I-5-4-75.Implementation of the Earley Acquiescence Ruling (Sixth Circuit)
Purpose | |
Background | |
Scope of the Earley AR | |
Interim Period Cases | |
Post-Effective Date Cases | |
Subsequent Applications | |
Questions and Answers | |
Inquiries |
ISSUED: December 2, 2024
I. Purpose
This instruction provides guidance for implementing Social Security Acquiescence Ruling (AR) 24-1(6), Earley v. Commissioner of Social Security, 893 F.3d 929 (6th Cir. 2018) (Interpreting Drummond v. Commissioner of Social Security, 126 F.3d 837 (6th Cir. 1997)): Effect of Prior Disability Findings on Adjudication of a Subsequent Disability Claim—Titles II and XVI of the Social Security Act. The Commissioner of Social Security published the AR in the Federal Register on November 25, 2024, and it became effective on December 2, 2024. The Earley AR also serves as notice of rescission of AR 98-4(6) (63 FR 31266), Drummond v. Commissioner of Social Security, 126 F.3d 837 (6th Cir. 1997) and AR 98-3(6) (63 FR 29770), Dennard v. Secretary of Health and Human Services, 907 F.2d 598 (6th Cir. 1990).
In Earley, the Sixth Circuit clarified its intent in Drummond and interpreted the holding in Drummond to be more limited than described in AR 98-4(6). Although the Sixth Circuit's decision does not apply or discuss Dennard, the Sixth Circuit's rationale in Earley extends equally to the issues addressed in AR 98-3(6).
Under the now rescinded AR 98-3(6) and AR 98-4(6), when adjudicating a subsequent disability claim arising under the same title of the Social Security Act (Act), adjudicators generally must adopt certain findings from the final decision by an Administrative Law Judge (ALJ) or the Appeals Council (AC) on the prior claim in determining whether the claimant is disabled with respect to the unadjudicated period.
AR 24-1(6) (Earley AR) rescinded and replaced AR 98-3(6) and AR 98-4(6). Under the Earley AR, when adjudicating a subsequent disability claim arising under the same or different title of the Act, the adjudicator will now consider certain findings from the prior final decision as evidence in determining whether the claimant is disabled with respect to the unadjudicated period. The adjudicator must make clear that they considered the prior finding as evidence in light of all relevant facts and circumstances.
II. Background
Sharon Earley applied for disability benefits, claiming that she was disabled starting on June 25, 2010. An ALJ found that she was not disabled for the period from June 25, 2010 through May 15, 2012, the date of the ALJ decision. Ms. Earley applied again in July 2012, arguing that she became disabled after the May 15, 2012 decision. The same ALJ, invoking Drummond and AR 98-4(6), issued a second unfavorable decision, stating that he was bound by his earlier findings because Ms. Earley did not offer new and material evidence of a changed condition. On review, the district court reversed. The district court construed Drummond to apply only if it would lead to a favorable outcome. Since any preclusive effect of the ALJ's prior findings would make it more difficult for Ms. Earley to be found disabled, the court found that Drummond did not apply to her case.
On appeal, the Sixth Circuit examined and clarified Drummond. The court found that the key principles protected by Drummond, consistency between proceedings and finality with respect to prior adjudicated claims, apply to both individuals and the government. At the same time, these principles do not prevent the agency from giving a fresh look to a new claim containing new evidence or a new regulatory threshold that covers a new period of alleged disability. The court rejected the argument that, “[i]n reviewing a second application by the same individual . . . the administrative law judge should completely ignore earlier findings and applications.” The court explained that “[f]resh review is not blind review” and that “a later administrative law judge may consider what an earlier judge did if for no other reason than to strive for consistent decision making.” Further, the court explained that “it is fair for an administrative law judge to take the view that, absent new and additional evidence, the first administrative law judge's findings are a legitimate, albeit not binding, consideration in reviewing a second application.” While “an applicant remains free to bring a second application that introduces no new evidence or very little new evidence after a failed application,” the court cautioned that such applicants “should not have high expectations about success if the second filing mimics the first one and the individual has not reached any new age (or other) threshold to obtain benefits.”
