Program Operations Manual System (POMS)
TN 6 (08-90)
DI 27515.050 CDR Issues in Collateral Estoppel Cases
1. CDR Issue Raised
The filing of a new application is not an event that raises a continuing disability (CD) issue on an existing disability.
If evidence obtained in conjunction with a new claim raises a CD issue (see DI 28001.015 for events which raise a CDR issue), a continuing disability review must be done whether or not a common issue exists between the two claims and regardless of when the periodic review is scheduled.
Before any CDR issue is resolved, first, process the new claim under adoption policy and on a post basis resolve the CDR issue.
Treat the prior claim and the adopted claim as concurrent claims needing CDR resolution (see DI 28030.000).
Handle overdue or current scheduled diaries in accordance with DI 26525.001 through DI 26525.065.
NOTE: In any adoption situation, if a diary was never established on the existing claim, if a current diary is due, or the diary is past due or will be due within 3 months, adopt the prior favorable determination and establish a MIE diary on the current claim to mature in 1 year, unless the diary was a MIP or MINE. If the diary on the existing claim is a MIP or a MINE, and no medical issue is raised with the new claim, set a MIP on the new claim to mature in 3 years or a MINE on the new claim to mature in 7 years (whichever applies).
2. Prior Determination Folder
The prior folder, and prior evidence, and the comparison point decision (CPD) are needed to determine/decide if medical improvement has occurred, i.e., to resolve CDR issues.
Since the prior folder will not always be received with the new claim, the DDS must request it following DI 20505.010 before initiating any development.
3. Prior Folder Not Found
The DDS will not assume that the prior folder is lost until two followups (see DI 20505.015) prove fruitless, and RO is asked to assist.
If the prior folder is determined to be lost, the DDS must develop information in accordance with DI 28035.020 through DI 28035.030 to make any necessary CDR determination.
4. Adopting a Prior Favorable Disability Determination After a “No Medical Improvement” Continuance Determination
A CDR determination under one title often will be material to the determination/decision made in a new claim under, the same or a different title of the Act.
A continuance determination based on no medical improvement (or exception) means the initial favorable disability determination is not terminated and thus the initial favorable disability determination/decision may be adopted when making a determination in a new claim.
Process a subsequent claim after a current CDR on the prior claim as follows:
|If Medical Improvement (MI)...||Then...|
is not shown, or MI shows currently disabled or unable to engage in SGA
Adopt the prior initial favorable disability determination to the new claim, provided all the conditions for adoption are met (DI 27515.001 through DI 27515.060).
Reflect the allowance code shown on the initial SSA-831-U3 decision on the adopted claim.
is shown and current ability to engage in SGA, or MI is not shown, but a MIRS exception applies resulting in cessation
Prepare a closed period adoption on the new title II claim provided all the conditions for adoption are met DI 27515.001 through DI 27515.060.
is shown-and a reopening is considered
Prepare a determination of current month cessation rather than a reopening and revision of the prior claim when medical improvement and the ability to engage in SGA occurred after approval of the award (even if this occurred within 12 months of onset date, since in these situations, duration was previously found to be met based on expected duration).
is shown and evidence does not allow reopening
Do not establish a closed period if the durational requirements are not met on the subsequent claim. See MI shown and current ability to engage in SGA (above), if closed period is applicable for the new application.
See DI 27515.015B.1. for procedures for when prior determination is to be reopened. Also see DI 27505.010 through DI 27505.020 for the rules of administrative finality.