If the appropriate CPD is unclear, the adjudicator must review any available documents
from the prior favorable medical determination. For example, the SSA-831, SSA-832,
or SSA-833 may contain the regulation basis code or vocational rule that was used
to support the favorable determination if the medical assessments cannot be located.
If there is an inconsistency between the information entered on the SSA-831 and the
medical assessment (e.g., the CPD medical assessment indicates the individual met
listing 4.02 but the SSA-831 indicates the individual met listing 4.06), the adjudicator
must carefully review the available evidence to determine the correct basis for the
decision to follow the CDR sequential evaluation process and determine if medical
improvement has occurred.
If the CPD folder is lost and the adjudicator cannot determine the CPD date or basis,
the adjudicator must follow instructions in DI 28035.015A to attempt to identify the CPD date prior to reconstruction. After identifying the
CPD, the adjudicator follows the instructions in DI 28035.020 to reconstruct the folder.
Queries may also be a useful tool to help determine the basis for the CPD (including
application of a collateral estoppel adoption determination by the FO) or resolve
inconsistencies, see DI 28035.015B.
The table contains examples of useful data to determine the CPD that may be found
within common queries, such as the Supplemental Security Income Display (SSID), Full
Account Query (FACT - Master Beneficiary Record or MBR display), Disability Determination
Services Query (DDSQ), or Processing Center Action Control System (PCACS):
Examples of useful data in common queries
Field Indicator
|
Query Type
|
Query Line
|
Query Field Code
|
Reference(s)
|
Date of Disability Onset
|
DDSQ (accessed through PCOM - Query Master- DDSQ; or via PCOM - Option 18 (NDDSS Master
File Menu), then Option 1 (DDS Query))
FACT or SSID
|
Case data
DISB
|
OND
DDO
|
SM 06002.200
SM 01601.595
|
State Closure Date (date the case cleared Disability Determination Services (DDS))
|
DDSQ
|
Case data
|
SCD
|
SM 06002.200
|
CPD date
|
DDSQ
|
Case data
|
ESD (examiner signature date)
|
SM 06002.200
|
Disability Diagnosis Code
|
DDSQ
FACT or SSID
|
Case data
DISB
|
DSI (Disability Identification Data – Permanent disability code, primary diagnosis
code, medical diary reason code)
DIG
|
SM 06002.200
SM 01601.595
|
Medical Diary Date
|
DDSQ
FACT or SSID
|
Case data
DIAR
|
DIA (displays diary type and diary maturity date)
MR (diary code of "MR" is a medical reexamination diary, the date is the diary maturity
date)
|
SM 016002.200
SM 01301.235,
SM 01601.580
|
Medical Diary Reason
|
DDSQ
SSID
|
Case data
DISB
|
MDR
|
SM 06002.200
SM 01601.595
|
Collateral Estoppel
|
PCACS
SSID
|
Listing Codes
DISB
|
“589” is a listing code that correlates with a collateral estoppel determination effectuated
by the FO for a Title II claim
"V" is an MDR code that correlates with a collateral estoppel determination effectuated
by the FO for a Title XVI claim
NOTE: A collateral estoppel determination effectuated by the FO does NOT meet CPD criteria.
Please note the FO may change the MDR from the systems generated code “V” to one that
matches the claim they are adopting the medical decision from; the code may not be
“V” for a Title XVI collateral estoppel adoption or “589” for a Title II collateral
estoppel adoption.
|
DI 11011.001E.3.a., DI 13015.110, GN 01040.100
SM 01601.595
|