If there is evidence of a prior determination, review the rules for reopening the
prior determination found in the following POMS references:
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DI 27501.001 Reopenings and Revisions: Pertinent Definitions and Related Policy
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DI 27501.005 Reopening and Revising a Determination or Decision
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DI 27505.001 Conditions for Reopening a Final Determination or Decision
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DI 27510.001 Period Covered by a Final Determination or Decision: “Period Adjudicated”
If you are able to reopen the prior determination, reopen and revise the prior denial
and establish the EOD as of the date disability began. If the EOD is not fully favorable,
prepare a personalized disability explanation (PDE) and send it with an interim allowance
notice. (See DI 25501.280 Notifying Claimants of Partially Favorable Allowances, NL 00705.226 Reopening 6 - Denial to Partially Favorable Onset (Not AOD) Title II, and NL 00705.231 Reopening 7 - Denial to Partially Favorable Onset (Not AOD) Title XVI.)
If you are not able to reopen the prior determination and, if an exception to establishing
the EOD within a previously adjudicated period does not apply, generally the EOD can
be no earlier than the day after the final disposition date stamped or printed on
the denial notice for the prior claim. Do not use the date we prepared the prior SSA-831
(Disability Determination and Transmittal) when establishing the EOD.
See DI 81020.130D Electronic Case Closure to determine the correct date of the prior personalized denial
notice (PDN) in electronically prepared cases.
See DI 27510.005D.2. Subsequent Claim Filed to determine if an exception to establishing the onset date
of disability within the previously adjudicated period applies.
If you are not able to reopen the prior determination or decision but an exception
to establishing the EOD within the prior adjudicated period applies, establish onset
as of the date the disability began. If the EOD is not fully favorable, prepare a
personalized disability explanation (PDE) and send it with an interim allowance notice.
(See DI 25501.280 Notifying Claimants of Partially Favorable Allowances.) To determine if an exception
to establishing the EOD within the previously adjudicated period applies, see DI 27510.005D.2.
If reopening a prior claim, prepare a detailed rationale using the format outlined
in DI 27536.005.
NOTE: Always attempt to obtain the prior folder(s) before reopening (see DI 20505.010C Prior Folder(s) Exists and a New Claim is Filed). There are circumstances that permit
reopening without the prior folder, such as lost or destroyed folders (see DI 27510.005H Subsequent Claim Filed).