Basic (03-86)

DI 42005.001 Overview

GN 03102.100 discusses the requirements for filing a request for reconsideration and includes the policies and general procedures for developing and processing such requests. Additional instructions for DO and DDS documentation of reconsideration requests are contained in DI 12005.001 and DI 27001.001. If a reconsideration case is received without sufficient documentation for a sound determination, develop additional evidence through the district office. Formal requests for reconsideration (on Form SSA-561-U2) and informal requests are received in the appropriate module receipts point. The Module Records Maintenance Clerk (RMC-ODO) will process routing and transfer of requests (where claim is not ODO jurisdiction) and association with any related claims folder. The RMC/ ODO will classify the material (medical issue for RECONE and nonmedical for RECONR) and route to the appropriate staffs for handling.

In the Processing Center (PC), Disability Reconsideration issues are the jurisdiction of the Disability Review Section (DRS) Disability Examiner Consultant (DEC). Individual Offices may issue local instructions regarding jurisdiction of reconsideration cases which may differ from this subsection. The material is associated with the folder in the PSC Processing Module by the Records Analysis Clerk (RAC) and routed to the DRS.

The Reconsideration Examiner (RECONE in ODO) and Disability Examiner Consultant (DEC in DRS) are responsible for the following:

1. A. 

   Review of reconsideration decisions of medical/vocational and SGA issues.

2. B. 

   Whereabouts unknown/failure to cooperate-requested evidence of current severity now submitted.

3. C. 

   Review of combined initial and reconsideration determinations (see DI 27010.001 and DI 27010.005).

4. D. 

   Review of continuing disability considerations in blindness cases - title II only. (Note under age 54 cases are handled by RECONE/ODO. Over age 54 claims are the responsibility of the DEC/DRS.) (See DI 13010.135)

5. E. 

   Pre-effectuation review of reconsideration determinations of continuing eligibility. (This review must be conducted at least once every 3 years on nonpermanent impairments.)

6. F. 

   Review of reconsideration issues on 301 (Vocational Rehabilitation) issues (this includes reconsideration of denial by the DDS on the initial level and cessation of benefits due to noneligibility.

7. G. 

   Review of reconsideration determinations of cessation of benefits due to expiration of the trial work period. (Extended Period of Eligibility (EPE) eligibility is also determined).

8. H. 

   Subsequent DIB or DWB claims filed after a prior Administrative Law Judge, Appeals Council, or court decision - claimant submits new evidence (see GN 04001.001).

9. I. 

   Reconsideration determinations of continuing disability cases when the DDS has transferred jurisdiction under emergency clause. NOTE: DI 43520.060 contains instructions for preparation of 833 determinations.

10. J. 

    Reopening of prior SGA decisions initial and/or continuance. (See DI 10501.001 — DI 10501.055)

Jurisdiction and functions of the reconsideration review (RECONR) are found in GN 03102.175.

Reconsideration of title XVI or dual entitlement title II-XVI cases involving initial determination of cessation (medical/vocational or blindness) are referred directly to the Administrative Law Judge.