III. Scope of the Earley AR
The Earley AR applies at the initial, reconsideration, hearings, and appeals level when the following are met (See also, Program Operations Manual System (POMS) DI 52707.010B):
There was a decision issued by an ALJ or the AC on a prior claim and such decision has become final (20 CFR 404.987 and 416.1487);
The prior ALJ or AC decision contains a finding of a claimant's residual functional capacity (RFC) or other finding that is required at a step in the sequential evaluation process for adjudicating disability as described in 20 CFR 404.1520, 416.920 or 416.924, as applicable;
The adjudicator is deciding a subsequent disability claim with an unadjudicated period arising under the same title or a different title of the Act as the prior disability claim; and
The claimant resides in Kentucky, Michigan, Ohio, or Tennessee at the time of the determination or decision on the subsequent claim.
NOTE 1:
The AR does not apply when an attorney advisor issued a fully favorable decision on the prior claim.
NOTE 2:
The AR does not apply when the requirements for disability on the prior claim are not identical to the requirements for disability on the subsequent claim (e.g., a prior Title XVI child disability claim and a current subsequent Title XVI adult disability claim).
NOTE 3:
The AR does not apply if the prior claim(s) file is lost or has been destroyed and the ALJ or AC decision cannot be located by SSA or by the claimant or claimant's representative.
IV. Interim Period Cases
A. General
Interim period cases are cases where notice of the determination or decision on a subsequent claim is dated June 27, 2018, the date of the Earley court decision, through December 1, 2024, the day before the effective date of the Earley AR. In accordance with 20 CFR 404.985(b)(2) or 416.1485(b)(2), a claimant may request application of the Earley AR to a determination or decision for an interim period case pursuant to POMS DI 52707.010C.1. and POMS DI 52707.015.
Interim period cases must meet the following technical criteria to qualify for readjudication:
The notice date of the determination or decision the claimant seeks to have readjudicated, is dated June 27, 2018 (the date of the Earley court decision) through December 1, 2024 (the day before the effective date of the Earley AR).
The claimant resided within the Sixth Circuit at the time of the determination or decision the claimant seeks to have readjudicated.
There is a prior final ALJ or AC decision on an earlier disability claim under the same or different title of the Act, in which the ALJ or AC evaluated the medical or other evidence and made a finding about the claimant's disability.
The determination or decision the claimant seeks to have readjudicated involves a different subsequent time period than that which was covered by the prior final ALJ or AC decision on the earlier disability claim.
The field office (FO) is responsible for evaluating whether the claimant's request for readjudication meets the technical criteria. When the FO determines the request meets the technical criteria, the FO will forward the request to the component that made the most recent determination or decision that the claimant seeks to have readjudicated (POMS DI 52707.015). The receiving component will issue a readjudication determination or decision. Adjudicators processing the readjudication will not take any action that would result in a less favorable outcome than the interim period decision.
The Earley AR can also be applied to an interim period case based on an adjudicator's own initiative, see subsection VII, Q&A 12.
B. Interim Period Cases Readjudicated at Office of Hearings Operations and Office of Appellate Operations
1. Notification of Earley Readjudication Request
In instances where the last decision on the claim was made at the hearing level, the FO will reactivate the claims folder in EDCS/eView and add a “Court case” flag to the Electronic Disability Collect System (EDCS) or eView with the following text, “Early AR readjudication.” See POMS DI 52707.015B.4. The FO will route the Office of Hearings Operations (OHO) readjudication cases to office code ELL (Falls Church NSD).
In instances where the last decision on the claim was made at the AC level, the FO will forward cases that satisfy the technical criteria to the Office of Appellate Operations (OAO) by emailing ^DCARO OAO with the subject line “Earley Readjudication Request.”
2. Establishing the Case and Adding Case Characteristics
All Earley readjudication cases where OHO or OAO made the final decision on the claim must contain the ERLY case characteristic.
HO staff will establish the case in HACPS and CPMS as a reopened case. HO staff will add the case characteristic ERLY. The ERLY characteristic must be applied at the OHO level to ensure that the correct Acknowledgement Letter and Notice of Hearing are generated in HACPS.
Designated OAO staff will establish the case in relevant case processing system(s) as a Reopening (REO) and will add the case characteristic ERLY.
3. Applicable Law
The period covered by a readjudication is the same period that was covered by the prior decision being readjudicated.
The adjudicator will apply the rules in 20 CFR 404 Subpart P (20 CFR 404.1501-1599) and 20 CFR 416 Subpart I (20 CFR 416.901-416.999d) used to determine whether an individual was disabled or blind that were in effect at the time of the final interim period decision, see subsection VII, Q&A 13.
