TN 11 (11-12)

Citations:

20 CFR 404.913 and 416.1413

A. Policy for establishing the EOD in reconsideration and appeal claims

If a claimant or a claimant’s appointed representative is dissatisfied with our determination or decision, he or she may request a reconsideration of the initial determination or appeal the reconsideration determination to the Office of Hearings Operations.

NOTE: In prototype states, the claimant appeals the initial determination directly to the OHO hearing level.

Provide an entirely new decision (De Novo Review).

The adjudicator who reviews the claim on appeal makes a determination based on all of the evidence in the file. This means the adjudicator makes a new determination regarding whether the claimant is disabled and regarding the EOD, if we find the claimant disabled. If we determine the claimant is disabled, we may establish the same, an earlier, or a later EOD than established in the initial determination. Therefore, on appeal, there is a possibility we may deny a claim previously allowed or allow a claim with a less favorable EOD at the reconsideration or appeal level.

B. Component roles for establishing an EOD for reconsideration and appeal claims

1. Field office (FO)

Upon receipt of an appeal, the FO informs the claimant or the claimant’s representative that the entire claim is under review, including the determination regarding the claimant’s disability status. The FO explains that the claimant’s disability status may change from “disabled” to “not disabled.” In addition, the FO informs the claimant or the claimant’s representative that, if we find the claimant disabled, the EOD may be the same, earlier, or later than the EOD established in the initial determination. For more detailed information on the FO roles in the reconsideration and hearing processes, see DI 12005.001 Documenting a Request for Reconsideration of an Initial Disability Claim and DI 12010.001 Request for Administrative Law Judge (ALJ) Hearing.

2. Disability Determination Services (DDS) or the Office of Hearings Operations (OHO)

The DDS or OHO adjudicator makes an entirely new determination or decision based on the evidence of record.

C. Component instructions for establishing an EOD for reconsideration and appeal claims

1. Field office (FO)

When taking an appeal claim, inform the claimant or the claimant’s representative that:

• we will make an entirely new determination or decision,

• there is a possibility the claimant’s disability status could change from “Disabled” to “Not Disabled,” and

• there is a possibility of a later EOD, if we find the claimant disabled.

2. Disability Determination Services (DDS) or the Office of Hearings Operations (OHO)

The DDS or OHO adjudicator:

• makes an entirely new determination or decision based on the evidence of record.

• secures additional information, if necessary, to determine if the claimant meets our medical criteria for disability.

• makes a new determination or decision concerning whether the claimant is disabled or not disabled.

• establishes an EOD based on the relevant technical, medical, and vocational factors of the claim, if they find the claimant disabled. This date may be the same, earlier, or later than the initial EOD.