TN 4 (12-09)

DI 20101.010 Disability Determination Services (DDS) Jurisdiction for Reconsideration Cases

A. Components that route reconsiderations to the DDS

The following components route timely filed requests for reconsideration (including ones in which a new application for another Title or type of claim is filed) to the DDS in the State where the claimant currently resides:

  • Field Office (FO).

  • Office of Disability Operations (ODO).

  • Program Service Center (PSC).

If a new application is filed with a request for reconsideration of a cessation and the claimant has left the State where the original cessation determination was made, the DDS in the State where the claimant currently resides has jurisdiction. The DDS in the claimant’s new State of residence also has jurisdiction of a reconsideration case if the original decision was revised by the Disability Quality Branch to one less favorable to the claimant. For additional instructions, see DI 20101.030.

B. Procedures for adjudicating reconsideration cases

1. Claimant leaves the State before a reconsideration determination is completed

The procedures are the same as those for initial claims:

  • CEF – Process certified electronic folders according to the instructions in Electronic Disability Collect System (EDCS) Routing Form DI 81001.045; or

  • MDF – Process modular disability folders according to the instructions in Disability Determination Services (DDS) and Social Security Administration (SSA) Jurisdictions – Claimant Moves DI 20101.035B.

2. Claimant fails or refuses to submit additional evidence for reconsideration

When a claimant files for a reconsideration of an initial medical determination, but fails or refuses to complete the necessary forms or to provide additional evidence to support the request, the DDS has jurisdiction and makes a determination based on the available information, as outlined in DI 23007.000, Failure to Cooperate.

NOTE: The FO should make a reasonable effort to complete the appropriate forms (e.g., SSA-3441-F6, SSA-827) and secure supporting evidence before forwarding the reconsideration to the DDS as outlined in DI 81010.150 - Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS). The DDS is required to follow up on FO requests for required forms; see DI 23007.005G.

3. Reconsideration of Title II and Title XVI claims when the initial determinations were prepared by different DDSs

The following sequence of events may occur when the initial determinations were prepared by different DDSs:

  • The claimant files a Title II claim that is denied by the DDS in State A.

  • The claimant moves to State B and files a Title XVI claim that is denied by the DDS in State B.

  • The claimant then requests reconsideration of both denials.

The DDS in the State where the claimant currently resides has jurisdiction for preparing both reconsideration determinations.

If two different DDSs prepare conflicting decisions on two separate claims filed in separate States, the DDS in the State where the claimant currently resides has jurisdiction for reopening and revising any previous determination.

4. FO reversal of a prior technical denial or substantial gainful activity (SGA) denial

The FO sends the claim to DDS when:

  • An FO reconsideration case needs a medical-vocational determination after resolution of the work issue.

  • An initial denial or CDR cessation was made on the basis of SGA and the FO determines that the claimant or beneficiary was not engaging in SGA. The FO explains on the SSA-821 (Work Activity Report – Employee) why the initial determination is being reversed.

These claims are processed at the initial level by the DDS.

NOTE: SGA evaluation does not apply to Title XVI recipients eligible because of blindness.

5. Other reconsideration situations

Jurisdictional guidelines for the following issues are the same as the guidelines for initial cases:

  • Reconsideration cases for work issues – see Initial and Subsequent Work Issue Cases DI 24001.005.

  • Recons