4. Hearing Level Procedures
a. Check for Readjudication Criteria
Upon receipt of a readjudication case and prior to assignment to an ALJ, OHO staff will evaluate the case to ensure that it meets the technical criteria for readjudication as detailed in POMS DI 52707.015 B. If OHO staff find that the case does not meet the technical criteria, they must refer the case to a manager to review. If management determines the readjudication request does not satisfy the technical criteria, OHO staff will document the reason why in a Report of Contact (ROC) (Form SSA-5002). Thereafter, OHO staff will close the case as a Special Dismissal (SPDI). OHO staff will then email the FO to alert them about the return of the case (POMS DI 52707.015 B.2 and 52707.030A).
If a readjudication case is already assigned to an ALJ when it is determined that the case does not meet the technical criteria, the ALJ must approve the dismissal before staff return the case to the FO.
NOTE:
In the event that OHO has jurisdiction over a subsequent application in addition to the readjudication, then staff responsible for the readjudication case will notify the hearing office where the subsequent application is pending when the request for readjudication is received; and when the final action on the readjudication has been released. See subsection VI for further instructions on subsequent applications.
b. Assignment to an ALJ
Earley readjudication cases should be assigned to an ALJ per HALLEX I-2-1-55.
c. Acknowledgement Letter of Request for Readjudication/Hearing
If the case meets the technical criteria for readjudication, OHO staff will send an acknowledgment letter to the claimant that confirms receipt of the request for readjudication. The acknowledgment will ask the claimant to provide any information the ALJ may need to help determine if applying the Earley AR to the claimant's case would change the prior decision. See Standard Hearings Operations Procedure (SHOP) section 1.4 for the acknowledgement letter language.
d. Provide Opportunity for Hearing
When the technical criteria are met, ALJs will conduct supplemental proceedings and provide the claimant the opportunity for a hearing on the issue of whether application of the Earley AR changes the outcome of the prior ALJ decision.
An ALJ may dismiss a request for hearing on the readjudication if the dismissal criteria are met, see HALLEX I-2-4-5.
NOTE:
ALJs must also consider whether an on-the-record fully favorable readjudication decision is warranted given the available evidence, per 20 CFR 404.948 and 416.1448.
e. Notice of Hearing
To provide notice of the hearing, the ALJ will send the claimant and the appointed representative, if any, a Notice of Hearing (NOH) that includes the Earley readjudication issue language. See SHOP section 1.4 for the appropriate issue language. OHO staff will follow the noticing requirements detailed in HALLEX I-2-3.
g. Readjudication Decisions
ALJs will use the guidance in subsection VII, Questions and Answers, when readjudicating the claim.
Per 20 CFR 404.985(b)(2) and 416.1485(b)(2), the readjudication decision is limited to consideration of the issues covered by the Earley AR and is subject to administrative and judicial review.
To determine whether application of the Earley AR would change the final decision of the interim period case, the ALJ must consider the findings contained in the final decision of the earlier claim as evidence in light of all relevant facts and circumstances. In determining the probative value of such a prior finding, the ALJ will consider the factors described in subsection VII, Q&A 3.
If the prior decision on the subsequent claim remains unchanged as a result of readjudication or does not result in an outcome more favorable to the claimant, the ALJ will issue a No Change in Outcome readjudication decision explaining why the Earley AR would not change the prior decision or result in a more favorable decision. The No Change in Outcome readjudication decision will notify the claimant that the prior decision remains the final decision of the agency. The notice of No Change in Outcome readjudication decision will include the language for appeal rights. See SHOP section 1.4 for the appropriate language to use in the decision and notice of decision in readjudications.
If application of the Earley AR results in a more favorable outcome, the ALJ will issue a favorable readjudication decision.
NOTE:
If the claimant filed a subsequent disability application after the interim claim that resulted in an allowance, the ALJ will not disturb the subsequent allowance.
h. Special Procedures for Processing an AC Remand When the AC Issued the Final Decision on the Interim Period Claim
As described in subsection IV, B.5., OAO may remand interim period cases where the AC made the final decision on the interim period claim. Upon remand, the ALJ will follow the instructions in subsection IV, B.4.c.-g. to readjudicate the claim under the Earley AR. However, the ALJ will issue a recommended decision, see HALLEX I-2-8-15 and SHOP section 6.2.2 for instructions on issuing recommended decisions. OHO staff will notify OAO that a recommended decision has been issued by emailing ^DCARO OAO. If there is a paper claim file, OAO will respond to OHO with further instructions if the paper materials should be routed to OAO.
