Effective Dates: 02/01/2022 - Present Previous | Next

TN 4 (02-22)

DI 28035.015 Disability Determination Services (DDS) Identification of the Comparison Point Decision (CPD) 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 or destroyed folder involved.

A. Background on CPD date

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

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

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    Reviewing all evidence and documents in the current folder (either in eView or paper) to obtain the filing date, month of entitlement, Office of Hearings Operations decisions, etc.;

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

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    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, DDS cannot rely on the completeness of the file. To determine if a case is a CEF, see DI 81001.005.

B. Review queries to locate the CPD date

The adjudicator will 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) MS 00501.018 Query Medical Information Data Screen (QMID)

The adjudicator will review the DCF Query Medical Information Data screen to determine the:

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    Date of the last medical review;

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    Diagnosis codes;

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    Next medical diary date; and

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    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

The adjudicator will review the following fields:

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    INSURED – Displays type of claim and date of filing

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    BENEFIT – Displays DOEI – date of entitlement initial

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    BENE ENT – CUR ENT CODE - Displays type of currently entitled benefit

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    DIB - Disability Insurance Benefits

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    DDO - Date of Disability Onset

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    DIG - Diagnosis Code - Mental or physical impairment that resulted in a disability

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    DOED - Date of entitlement to disability

b. Supplemental Security Record (SSR) SM 01601.000

The adjudicator will review the following fields:

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

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    DIAR – MR – Medical Review Diary

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    DISB – DSA - Date to State Agency

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    DDO - Date of Disability Onset

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    DIG - Diagnosis Code

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    DPM - Permanent Disability Indicator

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    CDR - CDR Event and Code

c. DDS Query (DDSQ) SM 06002.200

The adjudicator will review the following fields:

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    DEC – Decision

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    BAS – Basis

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    OND – Onset Date

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    DSI – Primary Diagnosis

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    DIA – Medical Diary Date

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    ESD – Examiner Signature Date

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    MSD – Medical Signature Date

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    SDI – Secondary Diagnosis

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    MLN – Medical Listing Number

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    SCD – State Cleared Date

C. Establish the CPD date

To establish the CPD date, the adjudicator will determine if the DDS:

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    Made the initial determination within the last 3 years. If there is no CDR date on the MBR, the allowance determination date is likely the CPD date.

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    Made the initial determination more than 3 years ago, or 7 years in medical improvement not expected (MINE) cases. The 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. Review 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, the adjudicator will review the following information if available:

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    Consultative examination scheduling documents;

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

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

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    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, the adjudicator will 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.

F. Example of determining CPD date

A CDR alert was generated 10/2018. The FO and the DDS were unable to locate the prior paper folder. The DDSQ shows 02/13/15 as the Title XVI onset date, with a 3-year medical re-exam diary. The case was closed (SCD) 06/07/15. The SSR shows current folder location L47 (Folder destroyed). There is no indication that SSA conducted a CDR between onset date and current CDR alert date. The established CPD is 06/07/15 – the date DDS made the last favorable determination.

G. References

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    DI 81001.005 Electronic Disability (eDib) and the Electronic Folder (EF)

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    MS 00501.018 Query Medical Information Data Screen (QMID)

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    SM 00510.000 Master Beneficiary Record (MBR)

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    SM 01601.000 Information Retrieval Systems Procedures

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    SM 06002.200 Parts of a Full Query Response

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428035015
DI 28035.015 - Disability Determination Services (DDS) Identification of the Comparison Point Decision (CPD) Date - 02/01/2022
Batch run: 12/07/2024
Rev:02/01/2022