Generally, a determination or decision may be reopened and revised only when:
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The determination or decision was incorrect when made; and
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A determination or decision, which may have appeared to be correct based on the available
evidence at the time it was made, may be reopened if it is later shown to have been
incorrect (e.g., DDS discovers new and material evidence showing the field office
made a failure to cooperate determination, but did not recognize the claimant has
a mental impairment that prevented him or her from cooperating). Refer to New and
Material Evidence (DI 27505.010B) for clarification of when new and material evidence can be used to reopen a prior
determination or decision.
There are exceptions to the general rule that only incorrect determinations or decisions
may be reopened and revised. See:
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Change of Ruling or Legal Precedent (Change of Position) – Operating Policy (DI 27505.020B.1.), and
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Policy – Only Incorrect Determinations Can Be Reopened and Revised (SI 04070.010C.) for when a determination or decision which was correct when made may be reopened
and revised.
See Also:
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Do Not Reopen Correct Determinations — Operating Policy (GN 04001.070) for additional reopening information and general guidance on this subject.
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For discussion about the requirements for adverse reopening of a disability determination
under the “error” exception as part of the Medical Improvement Review Standard (MIRS),
see error and reopening (MIRS) (DI 28020.375).
1. 1-Year Reopening Rule (Title II and Title XVI)
A final determination may be reopened within 1 year from the date of notice of the
initial determination “for any reason.” However, certain adverse reopenings and revisions
cannot occur unless the medical improvement regulations permit a finding that disability
has ceased or does not exist. See Policy - When the MIRS Applies (DI 28005.001D.).
Reopening within 12 months is not “automatic.” A request to reopen within 12 months
can be denied if there is no reason to revise the prior determination or decision.
2. 2-Year Reopening Rule (Title XVI)
A title XVI determination may be reopened within 2 years from the date of notice of the initial determination for “good cause.”
See Also
3. 4-Year Reopening Rule (Title II)
A title II determination may be reopened within 4 years from the date of notice of the initial determination for “good cause.” See
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Reopening Within 4 Years (Title II and Entitlement Under Title XVIII) (GN 04010.000).
4. “At any time” Reopening Rule
A determination may be reopened at any time as follows:
a. Title II Wholly or Partially Favorable Determination
Title II wholly or partially favorable determinations may be reopened:
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For fraud or similar fault (see Fraud or Similar Fault – Reopenings (DI 27505.015)); or
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To exclude a felony-related impairment from consideration because the claimant has
been convicted of a felony (see Evaluation of Prisoner/Felon CDR Cases (DI 28065.010); Reopening and Revision After Conviction of a Felony or Reversal of Felony Conviction
(DI 23501.075).
See Details
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Prior Favorable or Unfavorable Title II Determination or Decision - Felony Related
Impairment (DI 27520.020)
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Unrestricted Reopening - The Determination or Decision Was Procured by Fraud or Similar
Fault (GN 04020.010)
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Unrestricted Reopening - Criminal Conviction Affecting Benefit Rights — Policy Principle
(GN 04020.110)
b. Title II Wholly or Partially Unfavorable Determination
Title II wholly or partially unfavorable determinations may be reopened to:
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Correct an error on the face of the evidence or clerical error, provided that the
net result is more favorable to the claimant.
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Consider any excluded impairments because the claimant's felony conviction has been
overturned.
See Details
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Prior Favorable or Unfavorable Title II Determination or Decision - Felony Related
Impairment (DI 27520.020)
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Unrestricted Reopening - Clerical Error or Error on the face of the Evidence (GN 04020.080)
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Unrestricted Reopening - Criminal Conviction Affecting Benefit Rights — Policy Principle
(GN 04020.110)
Reopen only for fraud or similar fault.
Refer to Fraud or Similar Fault - Reopenings (DI 27505.015); and Fraud and Similar Fault – SSI (SI 04070.020).
5. Precluded from Reopening
When a favorable determination with error on the face of the evidence is precluded
from reopening because the period for reopening has expired, process in accordance
with the continuing disability review (CDR) procedures.