Under the rules of collateral estoppel, we will not again decide an issue we have already decided in a prior determination or decision, unless there are reasons to believe that the prior finding on the issue was wrong. The Disability Determination Services (DDS) may adopt, in a new claim, the findings of a prior favorable determination or decision. While these adoption determinations often involve claims arising under different titles of the Social Security Act, it may be appropriate to adopt a prior determination or decision under the same title for a different type of benefit because the underlying principle of issue preclusion (whether designated collateral estoppel or res judicata) may apply in the same title context.

The DDS has jurisdiction for all subsequent claims when collateral estoppel potentially applies. The field office (FO) will transfer potential collateral estoppel claims to the DDS for processing and determination. For FO instructions, see DI 11011.001.

NOTE: The Program Service Center (PSC) may also make collateral estoppel determinations when the PSC receives the new claim directly. For additional PSC instructions, see DI 40120.001.

The determination in a new claim may differ from the determination or decision in a prior claim when collateral estoppel does not apply. The determinations or decisions may appear to conflict with each other, however these are not considered conflicting determinations. For more information on different determinations or decisions for the same period, see DI 27515.035.

When collateral estoppel applies, the DDS may, with some exceptions, make the determination without medical consultant (MC) or psychological consultant (PC) review. For additional information, see DI 24501.001B.2 and DI 24501.002A.

When the potential onset date (POD) in the new claim is earlier than the EOD in the prior favorable determination or decision, the DDS must complete development for the period not previously adjudicated to determine the established onset date (EOD). This will require adjudication in the usual manner for the earlier period, including MC or PC review and signature. For information on medical evaluation, see DI 24501.002.

When a diary was never scheduled on the prior favorable determination or decision, the diary is due, or the diary is past due, or will be due within 3 months, set a MIE diary on the new claim to mature in 1 year unless the diary was MIP or MINE. When the diary on the prior determination or decision was MIP or MINE, and no CDR issue is raised, set a MIP or a MINE diary based on the individual case facts. For more information on diaries, see DI 26525.000.

Enter the regulation basis code “CE” for title II claims and “ACE” for title XVI claims in Item 22 of the SSA-831.

NOTE: Because eCAT functionality requires an MC/PC signature, the DDS may process collateral estoppel determinations that do not require an MC/PC signature outside of eCAT.

The Listing of Impairments undergoes periodic revisions that may change the rules to find that a claimant meets or equals a listing.

When the basis for the prior favorable determination or decision was meeting or equaling a listing, and that listing has not substantively changed or become more restrictive (i.e., more difficult to satisfy), collateral estoppel applies, provided none of the other restrictions in DI 27515.001E applies.

When the basis for the prior favorable determination or decision was medical-vocational rules, collateral estoppel applies except when:

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  The medical-vocational rules have changed (i.e., removal of inability to communicate in English), or

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  One of the other restrictions in DI 27515.001E applies.

When the basis for the prior favorable determination or decision was meeting or equaling a listing, and that listing has substantially changed or become more restrictive (i.e., more difficult to satisfy), collateral estoppel does not apply.

The table below shows the listings that have substantially changed or become more restrictive (i.e., more difficult to satisfy) over time and the date of the last such revision. When a listing is not in the table, it has not substantively changed or become more restrictive since initially published.

The table below is distinct from the table for res judicata determinations. For res judicata determinations, see DI 27516.010F.

When collateral estoppel does not apply due to a change in the listing, the Disability Determination Services (DDS) must complete development and make a new determination.

When the determination on the new claim is a denial, the DDS must enter list code 586 (Adoption does not apply - change in listing) in Item 26 of the SSA-831. For disability related list codes, see DI 33530.005.

When the basis of the prior favorable determination or decision was medical-vocational rules and the claimant has performed substantial gainful activity (SGA) since the date of the prior favorable determination or decision, he or she may have a changed vocational profile. When the claimant has a changed vocational profile, collateral estoppel does not apply and a new determination is required.

When the claimant has performed SGA since the date of the prior favorable determination or decision, the Disability Determination Services (DDS) must determine whether the claimant’s work activity is vocationally relevant.

When collateral estoppel does not apply due to a changed vocational profile, the DDS must complete development and make a new determination.

When the determination on the new claim is a denial, the DDS must enter list code 581 (Adoption does not apply - changed vocational profile) in Item 26 of the SSA-831. For disability related list codes, see DI 33530.005.

The FO will request the prior paper folder in accordance with DI 11005.085B before transferring the new claim to the Disability Determination Services (DDS) for determination.

Complete Item 7 on the SSA-3367 to document the prior paper folder request.

Do not delay transferring the new claim to the DDS while obtaining the prior paper folder. Once received, route the prior paper folder to the DDS to associate with the pending claim.

When the prior paper folder cannot be located, include a copy of the prior SSA-831 and SSA-832/833 when available.

