When the criteria in DI 11011.001A 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.

NOTE: FO collateral estoppel claims will be processed as District Office Final Authorization (DOFA), unless a DOFA exclusion applies. For general information on FO adjudicative responsibilities, see GN 01010.008.

When the criteria in DI 11011.001A in this section are met for a new Title II claim, but the potential onset date (POD) in the new claim is before the EOD in the prior claim, the DDS has jurisdiction for making a disability determination covering the period between the new claim's POD and the prior claim's EOD. For processing instructions, see DI 11011.001F in this section.

The FO cannot apply collateral estoppel when the new claim requires application of the adult definition of disability and the prior favorable disability determination or decision was made using:

• •

  childhood disability criteria , see DI 25201.005;

• •

  state welfare conversion, see DI 21501.005; or

• •

  statutory blindness criteria under Title XVI, see DI 26001.001.

IMPORTANT: Collateral estoppel may apply to adopt the adult disability determination or decision from an age-18 medical redetermination. Collateral estoppel may also apply to adopt the disability determination or decision from a welfare conversion case with a subsequent continuing disability review (CDR) continuance under federal criteria (for welfare conversion cases that have been allowed or continued under federal criteria, the SSI Display (SSID) rollback indicator (RB) field is coded “4”).

NOTE: Collateral estoppel may apply to adopt, in a new claim under Title II or XVI, a favorable statutory blindness determination or decision under Title II. However, a statutory blindness determination or decision under Title XVI may not be adopted in a new claim, because statutory blindness under Title XVI is not subject to SGA rules and duration requirements.

For medical CDR cessations, including those where we have not yet effectuated the cessation, as described in DI 40505.315, collateral estoppel does not apply to the new claim unless the cessation was reversed on appeal or reopening.

NOTE: If a CDR appeal is pending in the Electronic Disability Collect System (EDCS) and the new initial claim requires a determination by the DDS, the multiple pending cases (MPC) will consist of two different classification folders (initial and CDR). For instructions on EDCS exclusions and limitations, see DI 81010.030.

Determine whether the claimant may have engaged in SGA after the prior EOD.

If work activity after the prior EOD meets the “clearly not SGA” criteria, annotate the alleged monthly earnings and the remarks “clearly not SGA” on a Report of Contact in the applicable claims processing system. For defining “clearly not SGA,” see DI 10501.025A.

REMINDER: If the work after the prior EOD is not SGA, and the other criteria in DI 11011.001A in this section are met, collateral estoppel applies.

If the work after the prior EOD is SGA:

• •

  Document the work activity using the SSA-821-BK (Work Activity Report—Employee) or SSA-820-BK (Work Activity Report—Self Employment).

• •

  Document the SGA and potential onset date (POD) determination on the SSA-823 (Report of SGA Determination). In making the SGA determination, consider whether work which lasted 6 months or less meets unsuccessful work attempt (UWA) criteria. For evaluating duration and conditions of work that may constitute a UWA, see DI 11010.145E.

• •

  If a period of SGA precludes collateral estoppel but does not preclude a POD in the new claim, enter the POD on the SSA-3367 (Disability Report–Field Office) before sending the claim to the DDS.

NOTE: If SGA or other nonmedical factors in the new claim prevent the FO from establishing the POD, the FO must technically deny the new claim.

IMPORTANT: A UWA is not a measure of SGA and will not preclude collateral estoppel. When collateral estoppel applies, the FO is responsible for making applicable UWA determinations in the new claim.

The FO cannot apply collateral estoppel when the EOD in the prior claim is after the following applicable date in a new claim for benefits under Title II:

• •

  The date last insured (DLI) for disability insurance benefits (DIB), see DI 25501.320.

• •

  The prescribed period end date for disabled widow(er)s benefits (DWB), see DI 11005.050.

• •

  Attainment of age 22 in childhood disability benefits (CDB) initial entitlement cases, see DI 11020.015.

