Last Update: 9/08/05 (Transmittal I-3-36)
When a claimant or representative submits additional evidence in connection with a request for review, the analyst must determine whether the evidence is new and material, and if so, whether it warrants any change in the ALJ's decision. In a disability case, the evidence submitted must concern both the issues and the time period considered by the ALJ. See I-3-3-6 B. for a discussion of the closed record provisions. If the additional evidence is relevant to the issues and time period considered by the ALJ, and thus is material, the analyst must also decide whether it is new.
See I-3-3-6 A. for definition and general discussion of new and material evidence.
When evidence is new and material but does not provide a basis for granting review, the analyst must provide language for the denial notice assessing the “weight of the evidence” (20 CFR 404.970 and 416.1470) and explain why the evidence does not justify granting the request for review.
New evidence is not material to the issues considered by the ALJ if, for example:
the evidence shows a worsening of the condition after the expiration of insured status in Title II disability cases; or
the evidence shows a worsening of the claimant's condition and/or the onset of a new impairment after the date of the ALJ's decision.
When evidence is new but not material, the analyst must provide language for the denial notice explaining why the evidence is not material.
When evidence received duplicates evidence of record (all or part of an exhibit), the analyst must provide language for the denial notice describing the duplication and referring to the location of the evidence in the record.
When the “closed record” provisions apply, the Appeals Council will consider only the period through the date of the ALJ hearing decision and will not consider (based on the pending application) possible entitlement after that date. New evidence pertaining to the period after the ALJ hearing decision is “material” to the decision on the application before the Appeals Council if it can reasonably be related to the period on or before the date of the ALJ hearing decision. The Appeals Council only evaluates evidence that is not new and material to the period through the date of the ALJ hearing decision to the extent necessary to determine that it is not new and material.
If new evidence received with the request for review does not relate to the period on or before the date of the ALJ hearing decision, the analyst will return the evidence to the claimant with a notice as described in 20 CFR 404.976(b) and 416.1476(b) of the regulations, regardless of who submitted the evidence or whether the evidence suggests that the claimant may have met the requirements for entitlement after the date of the ALJ hearing decision. In situations where the new evidence is offensive or detrimental to the claimant's health, see I-3-6-1 C. 2. The analyst will retain a copy of the evidence in the claim file.
NOTE:
See I-3-5-90, Exhibit for temporary instructions regarding the requirement for detailed discussion of evidence and contentions in denial notices.