TN 1 (09-16)
DI 29005.040 Reopening an Initial Continuing Disability Review (CDR) Determination Made on a Request for Reconsideration
CITATIONS: Social Security Act, Section 205(b) Social Security Act, Section 205(b) 20 CFR 404.987 - 404.994, 416.1487 -416.1494
The rules of administrative finality may determine whether reconsidered determinations are reopened by the disability determination services (DDS) or other proper developing components. For additional information on reopening and revising CDR determinations, see DI 28501.025.
A. DDS believes the previous determination should be reopened
If the DDS receives evidence after the pre-hearing (PH) review or the disability hearing officer’s (DHO) determination is final, the adjudicator who made the final determination reviews the evidence.
Electronic evidence, when received, will generate an alert to the adjudicator. If we receive paper trailer material, the DDS must forward the material to the adjudicator using form, SSA-408 (Route Slip).
The adjudicator must review all electronic material and paper trailer material to determine if the case requires a reopening. If the DHO issued the reconsideration determination, refer the reopening issue to the disability hearing unit (DHU) that made the determination.
For more information on processing medical reactivations, see DI 81020.117. For more information on processing reopenings, see DI 81020.115.
B. Processing center (PC) requests reopening
In a situation where the PC requests a reopening, but after a review of the new evidence, the adjudicator who made the final determination disagrees, the DDS adjudicator performs the following actions:
document the folder to show why the reconsidered determination should not be reopened,
prepare an SSA-408 to transfer the case to the DHU, and
annotate the SSA-408 to show why the folder is being forwarded,
NOTE: In cases described above in DI 29005.040B in this section, it will not be necessary for the DDS to prepare the form SSA-887 (Summary of Evidence). If needed, the DHU prepares the Summary of Evidence.
C. Case is pending at the administrative law judge (ALJ) level
If trailer material is received that would reverse the DHO determination in an electronic case pending at the ALJ level, the DDS should complete a SSA-5002 (Report of Contact) explaining the reason for the reversal and place the SSA-5002 in the electronic folder (EF).
The DDS must notify the ALJ of the information in the SSA 5002, either electronically or telephonically.
If trailer material is in receipt that would reverse the DHO’s determination on a paper case from cessation to a continuance, the DDS should contact the ALJ and request an informal remand (IR). For more information on IRs, see DI 29005.030C.
DI 27505.001 Conditions for Reopening a Final Determination or Decision
DI 28501.000 Reopenings and Revision of CDR Determinations
DI 28501.025 Reopening and Revision of a Prior CDR Reconsideration Determination
DI 81020.115 Processing Reopenings
DI 81020.117 Processing Medical Reactivations
DI 81020.140 Processing Trailer Material for the Certified Electronic Folder (CEF)