TN 37 (05-15)
DI 28001.005 Disability Determination Services (DDS) Responsibilities with Other Components during a Continuing Disability Review (CDR)
A. Introduction to component responsibilities
DDS, field offices (FO), and processing centers (PC) share the responsibility for identifying, developing, and adjudicating continuing disability (CD) issues.
B. Policy for component responsibilities
1. FO responsibilities
Frequently, the CD issue will increase an individual’s contact by telephone or visit to a FO. The FO will identify, develop, and route the type of CD issue. It is important for the FO to identify accurately the type of CD issue involved, since the issue governs the development and subsequent routing.
There are two types of CD issues:
possible medical recovery (with or without work activity), and
work activity (with no medical issue).
When a CD issue arises, the FO will determine the status under Title II and Title XVI. If a Title II beneficiary has Title XVI eligibility (not denied or terminated) even though no Title XVI payments are being made, a Title XVI investigation of the CD issues will be made concurrently with separate Title II and Title XVI determinations. If a Title XVI recipient request reinstatement of payments after a period of suspension for non-disability reasons and there is a past due medical diary on the record, a CDR initiation is needed as soon as payment has been resumed.
For Title XVI CDRs, the FO has the following special responsibilities to:
terminate Title XVI payments;
process alerts for Title II terminations in concurrent Title II/XVI cessations;
prepare and release Title XVI notices following a work CDR; and
update the Supplemental Security Record (SSR).
The FO will also explore the possibility of a work issue when a report of earnings is made during a Title XVI redetermination. The FO personnel are responsible for establishing Title XVI work diary information and are alert to situations where eligibility may continue under section 1619 of the Social Security Act or the individual may be eligible for a new period of disability. The FO is also responsible for issuing initial substantial gainful activity (SGA) and reconsidered determinations in Title II cases.
2. DDS responsibilities
Medical development of CD cases is the responsibility of the DDS because they are especially equipped to obtain specific medical information and can pinpoint the development of clinical and laboratory evidence in light of the information already in the file. The DDS will request FO assistance when required. The FO or Office of Earnings and International Operations (OEIO)/Office of Disability Operations (ODO)/Program Service Center (PSC)- Disability Review Section (DRS) will send the case to the DDS of the State in which the individual is known to reside at the time of the current transmittal to the DDS. If the DDS finds the individual has moved to another State, the DDS that receives the case may transfer it to the other DDS. By affecting this transfer, the DDS will complete any development started before learning of the individual's new residence. The FO will transmit the case to the DDS of the State in which the individual is actually residing for a determination as to the continuance or cessation of:
disability or blindness, or continuance or cessation of impairment severity in extended period of eligibility (EPE) cases; and
unique Title XVI cases ( cessation with a new period of disability) in post-EPE 1619 cases.
If a State, other than the State of conversion in a non-rollback conversion case, makes a cessation determination, the DDS should route the folder to the State of conversion for consideration under the State plan. (In EPE cases, disability may have previously ceased because of SGA.) The DDS will notify FO/OEIO-ODO/PSC-DRS of the folder transfer and of the need, if any, to suspend benefits.
3. ODO responsibilities
CDR's are initiated in ODO as a result of:
ODO examines all information which raises a question of possible medical recovery or indicates an ability to work and screens out cases in which a CDR is not required. ODO and PSC-DRB may review FO and DDS determinations and, when appropriate, recommend further development. Under the ACID (Automated Continuing Investigation of Disability) program, ODO can establish Title II trial work diaries, MIE diaries, MIP or MINE diaries enter elapsed months of work in the TWP, and follow-up through the FO and DDS on all diaries. On each outstanding diary, ACID will generate periodic follow-up alerts, which ODO will forward for subsequent action.
4. DRS responsibilities
The DRS (formerly TAS) reviews PSC jurisdiction cases (disability insurance benefits (DIB) over 54, disabled widow(er)’s (DWB), and childhood disability benefits (CDB)), applying the same kind of disability review functions as do ODO examiners. DRS has jurisdiction of Title XVI only cases, which are assigned by Social Security Number (SSN) corresponding to the respective PSC. DRS will initiate medical and trial work investigations. Investigations are a result of establishing MIE, MIP, MINE, TWP diaries, or reports of medical improvement or work activity. DRS will make development requests, as needed to the FO or DDS for additional evidence. In addition, inputs are made to ACID (Title II) and to the SSR (Title XVI) by DRS to establish and cancel MIE, MIP, MINE, TWP diaries (Title II only).
5. Office of Earnings and International Operations (OEIO) responsibilities
Foreign disability claims are under the jurisdiction of the OEIO. We obtain these developments in these cases through the Foreign Service Posts (FSP's). OEIO has responsibility for the disability determination for Title II claims filed by or on behalf of individuals living outside the 50 States, District of Columbia, Puerto Rico, and Guam. Where the individual resides in the United States (U.S.), the DDS serving the individual's latest address has responsibility for the determination in initial and continuing cases. Therefore, where the individual resides in the U.S., CDR development is initiated through the FO that is the servicing office for the U.S. resident.
When a CDR is necessary for a U.S. resident, OEIO will request the appropriate FO to obtain the Form SSA-454-BK (Continuing Disability Review Report); conduct a face-to-face interview; have the individual complete the required Form SSA-827 (Authorization to Disclose Information to the Social Security Administration) and forward the folder to the DDS.
When the DDS completes its action, the folder returns to OEIO.
Individuals residing in foreign countries will not usually receive a face-to-face interview. However, when a foreign claimant interviews in a U.S. FO, we conduct a face-to-face interview. A foreign individual may visit a U.S. office, or, frequently Canadian or Mexican residents will come into a border FO. In these situations, the FO will offer all necessary assistance and conduct the face-to-face interview.
6. Office of Quality Review (OQR) responsibilities
Some CDR cases will be selected for Federal quality review when the DDS makes closure input. The DDS sends the sampled cases to OQR for review. As part of the quality review process, OQR will collect data about each case to provide management information regarding performance accuracy, the disability determination process, and program trends. Occasionally, OQR may request FO assistance, especially on work-related issues such as SGA.