TN 2 (09-14)

DI 28035.015 Disability Determination Services (DDS) Identification of the Comparison Point Decision Date

IMPORTANT: These instructions incorporate policy and procedure for both electronic continuing disability review (eCDR) and eCDR exclusion (paper) cases when there is a lost folder involved.

A. Background on comparison point decision (CPD) date

The DDS attempts to determine the CPD date before reconstructing the prior medical evidence in a continuing disability review (CDR) case by:

  • evaluating each case based on the facts and evidence available for that particular case;

  • reviewing all evidence and documents in the current folder (either in eView or paper) to obtain the filing date, month of entitlement, Office of Disability Adjudication and Review decisions, etc.;

  • reviewing all queries in file to document the date of the most recent favorable medical determination; and

  • reviewing any evidence that may be available in a prior non-certified electronic folder.

NOTE: A non-certified electronic folder (CEF) may be available with prior documentation. While documents in a prior folder may be considered during a review, if the prior folder is not a CEF, we cannot rely on the completeness of the file. To determine if a case is a CEF, see DI 81001.005.

B. Reviewing queries to locate the CPD date

Review the following processing systems and queries to locate and document the CPD date of the most recent favorable medical determination.

1. Disability Control File (DCF) MSOM CDR 001.018

Review the DCF Query Medical Information Date screen to determine:

  • when the last medical review occurred,

  • the diagnosis codes,

  • the next medical diary date, and

  • the basis for the diary date.

2. Queries

The following queries may have necessary information to determine the proper CPD.

a. Master beneficiary record (MBR) SM 00510.000

Review the following fields:

  • INSURED – displays type of claim and date of filing

  • BENEFIT – displays DOEI – date of entitlement initial

  • BENE ENT – CUR ENT CODE - displays type of currently entitled benefit

  • DIB –

    DDO – Date of Disability Onset

    DIG – Mental or physical impairment that resulted in a disability

    DOED – Date of entitlement to disability

b. Supplemental Security Record (SSR) SM 01601.000

Review the following fields:

  • CCTL – TMR – Master record Type (DI, DS, DC, etc.)

  • DIAR – MR – Medical Review diary

  • DISB – DSA Date to State Agency

    DDO – Onset

    DIG – Diagnosis Code

    DPM – Permanent Disability Indicator

    CDR – CDR Event and Code

c. DDS Query (DDSQ) SM 06002.200

Review the following fields:

  • DEC – Decision

  • BAS – Basis

  • OND – Onset date

  • DSI – Primary diagnosis

  • DIA – Medical diary date

  • ESD – Examiner signature date

  • MSD – Medical signature date

  • SDI – Secondary diagnosis

  • MLN – Medical listing number

  • SCD – State cleared date

C. Establishing the CPD date

To establish the CPD date determine if the DDS:

  • made the initial determination within the last 3 years. If there is no continuing disability review (CDR) date on the MBR, the allowance determination or date is likely the CPD date.

  • made the initial determination more than 3 years ago, or 7 years in medical improvement not expected (MINE) cases. A later decision should be the CPD date. However, due to delays in CDR processing, the absence of CDR data on the MBR may indicate that the initial decision is the CPD date.

D. Reviewing other sources to identify the CPD date

If the DCF, MBR, SSR and DDSQ do not provide all the information needed to determine the CPD date, review the following information if available:

  • consultative examination scheduling documents;

  • DDS residual files (e.g. records of determinations or decisions, consultative exams, etc.);

  • a DIB line CDR code of “M” on the MBR; and

  • trial work period (TWP) or extended period of eligibility (EPE) data on the DCF that may establish that a prior review was a work CDR.

NOTE: If a case pre-dates the DCF, review the MBR to obtain the TWP/EPE data.

E. Explanation of a CPD determination

The DDS will explain how it determined the CPD date or why it was unable to determine the CPD date. The explanation will provide the determined CPD date and discuss the evidence considered to support the conclusion DI 28091.010.

F. Example of determining CPD date

A CDR alert was generated 10/2013. The FO and the DDS were unable to locate the prior paper folder. The DDSQ shows 02/13/04 as the Title XVI onset date, with a 3-year medical re-exam diary. The case was closed (SCD) 06/07/04. The SSR shows current folder location L47 (Folder destroyed). There is no indication that we conducted a CDR between onset date and current CDR alert date. The established CPD is 06/07/04 – the date we made the last favorable determination.

G. References

DI 28091.010 Implementation of Simplified Decision Rationale Procedures

DI 81001.005 Certified Electronic Folder (CEF) Overview

MSOM CDR 001.018 Query Medical Information Data Screen (QMID)

SM 00510.000 Master Beneficiary Record (MBR)

SM 01601.000 Information Retrieval Systems Procedures

SM 06002.200 Parts of a Full Query Response

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DI 28035.015 - Disability Determination Services (DDS) Identification of the Comparison Point Decision Date - 05/11/2011
Batch run: 09/10/2014