DI 40115.015 Processing Center (PC) Action when Disability Determination Services (DDS) Establishes an Onset in Period Covered by a Prior Determination
A. DDS determination when reopening is possible
When the Disability Determination Services (DDS) establishes an onset in a period covered by a previously denied claim, refer the case:
to the reconsideration disability examiner (REDE) in the Office of Disability Operations, and
to the disability processing specialist (DPS) in the Processing Center.
When the rules of administrative finality warrant reopening or revision, the REDE/DPS can adopt the DDS determination and establish an onset that invades a prior period of adjudication.
B. DDS determination when reopening is not possible
When the DDS establishes an onset within a prior period of adjudication, and
more than 4 years have passed since the date of the initial determination, or
more than 12 months have passed since the initial determination, and
the disability criteria have changed since the prior determination,
the REDE/DPS cannot reopen or revise the prior determination.
For more information regarding when reopening is not possible see, When a Prior Unfavorable Title II Determination or Decision Cannot Be Reopened DI 27510.005D.
C. DDS sets onset in period of prior DDS determination
When the DDS had the prior folder when it made the decision and the SSA-831 (Disability Determination and Transmittal) is complete, provide the claims authorizer/claims technical examiner (CA/CTE) with an explanation and instructions for processing the determination.
When the examiner/DPS does not receive the prior folder, or the reopening and revision are without explanation.
Change the uneffectuated SSA-831 and show an onset date that does not invade the prior period adjudicated;
Route the claim to the CA/CTE with an attached SSA-559 (Claims Folder/Material Transmittal) requesting the CA/CTE to pay on the corrected determination;
Attach the SSA-567 (Notice of Subsequent Handling) to the folder for routing back to the REDE or DPS if routing a paper MDF or prepare the SSA-567 in the Paperless Processing Center; and
Use the SSA-847 (SSA Request for Case Action), if necessary, to return the folder to the DDS. If the case is not returned to the DDS, notify the DDS of the correction per GN 04440.220. Follow instructions for routing a certified electronic folder in DI 81000.000
When the claimant submits new and material evidence, the PC technician may either
Reopen and revise the prior determination, or
Return the file to the DDS after processing for consideration of reopening and revision of the prior determination.
D. DDS sets onset in period ruled on by Administrative Law Judge (ALJ) or Appeals Council (AC)
When the DDS sets onset in a period ruled on by an Administrative Law Judge (ALJ) or Appeals Council (AC):
Change the onset date on the uneffectuated SSA-831 to the day following the date of the denial decision of the ALJ or AC;
Enter in item 34 of the SSA-831 “Onset established after period ruled on by ALJ (or AC)”;
Notify the DDS of the correction per GN 04440.220, and
Attach an SSA-567 or prepare the SSA-567 in the Paperless Processing Center to route (after processing of the current determination) the folder back to a REDE or DPS for consideration of referral to appropriate office for reopening. Explain on the SSA-567 the basis for reopening.
When reopening is not possible and the reopening period after the ALJ or AC decision has expired, DDS onset can invade a prior period per DI 27510.005D.
E. DDS sets onset in period ruled on by a Disability Hearing Officer (DHO) or Office of Disability (OD)
When the DDS sets onset in a period ruled on by a Disability Hearing Officer (DHO) or Office of Disability (OD):
Follow procedures in section C above where there is probable basis for reopening and revising a decision, except enter in item 34 of the SSA-831 “Onset established after period ruled on by DHO (or OD)” and;
Forward the folder to the DHO Unit or OD, as appropriate, (after processing of the current determination) for consideration of the reopening issue.