Res judicata and Collateral Estoppel

Res judicata

  • Res judicata applies when:
    • The law or regulations pertaining to the alleged disabling condition have not changed.
    • And the subsequent claim presents no new facts or issues which were not considered in making the prior decision
  • For subsequent claims where the prior claim was denied through the DLI, POMS DI 27516.001-010 instructs the DDS to make a substantive decision in cases when the revised listings have become less restrictive.
    • A list is provided in DI 27516.010 of those listings that were considered to be less restrictive in 1994.
  • Due to the extensive changes to the musculoskeletal listings, the Office of Disability is taking the following position:
    • Res judicata can not be applied to the revised musculoskeletal listings.
    • A new determination should be prepared for all subsequent claims involving a musculoskeletal impairment if the prior claim was denied before 2/19/02.
  • The musculoskeletal listings have been so extensively revised that, while they are not in general, less restrictive.
    • The "issues" are different and include the use of functional criteria to indicate listing level severity.
    • The same is true for new claims involving inflammatory arthritis listings 14.09A, C, D, and E and 114.09 A, C, D, and E.

If the prior claim was denied before 02/19/02 and was denied through the date last insured, the prescribed period, or age 22, a new substantive determination should be prepared for:

  • All subsequent claims involving a musculoskeletal impairment.
  • Those claims evaluated under inflammatory arthritis listings 14.09A, C, D, and E and 114.09 A, C, D, and E.

 

  • However, new listings 14.09B and 114.09B for Ankylosing spondylitis or other spondyloarthropathies are the exception.
    • These listings have been extensively revised, BUT the criteria to meet them are more restrictive - the required angle of fixation has increased from 30 degrees to 45 degrees.
    • Therefore, absent any new facts, subsequent claims involving ankylosing spondylitis or other spondyloarthropathies may be denied based on res judicata.
    • Res judicata can be applied to new claims evaluated under these listings.

    Collateral estoppel

    • Changes in the musculoskeletal listings do not affect collateral estoppel.
    • If an issue has already been decided in a previous determination or decision, SSA accepts it unless there is a reason to believe it was wrong.
      • SSA is adopting a prior decision and not making a substantive decision.
    • A change in the listings does not constitute an error or preclude adoption.
      • For adoption purposes, SSA considers a change in the rules for determining disability or a change in the definition of disability, not a change in the listing criteria.