Effective Dates: 09/24/2026 - Present Previous | Next

TN 4 (09-26)

DI 27501.001 Medical Reopenings and Revisions: Pertinent Definitions and Related Policy

CITATIONS:

20 CFR 404.902 – 404.905, 416-1402 – 416.1405, 404.987 – 404.996, 416.1487 – 416.1494

A. Definitions

1. Medical reopening

A medical reopening is a formal review of an administratively final determination or decision to admit new and material medical evidence or to reevaluate the evidence used in the prior determination or decision. A reopening generally results in a more favorable determination or decision although an adverse medical reopening is occasionally appropriate.

For additional information on when reopening is appropriate see DI 27501.005.

NOTE: The term “determination” refers to adjudications at the initial and reconsideration levels, and “decision” refers to adjudications at the Administrative Law Judge (ALJ) and Appeals Council (AC) levels.

a. Adverse Medical Reopening (AMR)

An AMR is reopening of an administratively final initial or reconsideration-level allowance determination or continuing disability review (CDR) continuance based on medical factors that revise the determination to a denial, cessation, later onset, or closed period determination.

An AMR does not includes (1) adverse reopenings based on non-medical factors, such as substantial gainful activity (SGA) or field office (FO) determinations, or (2) medical reopenings that are not adverse, such as a reopening of a denial resulting in an allowance or a more favorable outcome.

An AMR does include cases that are reopened due to fraud or similar fault that involve medical matters. This does not include non-medical issues outside of DDS jurisdiction such as SGA and unreported work activity.

 

b. Reconsideration of an Adverse Medical Reopening (RAMR)

A RAMR occurs when an individual requests a reconsideration of an AMR. An individual has the right to request a reconsideration and receive a disability hearing if they have been receiving disability benefits and we make an initial or revised determination based on medical factors that the individual is not disabled because the impairment ceased, did not exist, or is no longer disabling.

A Disability Hearing Officer (DHO) review is not afforded to an individual who requests a RAMR for a less favorable onset. If an individual requests a RAMR for a less favorable onset, we follow the regular reconsideration process covered in DI 12005.000 and DI 27001.000. An appeal of an unfavorable RAMR for onset may ultimately result in an Administrative Law Judge (ALJ) review.

2. Revision

Any change in the end result or basis of a final determination or decision.

3. Final determination or decision

A determination or decision (initial or revised) is final as of the date of the notice unless:

  1. a. 

    it is timely appealed (or a civil action is filed); or

  2. b. 

    it is appealed late but good cause for late filing of an appeal or civil action is found; or

  3. c. 

    the Appeals Council (AC) takes jurisdiction on its own motion within 60 days of the date of the Administrative Law Judge (ALJ) decision; or

  4. d. 

    the AC denies a request for review (does not issue a decision), in which case the ALJ decision is the final decision; or

  5. e. 

    it is reopened and revised.

NOTE: Form SSA-L1157 Social Security Notice and SSA-L1157-SI Supplement Security Notice - are interim notices and not final notices.

B. References to related policy

1. Late filing of an appeal

Appeal Filing Issues (DI 27010.001)

2. Rules for reopening

Conditions for Reopening a Final Determination or Decision (DI 27505.001)

3. Medical improvement review standard (MIRS)

Legal Standard for Determining if Disability Continues (DI 28005.001.)

4. Adoption of the prior determination or decision

Applying Collateral Estoppel in Disability Claims (DI 11011.001)

5. Refilings for the same period (Res Judicata)

Field Office Res Judicata Development and Processing (DI 27516.001)

6. Period adjudicated

Period Covered by a Final Determination or Decision: “Period Adjudicated” (DI 27510.001)

7. Reopening and revision of a CDR determination

Reopening of Prior Favorable Initial Continuing Disability Review (CDR) Cases (DI 28501.015)

8. Good cause

Good Cause for Reopening (DI 27505.010)

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427501001
DI 27501.001 - Medical Reopenings and Revisions: Pertinent Definitions and Related Policy - 09/24/2026
Batch run: 09/24/2026
Rev:09/24/2026