TN 1 (01-01)

DI 13015.090 Not “Currently Disabled” - Full Replacement Folder Requested by DDS

A. Introduction

The DDS will determine whether an attempt should be made to create a replacement folder, and what portions of that missing file are relevant to the most recent favorable determination/decision (e.g., work history, medical evidence from treating sources, school records, and the results of consultative examinations). The DDS will consider the potential availability of old records in light of their age, and whether the source(s) of the evidence is/are still in operation, and whether reconstruction, in the form of a replacement folder, is needed. Regardless of the DDS decision to pursue reconstruction, SSA will not find that the individual has medically improved based solely on the original medical evidence being lost, but SSA can redevelop that missing medical evidence and make a MIRS determination.

B. Process

The DDS will return the folder(s) where medical evidence of record does not establish that the beneficiary/recipient is "currently disabled". If the DDS determines that folder reconstruction is warranted, it will instruct/ask the FO to obtain the names, addresses, and telephone numbers of all medical sources.

The DDS will establish the date of the CPD in lost folder situations per DI 28015.005B.3., DI 28015.005C.1., DI 28035.020, DI 28035.025 and DI 28010.105. DDSs would apply similar logic to determine the CPD in cases where the last favorable decision was made by an Administrative Law Judge (ALJ).

C. Procedure – FO Actions

When the DDS determines that folder reconstruction is warranted, the FO should proceed as follows:

  1. Contact the beneficiary/recipient for a supplemental interview addressing the beneficiary/recipient"s medical condition and treating sources at the CPD (as determined by the DDS).

  2. Cover the 12-month period prior to the CPD in the supplemental interview, unless the DDS has given other instructions.

  3. If you obtain any additional queries, keep the queries with pertinent data and circle/highlight the pertinent information, e.g., on the NUMI, circle/highlight any name change.

  4. Follow any instructions provided by the DDS in creating a full Replacement Folder. The DDS should be specific regarding the period of time (since onset or CPD) over which development is needed, and provide any known information about the physicians/clinics/hospitals so the FO can make the CDR interview more successful.

  5. Develop or obtain any additional disability forms, data, or queries requested by the DDS. See DI 11005.016 for Forms used in Disability Claims.

  6. If more than six months have passed since the file was previously documented, inquire about activities of daily living, complete the observations, and provide any other information relevant to the current disposition. Obtain information without being redundant or recording unnecessary information, e.g., onset and working history already contained/reflected in the file.

  7. If additional claimant contact is necessary, inform the claimant by phone/notice what period of time is involved and what information is needed. For example, advise the claimant that doctor records or hospitalization data are needed from the CPD/onset date, and provide that date. [Also see DCF MSOM 185-P regarding the Q831 screen for a lead on the potential CPD date.] This will allow the disabled individual or his/her representative time to obtain data before the interview.

  8. Return the claim to the DDS for development of the CPD evidence and the preparation of a CDR decision using MIRS.

D. Procedure – Potential Disability Forms

1. Adult CDRs

For adult CDRs obtain the following:

  • Form SSA-3368-BK (Disability Report - Adult) (See DI 11005.016A.2.);

  • Form SSA-3369-BK (Work History Report) (See DI 11005.025) - Try to obtain prior work history back to (earliest of) onset or last CPD, if known, up to fifteen years.

  • Form SSA-820-F4 (Work Activity Report - Self-Employed Person) or Form SSA-821-F4 (Work Activity Report - Employee) (See DI 10505.035 and DI 10510.025);

  • Update Form SSA-454-BK (Report of Continuing Disability Interview) - (if more than six months has past since it was first secured see DI 13015.070));

  • Form SSA-827(s) (Authorization for Source to Release Information to the Social Security Administration); and

  • Any State specific Medical Releases.

  • Any forms listed in DI 11005.016A.3. that may be used in disability cases.

NOTE: The dates shown on the SSA-3369-BK should be complete enough to determine what portion(s) of the individual"s education, training or work experience has been acquired since onset of disability.

2. Title XVI Child CDRs

For Title XVI Child CDRs, obtain the following:

  • Form SSA-3820-BK (Disability Report - Child) (See DI 11005.016A.2.b.);

  • Only if applicable, obtain Form SSA-3369-BK (Work History Report) as required per DI 11005.025 ff.;

  • Only if applicable, obtain Form SSA-3371-BK (Pain Report - Child) (See DI 11005.016A.2.d.);

  • Only if applicable, obtain Form SSA-820-F4 (Work Activity Report - Self-Employed Person) or SSA-821-BK (Work Activity Report - Employee) (See DI 10505.035 and DI 10510.025);

  • Form SSA-3375-BK, SSA-3376-BK, SSA-3378-BK and SSA-3379-BK (Function Report - Child) [Separate form for each age group: Birth-1, 1-3, 3-6, 6-12, 12-18.] -One of these forms must be completed whenever an SSA-3820-BK is required. (See DI 11005.016A.2.e. and DI 11005.030 - DI 11005.035);

  • Form SSA-3881-BK (Questionnaire For Children Claiming SSI Benefits) (See DI 11005.016A.2.i.);

  • Form SSA-454-BK (Report of Continuing Disability Interview) - (if more than six months has past since it was first secured see DI 13015.070) (See DI 13005.040 regarding Child Cases));

  • Form SSA-827(s) (Authorization for Source to Release Information to the Social Security Administration (SSA)), and

  • Any State specific Medical Releases.

  • Any forms listed in DI 11005.016A.3. that may be used in disability cases.

NOTE: The dates shown on the SSA-3369-BK should be complete enough to determine what portion(s) of the individual"s education, training or work experience has been acquired since onset of disability.

  1. Obtain a statement concerning the dates on which prior medical decisions were made.

  2. Obtain copies of any documents SSA has sent since initial allowance or CPD (whichever is later) dealing with prior medical decisions (e.g., notices, consultative examination scheduling letters, etc.).

  3. Advise the individual that he/she may be contacted again for additional information concerning other medical sources. Assure the individual that he/she will not be adversely affected just because the medical folder is lost.

3. Interview Completed - Routing Folder

  • Route the folder to the DDS via a Form SSA-408 (Route Slip) or designated regional routing form/flag.

  • Annotate the SSA-408 "CDR Lost Folder/Medical Evidence. Full reconstruction completed”.

E. References

  • DI 40525.000 ff.: PC instructions for the processing CDR lost/replacement folders and medical evidence.

  • DI 28035.000 ff.: DDS instructions for processing CDR lost/replacement folders and medical evidence.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0413015090
DI 13015.090 - Not "Currently Disabled" - Full Replacement Folder Requested by DDS - 07/07/2017
Batch run: 07/07/2017
Rev:07/07/2017