Evaluate any new claim evidence on its own merits and prepare a determination.
Establish the Disability Onset Date (DOD) within the period adjudicated when supported
by the evidence of record on file if:
More than 12 months have elapsed since the date of the notice of the initial determination
on the previous claim (thereby precluding reopening for any reason) and the disability
criteria have changed since the prior determination or decision. See Change of Ruling
or Legal Precedent (Change of Position) in DI 27505.020B.3.; or
More than 4 years have elapsed since the date of the notice of the initial determination
on the previous claim (thereby precluding reopening for “good cause”) and new and
material evidence establishes a DOD within the period adjudicated in the determination
or decision on the prior claim. See Additional Policy Reminders For Processing Cases
When Reopening Does or Does Not Apply in DI 27501.005C.2.; or
The prior determination was a FO (not DDS) denial for “insufficient evidence furnished”
(M5/M6), when a claimant fails to submit essential evidence see DI 11018.005.
NOTE: The component authorizing payment bases the retroactivity of benefits on the
date of new application.
We denied the number holder’s (NH’s) application for Disability Insurance Benefits
(DIB) filed in June 2002 in September 2002 and we released the determination notice
in the same month.
The NH filed for DIB again in September 2005. We also denied this application and
the initial denial notice was sent in December 2005. The NH filed for DIB a third
time in February 2007. We allowed this application based on new and material evidence,
with an onset date established in the period preceding the first application.
Although the determination on the first application cannot be reopened, the determination
on the second application may be reopened under the 4-year rule and benefit rights
may be established based on the September 2005 application.