After effectuation of the favorable determination, send the folder to the OAO for association and review of any new evidence.

    Office of Appellate Operations (OAO)
    5107 Leesburg Pike
    Falls Church, VA 22041-3255
  5. If the AC takes favorable action on the prior claim, notify the appropriate adjudicating component to stop processing the subsequent claim. If the AC remands the prior claim, notify the appropriate adjudicating component to stop processing the subsequent claim and to forward the claim file to the HO. Forward any new evidence sent from the AC to the appropriate adjudicating component when the AC denies or dismisses the RR on the prior claim.

B. Procedure -- Title II

Process the subsequent claim through MCS. After effectuation, show folder movement to the OAO branch (branch code) with jurisdiction over the prior claim. Generate the standard notice.

C. Procedure -- Title XVI

  1. Include the following remark on the SSR:

    PRIOR CLAIM AWAITING AC DECISION.

  2. Include the following remarks on the Development Worksheet (DW01):

    • ISSUE of “AC APPEAL.”

    • The SSR record number, e.g., “RECORD 1" in the remarks for that issue.

    • Set an appropriate tickle date for the AC's decision.

  3. If the subsequent claim is not a MSSICS claim, control the prior claim with the appeal pending at the AC with an MDW record, using the same ISSUE and REMARKS as shown above, or control it manually.

  4. Terminate the SSR and lock the claim iteration on the MSSICS pending file for the claim with the appeal pending at the AC. Follow procedures in SM 01010.060, SM 01010.061, and MSOM MSSICS 004.011 .

  5. Process the subsequent claim by following existing new claim procedures as if the prior claim had not been filed:

    1. The date of entitlement/eligibility can be no earlier than the day after the date of the ALJ decision.

    2. If the subsequent claim is an allowance or denial, process through normal systems procedures.

    3. If the subsequent claim is denied and the claimant appeals, process though normal systems procedures.

D. Appeals of subsequent claims

If the subsequent claim is denied at the initial level, the claimant may appeal to the reconsideration level and, if necessary, to the hearing level. Follow normal procedures for taking these requests, including routing the claim to the PSC or HO as appropriate. The ALJ will hold the subsequent application until the AC acts on the prior claim.