Basic (07-20)

DI 27515.001 Collateral Estoppel - Policy

A. Concept of collateral estoppel

Under the rules of collateral estoppel, we will not again decide an issue we have already decided in a prior determination or decision, unless there are reasons to believe that the prior finding on the issue was wrong. The Disability Determination Services (DDS) may adopt, in a new claim, the findings of a prior favorable determination or decision. While these adoption determinations often involve claims arising under different titles of the Social Security Act, it may be appropriate to adopt a prior determination or decision under the same title for a different type of benefit because the underlying principle of issue preclusion (whether designated collateral estoppel or res judicata) may apply in the same title context.

B. Jurisdiction of potential collateral estoppel claims

The DDS has jurisdiction for all subsequent claims when collateral estoppel potentially applies. The field office (FO) will transfer potential collateral estoppel claims to the DDS for processing and determination. For FO instructions, see DI 11011.001.

NOTE: The Program Service Center (PSC) may also make collateral estoppel determinations when the PSC receives the new claim directly. For additional PSC instructions, see DI 40120.001.

C. Examples of potential collateral estoppel situations

New Claim

Prior favorable determination or decision

Disability Insurance Benefit (DIB)

Supplemental Security Insurance (SSI) adult disability with an established onset date (EOD) prior to the DIB date last insured (DLI)

Childhood Disability Benefit (CDB)

SSI adult disability with an EOD between ages 18-22

CDB

CDB under another number holder (NH)

SSI

DIB

Disabled Widow(er) Benefit (DWB)

DIB with an EOD within the DWB prescribed period

D. Rules for applying collateral estoppel

1. Common issues

The claims must have a common issue. A common issue exists when two or more claims share an overlapping period and are/were decided under the same rules.

2. Same rules

The same rules for determining disability apply to the common issues at the time the new claim is filed.

3. Correct determination or decision

There is no reason(s) to question the correctness of the prior determination or decision.

NOTE: When the claimant has engaged in substantial gainful activity (SGA) after the prior favorable determination or decision, see DI 27515.010.

IMPORTANT: Even when collateral estoppel does not apply, the DDS may make a favorable determination based on evidence in the new claim.

E. When collateral estoppel does not apply

1. Change in rules

A prior favorable determination or decision is not adopted when the rules for determining disability applicable in the new claim are different from the rules that were applied in the prior determination or decision.

For example:

  • Blindness requirements for title II versus title XVI,

  • Childhood disability versus adult disability,

  • Change in medical-vocational rules (e.g., the removal of the inability to communicate in English as an education category), and

  • A substantial change to the Listing of Impairments.

For the basic principles and definitions of title XVI blindness or childhood disability, see DI 11055.001. For changes in the Listing of Impairments, see DI 27515.005B.

When collateral estoppel does not apply because there is no determination or decision under adult criteria and the new claim is a denial, the DDS must enter list code 585 (Adoption does not apply - no decision under adult criteria) in Item 26 of the SSA-831.

When collateral estoppel does not apply because of a substantial change to the listings and the new claim is a denial, the DDS must enter list code 586 (Adoption does not apply due to changes in the listings) in Item 26 of the SSA-831.

When collateral estoppel does not apply because of a change in medical-vocational rules and the new claim is a denial, the DDS must enter list code 588 (Adoption does not apply due to change in medical-vocational rules) in Item 26 of the SSA-831.

2. Prior favorable determination or decision clearly incorrect

A prior favorable determination or decision is not adopted when it is clearly incorrect or the error exception for continuing disability reviews (CDR) applies. For information on applying the prior error exception to medical improvement, see DI 28020.350. The DDS must not substitute judgment or arbitrarily question a prior favorable determination or decision. When the determination on the new claim is a denial, the DDS must enter list code 582 (Adoption does not apply due to error) in Item 26 of the SSA-831.