5. Appeals Level Procedures
For all interim period cases received by OAO, the AC will use the guidance in subsection VII, Questions and Answers, when readjudicating the claim.
If the FO sends an interim period case to OAO for readjudication, designated OAO staff will ensure that it meets the technical criteria for readjudication. If the readjudication request does not satisfy the technical criteria, OAO will document the reason why the case does not satisfy the technical criteria on a ROC, close the ARPS record as a Special Dismissal (SPDI), and return the case to the FO by email (POMS DI 52707.015 B.2).
If there is a paper claim file, OAO will respond to the FO with instructions for routing of the paper file, if necessary.
To determine whether application of the Earley AR would change the final decision of the interim period case, the AC must consider the findings contained in the final decision of the earlier claim as evidence in light of all relevant facts and circumstances. In determining the probative value of such a prior finding, the AC will consider the factors described in subsection VII, Q&A 3.
NOTE:
The AC will only develop the record and issue a decision for the period at issue in the interim claim. If the claimant filed a new disability application after the interim claim that resulted in an allowance, the AC will not disturb the subsequent allowance.
a. Fully Favorable Decision Supported
If application of the Earley AR results in a fully favorable readjudication decision, the AC will issue a favorable readjudication decision.
b. Fully Favorable Decision Not Supported
If the application of the Earley AR,
does not change the outcome,
does not result in an outcome more favorable to the claimant, or
results in a more favorable outcome that is not fully favorable,
the AC will issue a separate notice explaining its proposed findings regarding the readjudication. The notice will provide the claimant and any representative 30 days to comment on the proposed action and/or request a hearing on the issue of whether application of the Earley AR changes the outcome of the prior decision.
No Request for Hearing and Comments Do Not Support a Change in Action
If neither the claimant, nor any representative, requests a hearing within 30 days of the AC notice, and any comments submitted do not warrant a change in the AC's proposed action, the AC will issue a readjudication decision.
If the prior decision remains unchanged or does not result in an outcome more favorable to the claimant, the AC will issue a No Change in Outcome readjudication decision that will find that the earlier decision remains the final decision of the agency. The notice will include appeal rights to federal court on the issue of whether application of the Earley AR would result in a more favorable outcome to the claimant.
If application of the Earley AR results in a readjudication decision that is partially favorable to the claimant, the AC will issue a new partially favorable readjudication decision.
Request for Hearing Submitted or Other Grounds Support Remand
If the claimant or any representative requests a hearing in response to the AC's notice, the AC must remand the case to OHO for any issue on which the AC is not making a favorable finding.
The AC may also remand if the record is insufficient to make a decision on the readjudication request.
The AC remand will not vacate the prior final AC decision and will specifically note that:
The prior decision on the claimant's interim period claim satisfies the technical criteria for readjudication under the Earley AR.
The ALJ will conduct supplemental proceedings consistent with the Earley AR, including holding a hearing.
The ALJ will determine if the application of the Earley AR would change the outcome of the decision to be more favorable to the claimant.
The ALJ will issue a recommended decision.
The AC will use its normal procedures to issue the remand order and route the case to OHO office code ELL (NSD Falls Church).
OHO will notify OAO that a recommended decision has been issued by emailing ^DCARO OAO.
OAO will process the recommended decision consistent with HALLEX I-3-2-50C; except, the AC will only adjudicate the period through the date of the interim decision.
C. Appeals of Less Than Fully Favorable Readjudication Decisions
A denial of a request for readjudication based on the determination that the claim does not satisfy the technical criteria for application of the Earley AR in subsection IV.A is not subject to further review. If OHO or OAO receives an appeal of a determination that the claim does not satisfy the technical criteria for application of the Earley AR, OHO or OAO will dismiss the request (see HALLEX I-2-4-30 and I-3-4-20).
All readjudication determinations or decisions, including ones which find the application of the Earley AR does not favorably change the outcome, may be appealed. OHO and OAO will review determinations and decisions regarding readjudication under the Earley AR applying normal routing and review procedures. For requests for hearing of a DDS readjudication determination, OHO staff should see SHOP section 1.4 for the appropriate acknowledgement, notice, and decision, language. OHO staff should apply the case characteristic ERLA to requests for readjudication that are on appeal from DDS. OAO staff should apply the case characteristic ERLA to requests for readjudication that are on appeal from OHO.
NOTE 1:
When reviewing a claimant's appeal of a readjudication determination or decision, OHO will not issue a decision that is less favorable than the determination on the interim period case. If the outcome will not be more favorable, then OHO will issue a No Change in Outcome readjudication decision explaining why the Earley AR would not change the prior determination or result in a more favorable determination.
