TN 2 (01-21)

DI 27515.055 Work Incentive Status and Collateral Estoppel Claims

A. Introduction

The Social Security Act provides certain work incentives to assist and encourage disabled individuals who attempt to return to work. Accordingly, a beneficiary or recipient may file a new disability claim under another title (or for another type of benefit under the same title) when there is/was intervening work activity covered under a work incentive provision.

B. Resolve work issue first

The field office (FO) must resolve the work issue prior to the Disability Determination Services (DDS) making a determination. For information on FO and DDS responsibilities for work development, see DI 11010.140.

When the claimant alleges a visual impairment and is currently engaging in substantial gainful activity (SGA), the DDS must make a statutory blindness determination as explained in DI 11005.070D. In order to meet the duration requirement for disability, the claimant must meet the disability requirements and not have performed SGA for 12 months, except in cases of statutory blindness under title XVI or when the statutorily blind claimant is age 55 or older and work comparability provisions apply. For additional information on the duration requirement, see DI 25505.000.

When the claimant meets all requirements, including duration, adopt the prior favorable determination or decision when none of the restrictions in DI 27515.001E applies. Do not close the period for SGA. The FO is responsible for placing the new claim in the applicable work incentive status. When the prior favorable determination or decision is medically ceased, see DI 27515.055D.

When collateral estoppel does not apply due to not meeting the duration requirement and the new claim is a denial, the DDS must enter list code 583 (Adoption does not apply - claimant does not meet duration) in Item 26 of the SSA-831.

C. Continuing disability review (CDR) issues

When evidence in the new claim raises a CDR issue (either potential medical improvement (MI) or a potential specific exception to MI), see DI 27515.050.

D. Vocational rehabilitation section 301 Cases

When disability is medically ceased, a claimant may continue to receive benefits because of participation in an approved VR program (section 301 payments). Collateral estoppel does not apply. The DDS must complete development and make a new determination when the prior claim is in section 301 payment status. For more information on 301 cases, see DI 28060.001.

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DI 27515.055 - Work Incentive Status and Collateral Estoppel Claims - 01/13/2021
Batch run: 01/13/2021