SSA - POMS: DI 81020.025 - Processing Electronic Reconsideration Cases

A. Processing reconsideration cases when SSA-3441 not received from claimant

When a claimant files a request for appeal, but does not provide the necessary forms, including the SSA-3441 (Disability Report – Appeal), the Field Office (FO) transfers the case to the Disability Determination Services (DDS) for a disability determination. See Processing a Reconsideration Request for a Medically Denied Initial Disability Claim - DI 12005.005D and DI 12005.005E.

1. FO identifies cases without a claimant-completed SSA-3441

The FO annotates in EDCS that a 3441 was not received. These cases are identified by an alert on the Alerts and Message tab in eView titled “5002: 3441 not received” along with the description, “See Case Documents tab for detailed information.” Under the Case Documents tab, there is an SSA–5002 documenting the reason for appeal and the FO attempt(s) to obtain the 3441.

2. SSA-3441 received after case transfer to DDS

a. FO receives SSA-3441

If the FO receives a paper SSA-3441 after transferring the electronic reconsideration case, the FO updates the Certified Electronic Folder (CEF) by:

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Creating a barcode and faxing the SSA-3441 into the CEF; and
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Adding a message with no expiration date stating, “Claimant’s 3441 received MM/DD/YY, faxed into CEF.”

NOTE: The alert and SSA–5002 indicating 3441 not received remains in the CEF.

b. DDS receives SSA-3441

If the DDS receives a paper SSA-3441 after receipting the electronic reconsideration case, the DDS updates the CEF by:

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Creating a barcode coversheet and scanning the disability report into the CEF;
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Adding a message, with no expiration date, stating “Claimant’s SSA-3441 received MM/DD/YY scanned into CEF;” and
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Retain the alert and imaged SSA-5002 indicating 3441 not received in the CEF.

B. Implied request for reconsideration

The FO may receive documentation other than an SSA-561 (Request for Reconsideration) from a claimant requesting an appeal of the initial medical determination. If the FO receives a written request for an appeal, treat the document as an Implied Request for Reconsideration. The FO faxes the Implied Request into the CEF.

The DDS must review the Implied Request and use it in place of the SSA-561.

NOTE: The DDS must review the CEF for this document and use it in lieu of the SSA-561 when completing the medical evaluation.

C. Appeals of Less than Fully Favorable (LTFF) initial determinations

An LTFF determination appeal occurs when the claimant files an appeal based on one or more of the following:

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Closed Period (CP),
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Adverse onset date, or
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Medical diagnosis.

If the DDS receives a reconsideration claim of an LTFF determination, follow current procedures for processing reconsideration cases. If an appeal is filed while a medically reactivated claim is pending in the DDS, follow procedures in DI 81020.117 Processing Medical Reactivations.

D. Adopting medical assessments

If applicable, the DDS Medical Consultant (MC) or Psychological Consultant (PC) may adopt any of the initial level medical assessment(s) when evaluating reconsideration cases. See Adoption of Initial RFC Assessment – DI 24510.066B. To determine if the initial level medical assessment(s) may be adopted, see the following references:

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Options to Simplify Case Processing - DI 24510.066B, to adopt the prior SSA-4734-BK (Residual Functional Capacity Assessment Form), or SSA-4734-F4-SUP (Mental Residual Functional Capacity Assessment Form);
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Evaluation of Mental Impairments Using the Psychiatric Review Technique (PRT) - DI 24583.005, to adopt the SSA-2506-BK (Psychiatric Review Technique Form); and
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Childhood Disability Evaluation Form (SSA-538) - DI 25230.001B.4. to affirm the SSA-538.

To adopt the prior initial level medical assessment:

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Prepare an SSA-416

The MC or PC may complete an SSA-416 (Medical Evaluation), or similar eForm identifying which form(s) is adopted and include the reconsideration affirmation statement: “I have reviewed all the evidence in file, and the assessment of (date) is affirmed as written.” The reviewing MC or PC must sign and date the SSA-416 (or similar eForm) using the approved electronic signature function. The eForm must be uploaded to the CEF prior to the DDS case closure.

NOTE: The SSA-416, or similar eForm, cannot be used to affirm an SSA-538, a new SSA-538 must be created to reference the initial SSA-538. For more information regarding affirmation of the initial level SSA-538 at the reconsideration level, see DI 25230.001B.4.
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Prepare a New SSA-4734, SSA-4734-F4-SUP, SSA-2506, or SSA-538.

The MC or PC may create the following eForms to adopt an initial level medical assessment:

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SSA-4734-BK.
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SSA-4734-F4-SUP.
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SSA-2506-BK.
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SSA-538 (Childhood Disability Evaluation Form).
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SSA-416 (Case Analysis).

To complete the adoption, the MC or PC creates a new eForm and types the reconsideration affirmation statement (“I have reviewed all the evidence in file and the assessment of (date) is affirmed as written”) in the remarks section of the eForm. The reviewing MC or PC must sign and date the eForm using the approved electronic signature function. The eForm must be uploaded to the CEF prior to the DDS case closure.

Social Security

Program Operations Manual System (POMS)

DI 81020.025 Processing Electronic Reconsideration Cases