NOTE 2:
When reviewing a claimant's appeal of a readjudication determination or decision, the AC generally takes corrective action only if the outcome will be more favorable to the claimant than the interim period determination or decision.
V. Post-Effective Date Cases
A. General
All cases meeting the criteria described in subsection III, where the final determination or decision on an individual's subsequent claim is dated December 2, 2024 or after, are "post-effective date" cases which must apply the Earley AR.
NOTE:
If there is a readjudication interim period determination or decision, which is not final (e.g., the interim period determination or decision is still pending appeal), the component where the appeal is pending generally will apply the Earley AR when processing the pending appeal.
B. OHO Procedures
The assigned ALJ will issue a decision applying the Earley AR as appropriate. If a hearing has already been held, the ALJ will determine if a supplemental hearing is needed, pursuant to 20 CFR 404.944 and 416.1444, and HALLEX I-2-6-80, to evaluate the claim under the Earley AR. For example, a supplemental hearing may be needed in situations where the Drummond and Dennard ARs did not apply to the case, but the Earley AR does apply. If a supplemental hearing is needed, the issues section of the Notice of Hearing for the supplemental hearing should state that the ALJ is holding a supplemental hearing to gather evidence related to the application of the Earley AR to the claim.
If the request for hearing pertains to a determination dated within the interim period (June 27, 2018 through December 1, 2024), the claimant may request readjudication while the request for hearing is pending. If the hearing-level action does not result in the application of the Earley AR (e.g., the ALJ issues a dismissal), OHO must return the case to the jurisdictional component to process the readjudication request. While closing the case in OHO's case processing systems, staff will check the box on the transmittal sheet for “Further action necessary by claims processing component” and include a note in the Transmittal Remarks to the FO stating that the request for readjudication must be returned to the appropriate component for a determination on the readjudication request.
NOTE:
If a preponderance of the evidence supports a fully favorable on-the-record decision, ALJs must consider whether issuing a fully favorable decision is appropriate, instead of dismissing the claimant's request for hearing due to the claimant's failure to appear at the hearing. See 20 CFR 404.948 and 416.1448 and HALLEX I-2-4-25 C.
C. OAO Procedures
Requests for review of decisions dated on or after December 2, 2024 will be processed according to normal procedures. OAO adjudicators will ensure that the applicable policies in AR 24-1(6) and HALLEX I-5-4-75 are properly applied.
The AC will not grant review of a properly issued hearing decision dated prior to December 2, 2024 solely to apply the Earley AR. However, if the AC grants review for any other reason(s), the AC must apply the law in effect at the time it issues the AC decision. This requirement means the AC must apply the Earley AR to all AC decisions issued on or after December 2, 2024. When granting review, the AC will not cite “broad policy or procedural issue that may affect the general public interest” as a reason for granting review.
If the request for review pertains to a determination or decision dated prior to December 2, 2024, but which is also within the interim period (June 27, 2018 through December 1, 2024), the claimant may request readjudication pursuant to POMS DI 52707.010C.1. and POMS DI 52707.015 while the request for review is pending. If the AC action on the request for review does not result in application of the Earley AR (e.g., the AC issues a dismissal or a denial of a request for review), OAO must return the case to the jurisdictional component to process the readjudication request, as follows:
If the jurisdictional component is OHO, upon case closure, OAO staff will email ^OHO HQ NSD Earley Readjudication and request that they process the readjudication request. OHO staff will establish a reopening record in the relevant case processing system(s).
If the jurisdictional component is operations, upon case closure, OAO staff will email the jurisdictional FO and request that they forward the readjudication request to the jurisdictional Disability Determination Services (DDS) for processing.
VI. Subsequent Applications
In cases where there are both a final interim period determination or decision meeting the criteria for readjudication and a pending subsequent disability claim, typically the request for readjudication will be processed first unless the subsequent application requires expedited processing. See HALLEX I-2-1-40 and I-3-1-5.
When DDS has jurisdiction over the readjudication and a subsequent application is pending at the HO or OAO, DDS will notify the OHO or OAO by email of the readjudication claim. DDS will also add an ROC and message to eView to alert OHO and OAO staff that DDS is processing the readjudication and that the subsequent application should be held. When the action on the readjudication is complete, DDS will notify OHO or OAO by email and add a second ROC and message to eView (See POMS DI 52707.020).
