BASIC (02-12)

DI 71005.001 Border Field Office (FO) Process for Title II Initial Disability Claims Mexican Residents File in the United States

In 2008, the pilot, that allowed designated FOs to send claims filed by Mexican residents to designated disability determination services (DDS) for a determination, was expanded to include the Dallas and San Francisco regions. This business process applies to all FOs in Texas, New Mexico, California, and Arizona and DDSs in Texas, New Mexico, La Jolla California, Tucson Arizona, and Phoenix Arizona.

NOTE: These instructions do not apply to continuing disability reviews (CDRs) – For processing instructions see Continuing Disability Review Cases in DI 28000.000.

A. Border field office initial claim process for title II initial disability claims filed in the United States by Mexican residents

NOTE: If a non-border FO receives a claim filed by a Mexican resident, transfer the claim to the Office of International Operations (OIO) for a medical disability determination.

1. FO initial claims procedure

During the initial claims interview:

  • Complete the initial disability claim;

  • Collect claimant information in the Modernized Claims System (MCS) and the Electronic Disability Control System (EDCS);

  • Complete all required forms (i.e., application, medical reports, and medical releases);

  • Advise all Mexican residents that we will try to schedule a Consultative Examination (CE) with his or her medical source(s), if a CE is necessary. If it is not possible to schedule the CE with the claimant’s medical source(s), DDS may require him or her to attend a CE in the U.S.; and

  • Ask the claimant if he or she has a passport or other documents that will allow him or her to travel between Mexico and the U.S. for the CE and document this information on the SSA-3367 (Disability Report-Field Office).

2. Spanish forms and language assistance

Translate forms completed in Spanish at the border FO (e.g., SSA-3368- Disability Report-Adult). If the claimant has limited English proficiency, requests language assistance, or it is evident that the claimant requires language assistance, follow the procedures in GN 00203.011.

B. Border FO non-medical development

1. Concurrent FO and DDS development

Develop the non-medical portion of the title II claim simultaneously with DDS medical development. If at any time during the development process, you determine the claim does not require a medical determination, contact the DDS to request that they transfer the claim back to the border FO as a “No Determination” claim, according to the instructions in DI 81020.127.

2. Substantial gainful activity (SGA) and denials

Develop and resolve potential non-medical SGA denials and make all applicable claim folder inputs. If an SGA denial is appropriate:

  • complete all SGA development,

  • prepare a denial, and date, and

  • release the notice.

However, if you defer medical development because a potential SGA denial exists, resolve the non-medical factor (s) before sending the medical portion of the claim to the DDS. For guidelines on processing SGA denials in EDCS, see DI 81010.140.

3. Border FO medical development

If the claimant submits medical evidence, follow the instructions in DI 81010.125. If you receive medical records after forwarding the claim to the DDS, immediately fax or scan the medical evidence into the electronic folder.

C. Border FO adjudication process after receiving a DDS determination

After receiving the DDS determination, complete the following steps:

1. Title II allowance

Trigger payment in MCS and transfer the claim to OIO. For paper folders, complete an SSA-3601 (Claims Routing) and route the folder to OIO at the following address:

OIO
P.O. Box 17769
Baltimore, Maryland 21235-7769
System Destination Code: PC8

2. Title II denial

Hold the title II claim in the border FO (electronic or paper folder) until the claimant files an appeal, or the 6-month retention