Do not adopt a prior favorable disability determination or decision from a record in terminated status.

Determine that there is reason to believe that the prior disability determination or decision was wrong, such that collateral estoppel does not apply, only when presented with evidence that clearly indicates that the individual was not disabled. Do not complete unnecessary development or reviews, and do not review the prior record with the intent of finding an error.

NOTE: Collateral estoppel does not apply when we have identified the presence of fraud or similar fault (FSF) in connection with the prior favorable disability determination or decision.

When applying collateral estoppel to adopt a prior disability determination or decision, the FO must review transmittal forms (e.g., SSA-831 (Disability Determination and Transmittal) or Case Processing and Management System (CPMS) disposition page) or systems queries (e.g., DDS Query (DDSQ), Master Beneficiary Record (MBR), or SSID) with information on the prior favorable disability determination or decision and enter the prior diagnosis code(s) and medical diary period when completing the adjudicative screens for the new claim allowance.

If the claimant meets the same statutory definition of disability (based on the collateral estoppel criteria in DI 11011.001A in this section) and the applicable nonmedical requirements during the period covered by the application, determine the EOD for the new claim. Generally, the EOD is the earliest date that the claimant meets both the definition of disability and the nonmedical requirements for entitlement to benefits under Title II or eligibility for payments under Title XVI during the period covered by the new application.

NOTE: If the applicable EOD from the above table does not establish entitlement, e.g., the EOD would be after attainment of age 22 in a CDB initial entitlement case, collateral estoppel does not apply. 

IMPORTANT: The FO may not establish an EOD in the new claim earlier than the EOD in the prior claim. If there is a possibility of additional Title II entitlement before the prior EOD, follow the instructions in DI 11011.001F in this section.

1. a. 

   Title II claims

   On the Modernized Claims System (MCS) decision input (DECI) screen, enter the listing code of “589”.

   For MCS exclusions, complete an electronic form 101 (EF101) for the new or amended award, as applicable. Enter “collateral estoppel, PC action necessary to manually establish listing code 589” on the EF101 Benefit Continuity Remarks/Notice (BCRN) screen.

2. b. 

   Title XVI claims

   On the Disability page, select “adopt Title II disability determination” as the reason for not referring the case for a medical decision. This input will generate the medical diary reason (MDR) code of "V".

NOTE: The FO is not required to create a new EDCS segment or SSA-831 for the collateral estoppel determination in claims under either title. The adjudicative decision screens completed in the appropriate claims processing system will serve as the signed determination, and the mainframe record will serve as documentation of the claims activity. For more information on adjudicative policy and standards, as well as examples of adjudicative screens, see GN 01010.001.

If the prior claim is in temporary suspense status for non-disability reasons when the new claim is filed, attempt to resolve the payment suspense issue prior to completing processing of the new claim (e.g., if the prior claim is in “S8” suspense status for payee development, develop for a new payee or establish direct payment when necessary).

• •

  If the suspense issue on the prior claim is not resolvable when processing the new claim but will not result in a denial on the new claim, apply collateral estoppel to adopt the prior favorable disability determination or decision (if the criteria in DI 11011.001A in this section are met), and

• •

  If the suspense issue results in any period(s) of nonpayment status in the new claim, place the new claim payment status into the corresponding payment suspense for the applicable months, via the Title II suspension event (SUSP) screen or the Title XVI payment status page, prior to adjudication.

For Title II benefit suspensions, see GN 02602.005.

For Title XVI payment suspensions, see SI 02301.200.

Adopt the favorable disability determination or decision from a prior claim even when an initial medical CDR is pending for that claim. After processing the subsequent claim allowance, initiate a medical CDR on the new record and transfer the new CDR to the DDS to associate with the pending CDR.

NOTE: Do not initiate a CDR based solely on an expired diary on the existing claim. A new claim does not in itself raise a CDR issue on the existing entitlement, even when there is an expired diary. For more information on FO procedures in medical CDR cases, see DI 13005.001.