TN 2 (11-01)

DI 20505.010 Determining Need For Prior Folder

A. Procedure - DDS additional action

The FO will associate any prior folder with the current claim or document the claim to identify prior claims activity when it is sent to the DDS. If the FO documents prior claims activity and does not request or associate the prior folder with the current claim or the DDS has a need for the prior folder, the DDS must take additional action.

When the current claim is received in DDS, all information on the SSA-3367, SSA-3368, SSA-3820, etc., plus documentation about prior claims activity will be reviewed. DDS will initiate any necessary medical development immediately. Duplicate evidence related to the prior claim should not be requested, if it is apparent that the prior file will be received and that the prior file will contain that evidence.

B. Procedure - DDS will not request prior folder

The prior file would not routinely be needed if:

  • There is no possible reopening issue (DI 27500.000); or

  • The file shows that any onset date which might be established occurs after the disability earnings requirement is last met; or

  • An allegation is made that “onset” occurred within the past year and medical evidence submitted does not indicate the presence of an impairment(s) which might warrant an onset more than one year ago; or

  • Work that is determined to be SGA was performed during the l-year period preceding the filing date of the current application.

C. Procedure - DDS must request prior folder

In some cases, it is necessary to have the prior folder in order to adjudicate a current claim. Some examples of when a prior folder is needed for the current determination are:

EXAMPLE - 1 Current title II claim- Prior SSI Allowance (Unless SSI was a conversion case) - Collateral Estoppel, See DI 27515.000.

EXAMPLE - 2 Evidence in the current claim suggests possible reopening. (See DI 27500.000 - Reopenings and Administrative Finality.)

EXAMPLE - 3 Acquiescence Rulings that require consideration prior findings of an Administrative Law Judge or Appeals Council when making a disability determination arising under the same or different title of the ACT (See DI 32700.000 and DI 52700.000.)

Example - 4 Evidence in file indicates fraud or similar fault may be involved in the current or prior claim (See DI 23025.015).

If the FO has not requested the prior folder in these cases, the DDS must do so. If the FO has requested the prior folder, but it has not been received, follow-ups by DDS should be directed to the FO or other component that housed the prior folder.

If in reviewing the current claims folder for other types of claims, the DDS determines that a prior folder is necessary for current adjudication, the DDS should take the action to obtain the folder. These situations should be infrequent and will usually be the result of the need for DDS to establish a longitudinal medical history or to establish a mental impairment.

Do not initiate requests for duplicate medical evidence that should already be housed in the prior folder.

To Link to this section - Use this URL:
DI 20505.010 - Determining Need For Prior Folder - 07/09/2012
Batch run: 07/09/2012