TN 6 (08-90)

DI 27515.030 Applying Collateral Estoppel to a Prior Title II or Title XVI Decision of Not Disabled When a New Title II or Title XVI Claim is Being Adjudicated Within Six Months of the Notice

A. Policy

1. When to adopt

The DDS may adopt a prior title II or title XVI determination or decision of denial to a new title II or title XVI disability claim where all of the following conditions are present:

  1. The title II claim is for disability insurance benefits (DIB) not  disabled widow(er)'s benefits (DWB) or child disability benefits (CDB) or the title XVI claim is for adult disability (not child disability);

  2. Disability insured status continues to be met in the new title II claim;

  3. The new claim is being adjudicated within six months after the prior denial determination or decision;

  4. The DDS has the prior folder, or a copy of the prior determination (SSA-831-U3), or decision (ALJ or AC);

  5. The basis for the prior denial was “substantive” (not currently disabled) rather than “technical;”

  6. There is no additional evidence and no indication or allegation of an additional impairment or worsening of a previously alleged impairment since the last determination or decision, and no new medical treatment is alleged;

  7. The increase in the individual's age does not affect the decision (when the denial was based on medical/vocational factors);

  8. The prior decision was prepared on or after 02/26/79 (effective date of Medical Vocational Rules) and the rationale, the folder (if obtained) or the personalized explanation contains the “findings of fact;” and

  9. The prior decision resulted from adjudication under current disability evaluation criteria. See DI 27515.015 for changes in evaluation criteria and DI 34100.000ff for obsolete versions of the Listing of Impairments.

2. When not to adopt

Adoption will not apply when the criteria in DI 27515.030 A. 1. are not met or when there has been a “significant” change in the evaluation criteria (DI 27515.015). The following are examples of significant changes:

  1. Revisions to the Listing of Impairments (01/06/86).

  2. Revised mental impairment criteria (08/28/85).

  3. New criteria for evaluating multiple impairments.

B. Procedure

1. Preparation of determination

  1. Prepare an SSA-831-U3 adoption determination using regulatory basis, impairment code, etc., as noted for the prior denial.

  2. Check item 27 (rationale) of the SSA-831-U3, and proceed as in 2. below.

2. Preparation of SSA-4268-U4/C4

  1. Prepare an SSA-4268-U4/C4.

  2. If a rationale was prepared for the prior denial, only enter   on the SSA-4268-U4/C4 the following: “See SSA-831-U3 dated      for title II DIB (or title XVI Adult Disability) claim, SSN      . The statement of evidence in the last prior denial determination (or ALJ or AC decision) dated      for title II DIB (or title XVI Adult Disability), except as modified herein, is hereby incorporated by reference, but not the inferences, findings, or conclusions thereon. There is no indication or allegation of a worsening of the previously alleged impairment and no new medical treatment or additional impairment(s) is alleged since such prior determination (or decision).”

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