TN 8 (06-04)

GN 04440.227 Group II Onset Date Deficiencies Involving A Reopening

A. POLICY

A reopening issue occurs when an onset date is alleged or established within a period of disability already adjudicated. A group II period of disability onset date deficiency exists when the adjudicating component fails to obtain the prior folder and reopen the prior determination, when appropriate, or reopens the prior determination when it is not appropriate to do so. See DI 27505.001ff for an explanation of the rules of administrative finality and the rules for reopening and DI 27510.001 for an explanation of "period adjudicated." See DI 30005.125C.2. and DI 30005.126C.1. for a further explanation of an onset date deficiency involving a reopening.

B. PROCEDURE-REVIEW COMPONENT

If a reopening issue arises because an onset date is alleged, or the adjudicating component established an onset date, within a period already adjudicated, and a group II onset date deficiency involving a reopening exists, follow the procedure below.

NOTE: Be alert to situations in which reopening is not possible and the date of onset of disability may be placed within a period previously adjudicated. Refer to DI 27505.020 and DI 27510.005C.2.

1. Prior Folder in the Review Component

If the prior folder is in the review component, cite a group II onset date decisional deficiency and either return the folder to the adjudicating component for correction or correct the onset date in the review component per the instructions below.

NOTE: If the adjudicating component did not have the prior folder, cite a group II onset date documentation deficiency. See GN 04440.227B.2.

a. Return Case to Adjudicating Component for Correction

Return the case to the adjudicating component for correction if:

  • The case has another deficiency or incorrect action not formally defined which is unrelated to the onset date deficiency, and requires return to the adjudicating component for correction.

  • The case is being reviewed during the waiting period and the deficiency can be corrected without delaying payment.

  • The claimant is currently receiving a nondisability Title II benefit that is expected to continue.

  • The claimant dies before the review is completed.

If you return the case to the adjudicating component for correction per the above:

  • Prepare an SSA-1774-U5.

  • Request corrective action and return of the folder to the review component.

b. Correct the Case in Review Component

Correct the case in the review component if none of the conditions in GN 04440.227B.1.a. exist. Resolve the reopening issue and establish the correct onset date as indicated below.

  • Make a pen-and ink correction to the SSA-831-C3/U3.

  • Prepare any necessary rationales and notices.

  • For eCAT cases, prepare the reopening rationale using the Disability Determination Explanation Claim Communication. For non-eCAT cases, document the reopening rationale on form SSA-4268. Follow the format outlined in DI 27536.001 for preparing the reopening rationale.

See DI 27501.005, Reopening and Revising a Determination or Decision.

2. Prior Folder Not in the Review Component

If the prior folder is not in the review component, cite a group II onset date documentation deficiency and take the following action:

  • Prepare an SSA-1774-U5 and return the folder to the adjudicating component.

  • Tell the adjudicating component to obtain the prior folder, resolve the reopening issue, establish the correct onset date and return the corrected case to the review component.

NOTE: For those situations which meet the criteria in GN 04440.223A. for post-effectuation correction, establish an IOD and follow the post-effectuation procedures in GN 04440.223B. for initial claims, GN 04440.224B. for reconsideration claims and GN 04440.225 for concurrent Title II/Title XVI claims.