TN 2 (08-08)
DI 81020.115 Processing Reopenings
A. General - Defining reopenings
A reopening is a formal review of a determination or decision that has become administratively final to admit new and material evidence (per Good Cause for Reopening- DI 27505.010), or, where error is involved, a reevaluation of the evidence used in a prior determination or decision.
B. Processing reopenings
Versions 12.0 and 13.0 of the Electronic Disability Collect System (EDCS), eView, and Electronic Folder Interface (EFI) allow several types of reopenings to be processed electronically:
Medical Reactivations are supported in version 12.0. If there are no current pending claims in EDCS and the last medical decision requires reopening, see Processing Medical Reactivations - DI 81020.117.
If a current claim is pending, and the decision necessitates reopening a prior decision, version 13.0 supports processing the reopening electronically.
NOTE: Versions 12.0 and higher do not allow electronic processing of reopenings when a prior paper folder is involved. If a current claim is pending, the decision necessitates reopening a prior decision, and the prior folder is paper, you must convert the case to paper.
Version 14.0 allows the Disability Determination Services (DDS) to reopen Federal Reviewing Official (FedRO) decisions.
C. Processing electronic reopenings
Version 14.0 of EDCS/eView/EFI allows a reopening to be processed electronically when the prior folder(s) is a Certified Electronic Folder (CEF). If the DDS determines a CEF is a possible reopening and the prior folder(s) is a CEF, and the DDS case processing system has been upgraded to version 14.0:
Go to the Status/History Tab and select the “Reopen Prior Claim” link;
Place a checkmark in the box beside the claim(s) to be reopened;
Click on the “List prior CEF Claims” button at the bottom of the page;
Select the claim with the earliest appropriate filing date. The prior claim effective date propagates into the “Update the current claim with the reopened filing date of MM/DD/YYYY” field;
NOTE: If there are intervening claims, the following confirmation message is displayed, “You are reopening the following claim(s): Are you sure you want to reopen these claims?” Select “OK” on the confirmation box to reopen the intervening claim(s) or select “Cancel” to return to the previous page.
Return to the Reopening Process page;
Contact information of the person responsible for the reopening is propagated. The system defaults to the contact information of the logged-in user, however, this field can be overkeyed.
Complete the SSA-831 per Completion of Form SSA-831-U5 in Title II Reopening Cases - DI 27530.015 and Completion of Form SSA-831-U5 in Title XVI Reopening Cases - DI 27530.025.
Once the reopening is complete, the system automatically completes the following actions:
Prior claims are annotated with “reopened” in the Claims Action History Page;
Prior folder documents, including documents from any intervening folders, are copied into the current case;
A message is displayed below the Alerts and Messages Tab on the current folder, “This folder was combined with a prior folder to establish a reopening. View Prior Folder”;
“Yes” is displayed in the “Has Reopened Prior Claim” field;
A message is displayed on a prior folder that has been reopened along with any intervening claim(s) that has been reopened, “Decision(s) in this folder have been reopened. View reopened claim(s). [Claim Type(s)]”;
The DMA Document Tab displays “PF” and does not distinguish levels (e.g., IC, HR) on documents from prior folders within the initial folder when linked to a prior folder; and
A new link shows a history of when a claim is either reopened or canceled.
D. Canceling an electronic reopening
If the DDS determines that a reopening is not possible after beginning the reopening process, the user is able to cancel the reopening at various stages:
Select the “Reopen Prior Claim” link;
Select the “Cancel Reopening” button, which displays the “Cancel Reopening” page;
NOTE: Contact information of the person who is canceling the reopening is propagated.
A confirmation message is displayed, “Are you sure you want to cancel the following reopened claim(s)? If you continue, the reopened filing date and documents will be removed from the selected pending claim.”
If you select “OK” or “Cancel” in the confirmation box, you are returned to the “Reopening Process” page;
Annotate the CEF with an SSA-5002 (Report of Contact) documenting the reason for cancelling the reopening; and
Close the claim with a No Determination (ND).
E. DDS identifies possible reopening prior to DDS upgrade to version 12.0 or higher
If the DDS case processing system has not been upgraded to version 12.0 or higher, reopenings cannot be processed electronically. Current system limitations prevent decisional data from being changed once a case is closed. Once the DDS determines a CEF or a CEF Exclusion case is a possible reopening; and the prior folder is paper, a closed CEF, or a transferred CEF; and it is prior to the DDS upgrade to version 12 or higher; cease electronic case processing and create a paper Modular Disability Folder (MDF). (The Paper MDF becomes the official agency folder for the case). To reopen the prior folder:
Obtain the prior paper. If the prior paper folder has been lost or destroyed, refer to Subsequent Applications - DI 27510.005H.
