And so you find yourself in the position of having pursued your Social Security disability claim for years. You’ve applied and been denied repeatedly, and finally in front of an Administrative Law Judge (ALJ). Now you face the prospect of having to start the process all over again. The question now arises as to whether you will lose your rights to any benefits for the time period leading up to that ALJ denial. You are now faced with the possibility that even if you were to be successful on a new application, benefits may not be payable the time period that has already been decided by the ALJ.
The Res Judicata doctrine (with the words Res Judicata meaning the thing having been decided) raises its head in any situation where an ALJ has issued an unfavorable decision in your case and where that decision is not facing the possibility of further appeal. Thus, the issue arises where no further appeal has been taken and is pending before the Appeals Council, or if the decision was upheld at the Appeals Council level and either no further appeal has been undertaken or was denied at the Federal District Court level (and then no further appeal was timely taken at that point) Failing to pursue the matter further, within the time period prescribed for appeal following a denial, will cause the ALJ unfavorable decision to be come final.
As a Social Security lawyer assisting disability claimants throughout Maine, Massachusetts and New Hampshire, I frequently encounter such situations and assist individuals with filing new Social Security disability claims whereby we attempt to reopen the past denial with the hopes of recovering the retroactive benefits going back to when one first became disabled from working. The key to reopening past claims involving an ALJ denial (which has become final) is understanding what the doctrine of Res Judicata means.
The issue of Res Judicata is even more burdensome for those who have faced an ALJ denial through the time period for which they remain insured (that is to say, after one’s date last insured (DLI) for Social Security disability insurance (SSDI) benefits. In such a circumstance, reopening the past claim so as to be found disabled prior to one’s DLI is required in order to be entitled to receive any SSDI benefits at all.
The Social Security disability regulations provides guidance as to when the doctrine of Res Judicata applies at 20 C.F.R. §404.957(c)(1). In order for the doctrine to apply, and to thereby avoid relitigation of that time period (and potential reopening of that claim), there needs to be a previous determination about the claimant’s rights, under the same subpart of the regulations, on the same facts, on the same issues and the prior determination has become final. Our focus, ordinarily, will therefore focus on whether all of the relevant issues were explored the first time around.
Many times, we will find that either a prior attorney, representative or claimant will fail to focus on a specific disabling issues as they have decided to focus on perhaps other issues that they felt were more compelling at the time. For instance, someone may have severe orthopedic concerns and may have failed to mention the debilitating nature of their gastrointestinal problems (which might be causing abdominal problems or perhaps constipation or diarrhea issues). Certainly, these issues may be quite disabling in and of themselves, but may not have been the subject of one’s attempt to obtain Social Security benefits on a new application. Or the ALJ deciding the claim, even if such issues were raised by the claimant, may have failed to decide those issues in his/her prior decision.
New and material evidence that speaks to the prior period of time, and likewise evidences the fact that certain conditions were more severe than previously thought, can serve as a basis for a reopening of the prior claim (with a new determination that one has remained disabled going back prior to the date of the ALJ denial). In taking a look at the prior Social Security file and what records were reviewed, it may become obvious that certain providers’ records had not been updated for a number of months prior to the actual decision date or may have been missing altogether. These additional records can serve as a basis for finding that the medical condition was in fact more severe than initially determined. The regulations similarly provide that if there has been a change in the law since the time of the prior determination, this can serve as a basis for reassessment of a period of disability that had been the subject already of an ALJ’s review (and subsequent denial).
If you have been denied by an ALJ already and you are looking into filing a new Social Security disability application, get the assistance of an experienced Social Security disability attorney prior to doing so. Contact the Law Offices of Russell J. Goldsmith to discuss how we might be able to assist you with this process.