When OHO or OAO has jurisdiction over the readjudication and a subsequent application is pending at a different level of review, OHO or designated OAO staff will notify the component responsible for the subsequent application when the request for readjudication is received; and when the final action on the readjudication has been released. To provide notification OHO or OAO staff will add an ROC to the subsequent application record, as well as a message to eView.
NOTE 1:
If the favorable or partially favorable action on the readjudication request renders the subsequent application moot, no action on the subsequent application is necessary. The readjudication decision will acknowledge the subsequent pending claim and state that the decision on the readjudication request has rendered this claim moot.
NOTE 2:
If OAO remands the readjudication request pursuant to the instructions in subsection IV.B.5.b, the HO will issue a recommended decision. OAO will provide notification to the component where the subsequent application is pending when the AC-level decision on the readjudication request is issued.
As part of the case screening process for all cases, OHO and OAO staff should inspect open eView records to determine if there is a readjudication requests being processed.
VII. Questions and Answers
What does the Earley AR require?
The Earley AR requires that when adjudicating a subsequent claim with an unadjudicated period arising under the same or a different title of the Act as the prior claim on which there has been a final ALJ or AC decision, an adjudicator must consider a finding of a claimant's RFC or other required findings made at a step in the sequential evaluation process for determining disability in the prior claim as evidence in light of all relevant facts and circumstances.
The Earley AR directs the adjudicator of a subsequent disability claim to consider findings of RFC or other findings required under the sequential evaluation process made in a final ALJ or AC decision on a prior claim. What are the “other” findings to which the AR applies?
Findings that are "required" at a step in the sequential evaluation process provided under 20 CFR 404.1520 or 416.920 include:
Step 1: A finding as to whether a claimant's work activity constitutes substantial gainful activity (SGA);
Step 2: A finding concerning whether a claimant has a medically determinable impairment or combination of impairments that is severe and whether the impairment or combination of impairments meets the duration requirement;
Step 3: A finding concerning whether a claimant's impairment(s) meets or equals a listed impairment in Appendix 1 to Subpart P of 20 CFR Part 404;
Step 4: A finding concerning whether the claimant worked in the past and whether that work constituted past relevant work (PRW); a finding of the physical and mental demands of the claimant's PRW; a finding on whether the claimant can perform PRW as they previously performed it or as it is generally performed in the national economy;
Step 5: A finding of a claimant's age; a finding of a claimant's education; a finding of a claimant's PRW, including, as appropriate, the skill level of a claimant's PRW and whether a claimant's skills are transferable; a finding regarding other matters relevant to step 5, such as whether a claimant meets a medical-vocational profile; and a finding whether based on the claimant's RFC and the other step 5 findings, a claimant can do other work.
NOTE 1:
For findings required under the evaluation process for a child applying for Title XVI benefits based on disability, see 20 CFR 416.924 and POMS DI 52707.010B.1..
NOTE 2:
An assessment of the claimant's symptoms is not a finding that is required at a step in the sequential evaluation process described in 20 CFR 404.1520, 416.920, or 416.924 and is not a required finding to consider under the Earley AR.
The Earley AR requires the adjudicator of a subsequent disability claim with an unadjudicated period to consider certain findings made in a final ALJ or AC decision on a prior disability claim as evidence. How does an adjudicator of a subsequent claim consider this evidence?
In determining the probative value of the prior findings as evidence, the adjudicator must consider all relevant facts and circumstances on a case-by-case basis and will consider such factors as:
Whether the fact on which the prior finding was based is subject to change with the passage of time, such as a fact relating to the severity of a claimant's medical condition;
The likelihood of such a change, considering the amount of time between the period previously adjudicated and the period under consideration in the subsequent claim; and
The extent that evidence not considered in the final decision on the prior claim provides a basis for making a different finding with respect to the period being adjudicated in the subsequent claim.
NOTE:
In addition, the adjudicator should consider if, after the date of the final decision on the prior claim, there has been a change in the law, regulations, or rulings affecting the finding or the method for arriving at the prior finding. If so, the prior finding, considered as evidence, may be less probative.
The Earley AR indicates that an adjudicator generally should pay particular attention to the lapse of time between the prior claim and the subsequent claim. How does an adjudicator consider the impact of the passage of time?
The likelihood that a fact has changed generally increases as the time between the previously adjudicated period and the subsequent period increases. In situations where minimal time has passed, and no or very little new evidence has been introduced, it is more likely that the prior finding will remain the same.