3. Prior favorable title XVI determination or decision due to conversion

A prior favorable determination or decision is not adopted when title XVI disability is due to conversion unless there has been a subsequent CDR continuance under Federal criteria. For information on title XVI conversion claims, see DI 33025.005 and DI 23525.001.

Review the SSA-831/833 for the prior title XVI determination or a Supplemental Security Income Display (SSID) query to identify these claims. In a SSID, the rollback indicator (RB) field is coded 4 when the claim was allowed or continued under Federal criteria.

When the determination on the new claim is a denial, the DDS must enter list code 584 (Adoption does not apply - conversion case-no decision under Federal criteria) in Item 26 of the SSA-831.

4. Changed vocational profile

A prior determination or decision is not adopted when the claimant has a changed vocational profile. For information on when a changed vocational profile applies, see DI 27515.010.

When the determination on the new claim is a denial, the DDS must enter list code 581 (Adoption does not apply due to changed vocational profile) in Item 26 of the SSA-831.

5. Prior favorable determination or decision is terminated

A prior determination or decision is not adopted when the record is in terminated status. For using queries to determine current eligibility or entitlement, see DI 28030.010. When a title XVI prior favorable determination or decision is in suspense for technical reasons, see DI 27515.020A.

F. Other factors to consider

1. Prior determination or decision is a CDR continuance

A currently entitled individual may have undergone one or more CDRs before filing a new claim for a different type of benefit. The DDS must review the basis for the prior favorable determination or decision to determine whether collateral estoppel applies. For how to determine the basis for the CDR continuance using the SSA-832/833, see DI 28084.020C.

a. Prior determination or decision is a CDR continuance based on no medical improvement (MI)

Review the most recent CDR continuance based on meeting or equaling a listing or medical-vocational rules to determine whether collateral estoppel applies. When there are no CDR continuances other than for no MI, review the basis of the claimant’s initial favorable determination or decision to determine whether collateral estoppel applies. Ensure none of the restrictions in DI 27515.001E applies.

b. Prior determination is an administrative CDR continuance due to a lost folder issue.

Collateral estoppel does not apply. The DDS must complete development and make a new determination.

When the determination on the new claim is a denial, the DDS must enter list code 587 (Adoption does not apply - CDR continuance due to lost folder) in Item 26 of the SSA-831.

2. MI

Evidence obtained in the new claim may indicate medical improvement (MI) or that an exception to MI applies. MI or an exception to MI raises a CDR issue in the claimant’s existing entitlement regardless of whether collateral estoppel applies or a new determination is favorable or unfavorable. For CDR issues in collateral estoppel claims, see DI 27515.050.

G. Different determinations or decisions for the same period

The determination in a new claim may differ from the determination or decision in a prior claim when collateral estoppel does not apply. The determinations or decisions may appear to conflict with each other, however these are not considered conflicting determinations. For more information on different determinations or decisions for the same period, see DI 27515.035.

H. Review, closure, and completion of the SSA-831

When collateral estoppel applies, the DDS may, with some exceptions, make the determination without medical consultant (MC) or psychological consultant (PC) review. For additional information, see DI 24501.001B.2 and DI 24501.002A.

When the potential onset date (POD) in the new claim is earlier than the EOD in the prior favorable determination or decision, the DDS must complete development for the period not previously adjudicated to determine the established onset date (EOD). This will require adjudication in the usual manner for the earlier period, including MC or PC review and signature.

For information on medical evaluation, see DI 24501.002. Enter the regulation basis code “CE” for title II claims and “ACE” for title XVI claims in Item 22 of the SSA-831.

NOTE: Because eCAT functionality requires an MC/PC signature, the DDS may process collateral estoppel determinations that do not require an MC/PC signature outside of eCAT.


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http://policy.ssa.gov/poms.nsf/lnx/0427515001
DI 27515.001 - Collateral Estoppel - Policy - 06/06/2011
Batch run: 07/28/2020
Rev:06/06/2011