TN 12 (07-24)

DI 27515.001 Collateral Estoppel Issues and Title II Claims Involving Possible Earlier Onset

A. Collateral estoppel policy

We will not again decide the issue of disability if, in a prior final determination or decision (and any subsequent continuance determination or decision), we have already decided that the individual is disabled for the time period covered by the new application and all of the following conditions are met:

  1. 1. 

    Both the prior determination or decision and new claim require application of the same statutory definition of disability.

  2. 2. 

    We have not made an intervening medical determination or decision finding that the individual’s disability ceased.

  3. 3. 

    The claimant has not engaged in substantial gainful activity (SGA) since the prior established onset date (EOD).

  4. 4. 

    The EOD in the prior claim is on or before the date when the nonmedical requirements for entitlement are last met in the new claim.

  5. 5. 

    The record with the prior favorable disability determination or decision is not in terminated status.

  6. 6. 

    We do not have reason to believe that the prior disability determination or decision was wrong.

NOTE: The Title II claims processing procedures described in this section are generally for the field office (FO) and Disability Determination Services (DDS) but may also apply to the Program Service Center (PSC) Disability Processing Branch (DPB) and Disability Processing Unit (DPU), as applicable.

B. Jurisdiction of disability claims involving collateral estoppel

1. FO jurisdiction

When the criteria in DI 27515.001A in this section are met and adopting the prior disability determination or decision would be fully favorable in a new initial claim or reconsideration, the FO has jurisdiction for applying collateral estoppel.

For additional information about FO processing requirements, see DI 11011.001.

2. DDS jurisdiction

When the criteria in DI 27515.001A in this section are met, but the potential onset date (POD) for a new Title II claim is before the EOD in the prior claim, the DDS has jurisdiction for making a disability determination covering the period from the new claim POD to the prior EOD.

NOTE: If a collateral estoppel case is pending with the DDS and adoption of the prior disability determination or decision would be fully favorable for the new claim, return the case to the FO with “no determination” (ND) reason “FO determination requested.” Add a message to the folder stating “Adoption of the prior disability determination or decision would be fully favorable for the new claim. The FO must determine whether collateral estoppel will apply per instructions in DI 11011.001.” For instructions on adding messages to the certified electronic folder (CEF), see DI 81020.090B. For more information on ND processing, see DI 81020.127.

C. FO processing of Title II collateral estoppel claims with DDS jurisdiction of EOD determination

When the POD in a subsequent Title II disability claim precedes the EOD from the prior favorable determination or decision under a different title or for a different benefit under the same title, the FO cannot apply collateral estoppel to issue a fully favorable determination based on the prior disability determination or decision.

In these situations, the FO is responsible for reviewing the applicable case information to determine that the criteria in DI 27515.001A in this section are met and collateral estoppel would apply from the prior EOD. The FO then:

  1. 1. 

    Obtains the necessary forms, e.g., SSA-3368 (Disability Report–Adult) and SSA-827 (Authorization to Disclose Information to the Social Security Administration).

  2. 2. 

    Identifies the case by entering remarks “The FO finds that collateral estoppel would apply from the prior EOD of [mm/dd/yyyy] - a determination is needed on a possible earlier onset date before the benefits may be issued on the new claim.” with the applicable POD on the SSA-3367 (Disability Report–Field Office).

  3. 3. 

    Adds the case flag for “Potential Collateral Estoppel Issues Apply.”  

  4. 4. 

    Sends the claim to the DDS for a determination on whether the evidence supports the earlier onset applying the sequential evaluation or the prior EOD must be adopted.

D. DDS processing of Title II collateral estoppel claims

The DDS will only process collateral estoppel cases that require consideration of the period before the prior EOD.

1. Development

Develop evidence to consider the period from the POD to the prior EOD following initial claim development procedures.

