DI 81020.255 Processing a Reconsideration Appeal of an Electronic Continuing Disability (eCDR) Cessation
Continuing Disability Review (CDR) reconsiderations, including the Pre Hearings (PH) and Disability Hearings Unit (DHU) cases, are no longer excluded from electronic folder case processing.
The beneficiary completes a paper SSA-789 (Request for Reconsideration – Disability Cessation), a paper SSA-3441 (Disability Report - Appeal) and the appropriate number of SSA-827s (Authorization to Disclose Information to the Social Security Administration [SSA]). The FO keys limited data into EDCS, such as the beneficiary’s SSN, name, address and phone number, and the SSA-3441 data.
The FO faxes the SSA-789 and SSA-827 into the CEF and mails the paper SSA-827s (and the paper Comparison Point Decision (CPD) folder, if applicable) to the DDS under the cover of an EDCS route slip.
B. DDS Responsibilities for eCDR Reconsideration Appeals
1. Pre Hearings Review Process
The case is receipted and assigned to a PH reviewer/examiner per existing procedures. Follow the guidelines in eCDR Development - DI 81020.220, to evaluate the case. After completing the review, follow the guidelines in DI 29005.001 through DI 29005.005 - Reconsideration Standards and Development Guidelines. If the PH reviewer disagrees with the cessation, the prior decision can be reversed and benefits continued. If the PH reviewer/examiner agrees with the prior decision, the case is sent to the Disability Hearings Unit.
a. Pre Hearing Favorable Decision
The SSA-832 (Cessation or Continuance of Title XVI) and/or SSA-833, (Cessation or Continuance of Title II) is prepared following the guidelines in Electronic Continuing Disability Review (eCDR) Determinations - DI 81020.240, and the claim is sent to FO.
b. Pre Hearing Unfavorable Decision
If the PH reviewer/examiner agrees with the cessation, follow the instructions in Disability Determination Services (DDS) Action When Fully Favorable Reconsideration Determination is not Issued - DI 29025.001.
The PH reviewer/examiner cannot write “ADVISORY” in red at the top of any electronic Residual Functional Capacity (SSA 4734-BK), Mental Residual Functional Capacity (SSA-4734-F4-Sup.), Psychiatric Review Technique (SSA-2506 BK) or Childhood Disability Evaluation (SSA-538 F6) forms.
If the form has not been imaged into the CEF, the PH reviewer/examiner should follow these instructions:
Physical Residual Functional Capacity Assessment (SSA-4734-BK). Annotate “ADVISORY” in Section IV Additional Comments.
Mental Residual Functional Capacity Assessment (SSA-4734-F4-Sup). Annotate “ADVISORY” in Section III Functional Capacity Assessment.
Psychiatric Review Technique (SSA-2506 BK) Annotate “ADVISORY” in Section IV Consultant’s Notes.
Childhood Disability Evaluation Form (SSA-538-F6) Annotate “ADVISORY” in Section III Explanation of Findings
If the form has been imaged into the CEF and cannot be changed, the PH reviewer/examiner will access eView and annotate Advisory in the “Notes” field next to the assessment form. To access the Notes field, the user will click on “Details” and type in Advisory in the note field.
The PH reviewer/examiner closes the PH level claim as a No Determination (ND), selects the reason “PH transfer to DH” and sends the case to the closure unit. The destination office will be the DDS. This action closes the PH level and sends a new download to the DDS with a case level of DH.
NOTE: No notice is sent to the claimant during this transfer; all actions are done internally.
2. Disability Hearings Unit (DHU) Process
a. Receipting DHU Claims
When the PH reviewer/examiner closes a claim as a No Determination (ND) with the reason “PH transfer to DH:”
The claim level is automatically updated to DH,
A new electronic folder interface download is sent to the DDS.
The DHU claim will be receipted and assigned to a hearings officer.
b. DHU Processing
Follow normal procedures for processing and adjudicating the case. Ensure that all essential folder documentation is saved in the CEF.
NOTE: If a disability hearings officer determines that a case must be returned to the PH, there is a companion ND reason “DH transfer to PH” that will change the level back to PH and send a download to the DDS. Discretion must be used when sending the case back to the PH level because of the impact on DDS productivity statistics.
c. DHU Closure
All final decisions, both favorable and unfavorable, will be routed to the FO. If necessary, the FO will forward the case to the Program Center.
d. Quality Review of DHU Cases
Currently, DHU cases are not selected for external quality review.