TN 66 (11-11)

DI 11055.075 Using the Prior Favorable Title XVI DDS Disability Determination When a Claimant Files a New Application for Supplemental Security Income (SSI) Based on Disability After the FO Denies the Prior Claim for Non-Medical Reasons

IMPORTANT: These instructions only apply in initial title XVI claims situations.

There are situations where the Disability Determination Service (DDS) makes a favorable determination on an initial title XVI claim for SSI based on disability or blindness but, before any benefit payment has been issued, the field office (FO) technically denies the claim for non-medical reasons, e.g., excess income.

If the claimant files a new SSI application within 12 months of the date of the favorable DDS determination, we do not require a new DDS disability determination if the claimant:

  • meets all non-medical entitlement factors, and

  • no benefit payment has been issued.

NOTE: If a payment has been issued, follow the SSI post entitlement (PE) suspension or reinstatement procedures in SI 02301.200 SI 02301.210.

A. When a new DDS disability determination is required

The FO must send the new SSI application for a new DDS disability determination if:

  • The claimant files the application after 12 months from the date of the prior favorable DDS disability determination; or

  • The DDS established a medical improvement expected (MIE) diary and it is 6 months or less before the scheduled reexamination date.

B. When a new DDS disability determination is not required

A new DDS disability determination is not required if:

  • The claimant files the new SSI application within 12 months from the date of the prior favorable DDS disability determination; and

  • There is no intervening work activity; and

  • There is no allegation of medical improvement.

If a new DDS disability determination is not required, take the following actions:

  • Use the disability data from the prior favorable DDS disability determination to complete the Disability Clearance Data (CDIB) screen in the Modernized Supplemental Security Income Claims System (MSSICS); and

  • Process the new SSI application under current procedures.

C. Claims documentation

In all claims situations, ask the claimant about:

  • Work activity; and

  • Possible medical improvement issues since the established onset date.

Document the claimant’s response on a report of contact.

D. References

  • SI 00603.011 Procedure When a Nondisability Denial is Reversed

  • SI 04010.020 SSI Appeals Considerations

  • SI 04070.010 Title XVI Administrative Finality – General Reopening Policies

  • SI 04070.015 Reopening SSI Determinations

  • DI 12010.030 Field Office (FO) Reversal of Nonmedical Denial When Request for Administrative Law Judge (ALJ) Hearing Filed


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0411055075
DI 11055.075 - Using the Prior Favorable Title XVI DDS Disability Determination When a Claimant Files a New Application for Supplemental Security Income (SSI) Based on Disability After the FO Denies the Prior Claim for Non-Medical Reasons - 11/13/2012
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