TN 6 (08-90)
DI 27515.040 DWB Claim Filed - Prior Disability Has not Ceased
An individual entitled to title II or title XVI disability may meet the disability requirement for DWB entitlement.
1. Prior Favorable Disability Determination /Decision
A prior favorable disability determination/decision will be adopted to DWB if the DWB application was filed January 1, 1991 or later for entitlement for months after December 1990. (DI 10110.001B)
For DWB application filed prior to January 1, 1991 and for entitlement prior to December 1990, a prior favorable disability determination/decision will not be adopted to award a DWB if the prior determination/decision was based on both medical and vocational considerations, or the prior disability onset is later than the end of the DWB prescribed period.
When a common issue does not exist, the DWB claim will be evaluated on its merits to determine disability under current criteria before the end of the prescribed period.
In ALJ decision cases, always obtain the folder to ascertain whether the ALJ decision was based solely on medical factors (the determination basis code may not be correct on these decisions).
A prior meets or equals determination subsequently continued on a medical-vocational basis will prevent the use of adoption since the Listing criteria are no longer met. A meets or equals continued because a new Listing is met may be adopted to DWB for entitlement.
1. Initial Claim
The same rules for determining disability apply:
Obtain a query or a prior folder to determine if adoption should occur.
Adopt the prior determination for DWB applications filed January 1, 1991 or later for entitlement for months after December 1990. (DI 10110.001 B.). For DWB application filed prior to January 1, 1991 and for entitlement prior to December 1990 follow DI 27515.040 B.1., item b.
NOTE : ODIO/PSC maintains jurisdiction in DWB title II cases.
Prepare DWB determination (see DI 27515.020C.4.)
2. Intervening CDR Determination
Adopt CDR determinations if the DWB application was filed January 1, 1991 or later for entitlement for months after December 1990. (DI 10110.001 B.)
For DWB application filed prior to January 1, 1991 and for entitlement prior to December 1990, adopt a prior meets or equals determination /decision subsequently continued on the basis of no medical improvement (or exception), although the DWB does not meet current Listing. The no medical improvement continuance does not terminate the prior disability finding and that prior basis for entitlement remains in effect for purposes of adoption.
EXAMPLE : An individual files a DWB claim and is previously entitled to title XVI payments. The comparison point determination is March 1, 1979, when the severity of the individual's impairment was found to equal a Listing. The results of a CDR show that although no current Listing was met or equaled at the time of the CDR no medical improvement has occurred. Assuming that no exception to medical improvement applied, the individual is considered to equal a Listing and the DWB claim will be allowed by adopting the prior favorable title XVI disability determination or decision of March 1, 1979.