TN 24 (02-19)

DI 23022.055 Adding and Modifying Compassionate Allowances (CAL) status; Removing and Reinstating CAL and Quick Disability Determinations (QDD) Status

A. Actions on CAL cases

Adjudicators must have proper security access and jurisdiction of at least one pending claim to manually add, remove, modify, or reinstate a case to the CAL process. Regional Office (RO) need only the proper security access. Field office (FO) users do not have this capability.

Process add, remove, modify, and reinstate actions on the Compassionate Allowances page in eView. The Office of Disability Policy (ODP) CAL website provides more information on CAL, houses the impairment summaries, and provides CAL updates. Users must process CAL updates in eView to avoid changing an existing QDD indicator on the case. For instructions on accessing the CAL indicator in eView, as well as an explanation on the available information and actions displayed under the indicator, see DI 23022.030E.

B. Adding CAL indicator for fast-track processing

If there is no previous CAL history, the Disability Determination Services (DDS), the Office of Quality Review (OQR), and the Office of Hearings Operations (OHO) can manually add cases to CAL processing at any adjudication level.

The following chart includes a few examples for adding cases to CAL (but not limited to):

When to Add CAL Cases

Examples

New allegation of CAL condition

DDS receives a report from claimant or FO of a CAL condition that was not included in the initial claims allegations on the SSA-3368-BK Disability Report—Adult or SSA-3820-BK Disability Report—Child.

New evidence of CAL condition

DDS discovers a new CAL condition in the Medical Evidence of Record (MER).

System did not identify CAL condition

CAL condition was alleged before the initial transfer, but the system did not recognize it due to misspelling, incorrect abbreviation, etc.

When the DDS or OQR manually adds a claim as CAL, the system sends the following message to both eView and the DDS legacy system: “Case has been identified as a Compassionate Allowance because of the following conditions: <insert conditions>.

C. Modifying a CAL indicator for fast-track processing

DDS, OQR, and OHO can modify a case in CAL processing.

The following chart includes examples for modifying CAL cases (but not limited to):

When to Modify CAL Cases

Examples

Revise or correct conditions

Claimant alleges Large Intestine Cancer. MER shows diagnosis as Small Cell Cancer of the Large Intestine

Allegation of another CAL condition

DDS receives a report from claimant or FO of a CAL condition that was not included in the initial claims allegations on the SSA-3368-BK Disability Report—Adult or SSA-3820-BK Disability Report—Child.

Evidence of another CAL condition

DDS discovers another CAL condition in the MER.

The DDS can modify CAL conditions by removing the incorrect CAL condition and adding other CAL condition(s). Upon successfully modifying the CAL conditions, the electronic folder interface (EFI) sends the following message to both eView and the DDS legacy system: “Case has been updated with the following Compassionate Allowance conditions: <insert reason>.”

D. Remove cases from CAL and QDD fast-track processing

IMPORTANT: A component must have jurisdiction to remove a case from fast-track processing.

1. CAL cases

The DDS, OQR, and OHO can remove a case from CAL processing. When the DDS or OQR removes a case from CAL processing as described in DI 23022.055A, the EFI sends an automatic message to both eView and the DDS legacy system, as follows: “Case has been removed from the Compassionate Allowance process because <insert reason>.”

2. QDD cases

The DDS, OQR, or the RO, may remove a case from QDD processing only with supervisory approval. FO staff and supervisors do not have this capability. The DDS may remove a case from QDD processing at the point it meets any one of the criteria listed in DI 23022.055E in this section. Remove a case from QDD using eView or your case processing system. To access the QDD page in eView:

  1. a. 

    Select the yellow Edit/Lock case link at the top of the page.

  2. b. 

    Select the QDD link at the far right on the header bar to display the QDD page. Click on the “Remove” button to display a box with a drop-down list of the reasons for removal.

  3. c. 

    Select the correct reason and then select “OK”. The system will remove the case from QDD, and the indicator on the header bar will change to QDD: N.

NOTE: 

The DDS can reinstate a case to QDD with DDS supervisory approval.

 

E. Streamlined fast-track processing removal reasons

The disability examiner must identify the proper reason for removing cases from the fast-track process. The following is a list and explanation of removal reasons. It is possible that more than one removal reason applies, however, the system will only display one.

When to Remove CAL and/or QDD cases Explanations
All claims in the case are denials

Use this removal reason if the adjudicator receives all available MER and all claims in the case are denials, with the following exceptions.

  • One claim is fully favorable, the other is not – Do not remove;

  • One claim is a denial, the other is an adverse onset – Do not remove;

  • Both claims are denials – Remove.

NOTE: OQR should not remove the CAL indicator solely on a deficiency for corrective action or additional development, unless OQR assumes jurisdiction of the case/claim.

 

All claims in the case are DDS “no determination”

Use this removal reason if the DDS returns all claims in the case to the FO with no determination (the DDS does not expect to receive the claim back).

For instructions on processing no determination claims, see DI 81020.127.

 

Non fast-track action or development is required

Class action re-adjudication. For instructions on court-ordered reviews, see DI 42502.001 Court-Ordered Reviews -- Jurisdiction

 

Extensive FO development or assistance required

Examples of FO development or assistance required :

  • Work issues,

  • Whereabouts unknown,

  • Age verification,

  • Marital status, or

  • Citizenship status.

 

Clearly not a CAL case – remove CAL only,

if,

  • Review of all the MER evidence does not confirm the CAL condition alleged on the SSA-3368 or SSA-3820; or

  • The system picked up a particular CAL condition but, upon further review, it is obvious that the condition is not a CAL condition for the claimant.

Example of clearly not a CAL case :

The allegation belongs to another family member as recorded in the remarks section.

NOTE: In situations where the case was identified as QDD and CAL, the adjudicator may remove the CAL indicator but must leave the QDD indicator.

Medical deferment – see DI 22505.010.
Reactivation – see DI 81020.117
Reopening – see DI 27505.001

F. Reinstating a case to CAL or QDD fast-track processing

1. Reinstating a case to CAL processing

If the last CAL action was a removal from CAL processing, the DDS, OQR, and OHO can reinstate certain cases. The following chart includes examples for reinstatement (but are not limited to):

When to Reinstate CAL Cases Examples
CAL condition mistakenly removed Action taken to remove CAL on the incorrect claim.
Medical evidence supporting the CAL condition is received after removal. Previous MER did not substantiate the CAL condition but subsequent MER received after removal confirms the CAL condition.

When the DDS reinstates a claim as CAL, the EFI will send the following message to both eView and the DDS legacy system: “Case has been identified as a Compassionate Allowance because of the following conditions: <insert conditions>.”

2. Reinstating a case to QDD processing

If necessary, with supervisory approval, you may reinstate a case previously removed from QDD.

G. References

  • DI 23022.030 Identifying and Receipting Compassionate Allowances and Quick Disability Determinations Cases

  • DI 23022.040 Compassionate Allowances and Quick Disability Determinations Fast-Track Case Development

  • DI 23022.050 Making the Determination in a Compassionate Allowances or Quick Disability Determinations Fast-Track Case

  • DI 27505.001 Conditions for Reopening a Final Determination or Decision

  • DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS)

  • DI 81020.117 Processing Medical Reactivations

H. Resources

The Office of Disability Policy (ODP) CAL website provides more information on CAL, houses the impairment summaries, and provides CAL updates.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022055
DI 23022.055 - Adding and Modifying Compassionate Allowances (CAL) status; Removing and Reinstating CAL and Quick Disability Determinations (QDD) Status - 04/06/2018
Batch run: 02/27/2019
Rev:04/06/2018