What are “static” and “non-static” facts and how must an adjudicator evaluate these facts from the prior ALJ or AC decisions?
Static facts, such as the mental and physical demands of a claimant's PRW or the skill levels of the claimant's PRW, are facts not expected to change with the passage of time.
Non-static facts, such as the severity of the claimant's medical condition, the claimant's RFC, or whether a claimant performed a job recently enough for it to qualify as PRW, are facts that may be subject to change with the passage of time.
The adjudicator must consider all relevant facts and circumstances on a case-by-case basis, while keeping in mind that new evidence presented in the current claim could change how to evaluate static and non-static facts from a prior ALJ or AC decision.
Does the Earley AR requirement to consider prior findings as evidence affect the method of adjudication under the sequential evaluation process with respect to the subsequent claim?
Yes—to the extent that the adjudicator of the subsequent claim must first consider each step in a prior finding as evidence. The sequential evaluation order of consideration is unchanged, but a question at each step when applying the Earley AR is how much evidentiary value should be given to a “required” prior finding in that step (see subsection VII Q&A 3).
What decision rationale is necessary to comply with the Earley AR?
Decisions in cases in which the Earley AR applies must refer to the Earley AR, and the adjudicator must make clear that the adjudicator considered the prior finding as evidence in light of all relevant facts and circumstances.
While the adjudicator must acknowledge consideration of the ALJ or AC findings in the prior disability decision and provide an explanation as to any deviation from those findings; it is not necessary for the adjudicator to document consideration of the prior findings at each step of the sequential evaluation process.
Does the Earley AR apply if the prior ALJ or AC final decision was issued for a Title XVI claimant who was under age 18 and that claimant has since attained the age of 18 and has a subsequent claim, with an unadjudicated period?
No. The Earley AR does not apply when the requirements for disability on one claim under the same or a different title (e.g., a prior Title XVI child disability claim) are not identical to the requirements for disability on a subsequent claim (e.g., a current Title II or Title XVI adult disability claim).
Under the Earley AR, how should an adjudicator consider a prior finding if it was made based on a now obsolete standard?
If the new criteria are different from those in effect at the time of the prior decision, a new standard is involved. The difference in standards is a reason why the prior finding, considered as evidence, may be less probative. The adjudicator must make a new finding in the current decision using the current standard.
Under the Earley AR, how should an adjudicator consider a prior finding that was based on an error?
If the criteria for reopening are met, an adjudicator may reopen the prior decision (20 CFR 404.989 and 416.1489). If the decision on the prior application is reopened and revised and the revised decision renders the subsequent application moot, then the prior findings need not be considered as evidence.
If the prior decision cannot be reopened and revised (See 20 CFR 404.988 and 416.1488) then the prior finding(s) must be considered as evidence. However, an error in the prior decision or new and material evidence are reasons why a prior finding, considered as evidence, may be less probative.
How does the Earley AR apply if there is more than one prior claim with an ALJ or AC decision?
The answer depends on when the final ALJ or AC decisions on the prior claims were issued. See the below table for guidance and POMS DI 52707.020B.2.d.
Prior Claim Scenarios
Earley Application
If the most recent ALJ or AC decision was issued before 6/27/18 (the date of the Earley court decision).
Consider relevant findings only from the most recent ALJ or AC decision.
If the most recent ALJ or AC decision was issued on or after 12/2/2024 (effective date of the Earley AR).
Consider relevant findings only from the most recent ALJ or AC decision.
If the most recent ALJ or AC decision was issued during the period from 6/27/18 – 12/1/2024 (an interim period case) and there is another pre-Earley ALJ or AC decision (i.e., issued before 6/27/18).
Consider relevant findings from both decisions.
If the most recent ALJ or AC decision was issued during the period from 6/27/18 – 12/1/2024 (an interim period case) and there are two or more pre-Earley ALJ or AC decisions.
Consider relevant findings from the interim period case and the most recent pre-Earley ALJ or AC decision.
When will the Earley AR be applied to a claim in an interim period case (from June 27, 2018 through December 1, 2024)?
The Earley AR will be applied to interim period case claims under two scenarios:
An individual requests application of the Earley AR to the interim period claim pursuant to POMS DI 52707.010C.1. and POMS DI 52707.015; or
The interim period case is discovered by an adjudicator in the course of development/adjudication of a current claim and the adjudicator concludes (without any request from the claimant) that application of the Earley AR would change the final determination or decision on the prior claim to be more favorable to the claimant.
