TN 1 (02-06)
DI 28057.030 DDS Actions Upon Receipt of Appeal Request
A. Policy - Receipt of Cases
Although the medical review standard and forms used in these cases are the same as for continuing disability reviews (CDR), the Disability Hearing Officer procedure for reconsiderations is not used. An EXR case does not meet the statutory requirement for a Disability Hearing Unit (DHU) hearing. Follow the procedures in DI 27001.000 for the regular initial reconsideration procedure.
B. Procedure – Case Receipt Input
Enter the following information on the NDDSS:
If the field is...
Enter the usual information
AN, BIC, AH, XAH, DB, XAN, AD, ZIP
Obtain data from the initial expedited reinstatement determination (SSA-832-U3/SSA-833-U3 Cessation Or Continuance of Disability or Blindness Determination and Transmittal Form)
Enter the level code DH followed by claim type
Enter the current date (MMDDYY)
Enter the office code of the office that sent the folder to the DDS
Input a CDT code of 05
C. Policy - Medical Review of Cases
Review the case using the instructions contained in section DI 28057.015.
D. Procedure - Completion of Determination Forms
Complete a SSA 832/833 in the usual manner except as follows:
Item 5: Enter the established onset date from the entitlement file.
If the individual is under a disability, check block A.
If the individual is not under a disability or the impairment(s) is not the same as or related to the comparison point decision (CPD) impairment, check both blocks B and C. The date for both is the date of the EXR request.
Item 10: Check block D, “Other”.
Title II Cases: For a determination that the current impairment(s) is not the same as or related to the CPD impairment(s), enter code 28.
Title XVI Cases: For a determination that the current impairment(s) is not the same as or related to the CPD impairment(s), enter code 61.
For a determination that the individual is not under a disability based on MIRS, use the codes for a CDR MIRS cessation (see DI 28084.015).
Item 20: enter WRM code of 31 (defined as “Expedited Reinstatement Case”)
Enter appropriate remarks (Reconsideration Reversal, Reconsideration Affirmation, and/or Reconsideration Escalation).
Enter remark “Expedited Reinstatement.”
For cases where the individual is found to be under a disability, enter “This revises determination approved MMDDYY.”
Establish the month of entitlement/eligibility (MOE) by entering “MOE MMDDYY”. The month of entitlement (MOE) is based upon the individual's disability and the work data the FO provided in the SSA-454 and SSA-820/821. See DI 28057.015E. and DI 28057.015F. for instructions on establishing the MOE. The FO should have documented months of SGA and non-SGA during the retroactive period on the SSA-820/821 and SSA-454.
Item 29: Leave blank. The FO will issue the denial notice and OCO/PC will issue the award notice.
E. Procedure - Case Clearance
Take the following steps to clear an EXR reconsideration case:
Enter on the NDDSS using normal procedures found in SM 06001.499 and SM 06001.502.
Input WRM code 31, Expedited Reinstatement Case, to identify these cases for management information purposes.
For determinations that the individual is not entitled to EXR based on the impairment not being the “same as or related”, input a “Reason for Cessation” code of 28 for title II or 61 for title XVI. If denial of the EXR request is based on MIRS, use the codes for a CDR MIRS cessation.
Enter an SO code of “N”.
Forward the folder to the appropriate DQB if the case is selected for quality assurance review.
If the decision is favorable, fax the EXR approval to the FO, so the FO can initiate necessary non-medical development (see DI 11010.340) (or use other locally arranged alternative to expedite processing).
Forward the folder to the FO for any appropriate action if the case has not been selected for DQB review. The DDS should NOT send any EXR cases directly to OCO/PC.
SM 06001.120, DDS receipt (DREC) process.
SM 06001.502, DDS closure (D833) process