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  Prepare a title II determination adopting the prior title XVI determination or decision under Federal criteria when none of the exceptions in DI 27515.001E applies.

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  Adopt the prior title XVI determination or decision even when in suspense for technical issues. Collateral estoppel does not apply when the prior favorable determination or decision is in terminated status. For using queries to determine current title XVI eligibility, see DI 28030.010.

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  Review the prior favorable determination or decision when needed to determine the established onset date (EOD) in accordance with guidelines in the table below. For requesting a prior paper folder, see DI 20505.015.

NOTE: When collateral estoppel applies, the Disability Determination Services (DDS) may establish a title II EOD later than the date set by a prior title XVI determination or decision because of the performance of substantial gainful activity (SGA) after the title XVI EOD or because the date first insured is later than the title XVI EOD.

The DDS may have made a favorable determination on an initial title XVI claim for Supplemental Security Income (SSI) based on disability or blindness, but the FO technically denied the claim (e.g., excess income) before issuing any benefit payment.

When the claimant files a new application, collateral estoppel does not apply and a new determination is required.

NOTE: Even when collateral estoppel does not apply, the DDS may make a favorable determination based on the evidence in the new claim.

Generally, the determination or decision for claims under different titles and benefit types should agree. However, different determinations or decisions may be appropriate because the rules for determining disability differ or because eligibility factors are not satisfied.

Examples include:

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  Collateral estoppel does not apply due to a change in the listing and the evidence in the new claim results in a denial using the current rules,

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  Collateral estoppel does not apply due to a changed vocational profile and the evidence in the new claim results in a denial at steps 4 or 5 of the sequential evaluation process, and

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  Collateral estoppel does not apply due to a change in medical-vocational rules (i.e., removal of inability to communicate in English).

For information on when collateral estoppel does not apply, see DI 27515.001E and DI 27515.001F.1.b.

The following applies to prior determinations or decisions made on or after July 29, 2020.

When evidence in the new claim raises a CDR issue (either potential medical improvement (MI) or a potential specific exception to MI), a CDR is required whether or not a common issue exists between the two claims and regardless of when the periodic review is scheduled. For information on MI in CDRs, see DI 28010.000. For information on the specific exceptions to MI that may raise a CDR in new claim, see DI 28020.001.

IMPORTANT : The specific exception to MI for failure to cooperate only applies when the claimant refuses to cooperate with the new claim and the evidence demonstrates potential MI or the claimant indicates he or she no longer wishes to continue benefits.

NOTE: Neither the filing of a new claim nor an overdue diary is an event that raises a CDR issue. For events that may initiate a CDR, see DI 13001.005.

For more information on CDRs, see:

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  DI 13001.005 and DI 28001.015 Events That May Initiate a Continuing Disability Review (CDR).

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  DI 13010.012 Protection from Medical Review Based on Work Activity.

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  DI 13010.135 Title II Continuing Disability Considerations in Blindness Cases.

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  DI 55025.010 Processing the Medical Continuing Disability Review (CDR) for Beneficiaries with Tickets.

The Social Security Act provides certain work incentives to assist and encourage disabled individuals who attempt to return to work. Accordingly, a beneficiary or recipient may file a new disability claim under another title (or for another type of benefit under the same title) when there is/was intervening work activity covered under a work incentive provision.

The field office (FO) must resolve the work issue prior to the Disability Determination Services (DDS) making a determination. For information on FO and DDS responsibilities for work development, see DI 11010.140.

When the claimant alleges a visual impairment and is currently engaging in substantial gainful activity (SGA), the DDS must make a statutory blindness determination as explained in DI 11005.070D. In order to meet the duration requirement for disability, the claimant must meet the disability requirements and not have performed SGA for 12 months, except in cases of statutory blindness under title XVI or when the statutorily blind claimant is age 55 or older and work comparability provisions apply. For additional information on the duration requirement, see DI 25505.000.

When the claimant meets all requirements, including duration, adopt the prior favorable determination or decision when none of the restrictions in DI 27515.001E applies. Do not close the period for SGA. The FO is responsible for placing the new claim in the applicable work incentive status. When the prior favorable determination or decision is medically ceased, see DI 27515.055D.

When collateral estoppel does not apply due to not meeting the duration requirement and the new claim is a denial, the DDS must enter list code 583 (Adoption does not apply - claimant does not meet duration) in Item 26 of the SSA-831.

When evidence in the new claim raises a CDR issue (either potential medical improvement (MI) or a potential specific exception to MI), see DI 27515.050.

When disability is medically ceased, a claimant may continue to receive benefits because of participation in an approved VR program (section 301 payments). Collateral estoppel does not apply. The DDS must complete development and make a new determination when the prior claim is in section 301 payment status. For more information on 301 cases, see DI 28060.001.