Note that the application of the Earley AR to an interim period case is different from the rules for reopening and revising final determinations or decisions. A claim on which there was a final determination or decision in the interim period may be readjudicated under the procedures in subsection IV at any time, even if the case could not be reopened under 20 CFR 404.988 and 416.1488.
When an interim period case is readjudicated what law applies?
The period covered by a readjudication is the same period that was covered by the prior decision being readjudicated.
The adjudicator will apply the rules in 20 CFR 404 Subpart P (20 CFR 404.1501-1599) and 20 CFR 416 Subpart I (20 CFR 416.901-416.999d) used to determine whether an individual was disabled or blind that were in effect at the time of the final interim period decision. See the Code of Federal Regulations (Annual Edition) for prior rules. For example:
The adjudicator will apply the listings that were in effect at the time of the final interim period decision. For a comprehensive list of obsolete listings, see POMS DI 34100.000.
The adjudicator will consider an individual's residual functional capacity and vocational background using the rules that were in effect at the time of the final interim period decision.
Are Drug Addiction and Alcoholism (DAA) redeterminations under Pub. L. No. 104-121 subsequent claims for purposes of the Earley AR? Is a conclusion that DAA “is material” or “is not material” a finding that is required at a step in the sequential evaluation process for purposes of the Earley AR?
DAA redeterminations are considered subsequent claims for the purposes of the Earley AR. When an individual with DAA is found disabled considering the effects of DAA, a determination must then be made excluding the effects of DAA to determine whether DAA is material to the finding of disability. Adjudicators must use a two-part process. First, they must follow the sequential evaluation process, considering all of a claimant's impairments, including DAA, to determine whether the claimant is disabled. Second, if the claimant is found disabled under the first part of the process, adjudicators must again follow the sequential evaluation process, but without considering the effects of DAA, to determine whether the claimant would be found disabled if they were no longer using drugs or alcohol. If the individual would not be found disabled under the second part of the process, DAA is material to the determination of disability. If the individual would be found disabled, DAA is not material.
When there is a prior decision in which an ALJ or the AC has set out findings showing how the conclusions were reached for both of these steps in the sequential evaluation process, the adjudicator of a subsequent claim must consider the findings from both parts of this two-step process when adjudicating a DAA case under the requirements of the Earley AR. If there is a prior decision in which an ALJ or the AC found that DAA was material or not material but without providing support for the materiality conclusion, then there will be no findings that are relevant to the decision of whether an individual's DAA is material to the determination of disability.
In adjudicating the subsequent claim, the adjudicator must consider the prior required findings from the ALJ's or AC's decision about whether the individual is disabled under the first part of the DAA process. If the claimant is determined to be disabled under the first part of the DAA process, consider such findings as evidence to be evaluated along with the other evidence in the subsequent claim in determining disability under the second part of the DAA process.
What if the prior file has been lost or destroyed?
Generally, files of denied claims are retained in the National Records Center for up to 5 years.
If the prior file is lost or destroyed, it may still be possible to apply the Earley AR if the adjudicator can obtain a copy of the final ALJ or AC decision on the prior claim. Therefore, the adjudicator should attempt to obtain a copy of the prior ALJ or AC decision from the claimant, the representative, or any available ALJ or AC files. If a copy of the prior ALJ or AC decision is available, the adjudicator will review the decision to determine the relevant facts and circumstances on which the ALJ or AC based their prior finding(s).
If the adjudicator cannot obtain a copy of the prior ALJ or AC decision, they cannot apply the Earley AR because there is no way of knowing what the prior findings were. Accordingly, if the prior file is lost or has been destroyed and the ALJ or AC decision cannot be located anywhere in SSA or by the claimant or claimant's representative, the AR cannot be applied.
For an interim period case, if the prior file has been lost or destroyed and the adjudicator cannot obtain a copy of the prior decision, the interim case cannot be readjudicated.
For a post-effective date case, if the prior file has been lost or destroyed and the adjudicator cannot obtain a copy of the prior decision, they should: admit all documentation into the record; ensure that the current record is fully developed; and issue a decision based on the available evidence of record.
VIII. Inquiries
Hearing office personnel should direct any questions to their Regional Office. Regional Office personnel should email the Division of Field Procedures in the Office of the Chief Administrative Law Judge at |||OHO OCALJ DFP. OAO personnel should direct any questions through their management chain and Division Chief AAJ. Management may refer questions to the Executive Director's Office at ^DCARO OAO.