2. Evaluation

The adjudicative team, including the medical consultant and psychological consultant, as appropriate, evaluates the period from the POD to the prior EOD using the sequential evaluation process to determine whether an earlier EOD is supported by the evidence. For the period beginning with the prior EOD, the DDS will not redetermine the issue of disability and must adopt the prior favorable determination or decision.

IMPORTANT: Do not adopt the prior finding of disability if any of the criteria in DI 27515.001A in this section is not met. When collateral estoppel does not apply and a disability determination is necessary for the full period covered by the application, the DDS must complete development and make a new determination that may be favorable or unfavorable based on the evidence in the new claim. Before requesting new evidence, consider development already undertaken and relevant evidence in the prior folder(s), following instructions in DI 22505.006B.1.

3. Documentation

Document sequential evaluation findings for the unadjudicated period as with any initial claim.

a. Preparing the SSA-831

Prepare the SSA-831 following instructions in DI 26510.000 and:

  • In Item 15, enter the EOD.  If disability cannot be established before the prior EOD, use the prior EOD.

  • In Item 22, if disability is established before the prior EOD, enter the regulation basis code (RBC) that reflects the nature of the favorable determination for the earlier period under adjudication. If disability is not established earlier than the EOD for the prior favorable determination or decision, enter RBC “CE” (collateral estoppel - Title II). For RBC reference tables, see DI 26510.045.

  • In Item 17, enter the appropriate diary information based on the individual case facts in the prior favorable determination or decision and the new claim. For information on entering the diary, see DI 26510.020.

NOTE: Set a medical improvement expected (MIE) diary to mature in 1 year if the diary on the prior determination or decision was never scheduled, or if the prior determination or decision was scheduled an MIE or vocational diary that is due, past due, or will be due within 3 months. When the prior favorable determination or decision was medical improvement possible (MIP) or medical improvement not expected (MINE), set an MIP or MINE diary based on the individual case facts. For more information on determining the appropriate diary, see sections in DI 26525.000.

b. Preparing the rationale

On the disability determination explanation (DDE):

  • State that the EOD is based on the prior EOD from which collateral estoppel applies and the POD provided by the FO.

  • Discuss your analysis of the medical and nonmedical evidence used to make the disability determination for the period from the POD to the prior EOD.

  • If the EOD in the new claim will differ from the POD, explain why the evidence does not support the earlier onset date.

For other elements to include in the DDE, see DI 26515.001. For onset policy, see sections in DI 25501.000.

c. If the determination is not fully favorable

Prepare and send the personalized disability notice (PDN) with a personalized disability explanation (PDE) clearly explaining the basis for the EOD. For information on notifying claimants of partially favorable determinations, see DI 25501.280.

NOTE: A subsequent claim does not itself raise a continuing disability review (CDR) issue on the existing entitlement, even when the determination on the new claim is unfavorable or the diary on the existing claim is expired. For events that may initiate a CDR, see DI 13001.005. For information on medical improvement (MI), see DI 28010.000. For information on the specific exceptions to MI, see DI 28020.001.

E. New claim pending with a CDR reconsideration

When a new initial claim is concurrently pending with a medical CDR reconsideration under a different title or claim type and, upon reconsideration, the DDS decides to reverse the cessation to a continuance:

  • If the concurrent determination would be fully favorable in the new initial claim, issue the determination for both the CDR reconsideration and the new claim.

  • If the concurrent determination would be less than fully favorable in the new initial claim, issue the reconsidered CDR determination and return the new claim to the FO with ND reason “FO determination requested.”

When returning the new claim with ND, add a message or SSA-5002 (Report of Contact) to the folder stating “Initial claim processing stopped because the new application became a potential collateral estoppel case when the prior cessation was reversed. The FO must determine whether collateral estoppel will now apply per instructions in DI 11011.001.”


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427515001
DI 27515.001 - Collateral Estoppel Issues and Title II Claims Involving Possible Earlier Onset - 07/12/2024
Batch run: 07/12/2024
Rev:07/12/2024