If the prior case is a CEF or a transferred CEF, the DDS:
Prints all essential materials for all adjudicative levels from the prior CEF(s) and files it in a paper folder. For a definition of essential materials see Documenting the Disability Folder - Disability Determination Services (DDS) - DI 20503.001B.1.,
Add a message in eView to show that the case has been converted to paper and associated with a reopening.
Alerts the FO or last office of jurisdiction to update the PFI.
Create an SSA-5002 (Report of Contact) documenting the following in the CEF:
Post a message in eView to indicate that electronic processing ceased effective (MM/DD/YYYY) because a prior claim was reopened;
NOTE: The DDS may reference the SSA-5002 in the message.
Update the Paper Folder Indicator (PFI) to show that the current claim is being processed as a paper MDF;
NOTE: Update PFIs before the DDS closes the case. It cannot be done after the case closes because the case is then in Field Office (FO) jurisdiction and DDS no longer has update capability.
Close the current case as a ND on the National Disability Determination Service System (NDDSS);
NOTE: Do not attempt to change the CEF claim type to match the reopened claim or the CEF transactions may fail or incorrect payments could result.
Print all essential folder materials for all adjudicative levels contained in the CEF. File the printed documentation in the MDF for the reopened claim. For a definition of essential folder materials, see Documenting the Disability Folder - Disability Determination Services (DDS) - DI 20503.001B.2.
NOTE: Do not print documents from the Green (Temporary) section of the CEF.
Receipt and process the MDF on NDDSS following current procedures. Refer to How to Complete the Update (DUPD) Data Input Screen - SM 06001.220;
Complete the SSA-831 per Completion of Form SSA-831-U5 in Title II Reopening Cases - DI 27530.015 and Completion of Form SSA-831-U5 in Title XVI Reopening Cases - DI 27530.025;
Enter “A CEF has been converted to paper and is associated with this Reopening” in item #34 of the revised SSA-831;
Scan a copy of the reopened SSA-831 into the current CEF upon completion of the reopening for informational purposes;
Prepare an SSA-408 (Route Slip), annotate “Prior Folder Reopened – CEF Processed as No Determination”, attach it to the paper MDF, and mail it to the appropriate office; and
Forward any trailer material per Disposition of Trailer Material - DI 22520.001.
NOTE: Paper processing of the case is necessary because the critical entitlement dates (e.g., application date, insured status dates) associated with the current CEF may be different than those associated with the reopened claim.
F. Field Office (FO) identifies possible reopenings prior to DDS upgrade to version 12.0 or higher
1. Determining if a closed CEF needs reopening
If the FO questions the DDS determination due to a technical factor of entitlement (e.g., filing date, insured status, work issue), contact the DDS and decide with the DDS if:
If the issue does not affect the DDS determination and the case does not need to be returned to the DDS, the FO documents the discussion on an SSA-5002 (Report of Contact) and adds it to the CEF. For the complete FO procedures, see Certified Electronic Folder (CEF) Exclusions - DI 81010.030F.
2. Reopening a CEF is necessary
a. FO actions
If you must return the CEF to the DDS, take the following actions:
Print sections A through D and file the documents in a paper MDF;
Document the case with an SSA-5002 that the case is being processed as a reopening and is now a paper MDF;
Add a message in eView without an expiration date; and
Update the paper folder indicator (PFI) to reflect the case is a paper MDF.
For more information on possible reopenings by the FO, see Certified Electronic Folder (CEF) Exclusions - DI 81010.030F.
b. DDS actions
Upon receipt of the paper MDF:
Receipt and assign the case;
Print sections E and F of the CEF, and file in the paper MDF; and
Process the case according to current procedures.
Maintain all documentation in the paper MDF.
3. DDS determines the case should not be reopened
If the DDS determines that the case should NOT be reopened:
Advise the FO to close the manual controls for the case;
Alert the FO to update the PFI to show the case is a CEF;
Add an SSA-5002 to the CEF to document that a reopening is not appropriate;
Delete the message in eView that was added by the FO when they sent the paper MDF to the DDS;
Add any developmental documentation that is not already contained in the CEF; and
Destroy the paper MDF.
G. FO identifies a possible reopening and the DDS case processing system has been upgraded to version 13.0 or higher
The FO follows current procedures in DI 81010.030F.
The DDS follows current procedures in DI 81020.115C.