Identification Number:
DI 12026 TN 3
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Reconsideration - Disability Hearing for a Medical Cessation/Adverse Medical Reopening Determination - Title II and Title XVI
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 120 – Appeals Processing
Subchapter 26 – Reconsideration - Disability Hearing for a Medical Cessation/Adverse Medical Reopening Determination - Title II and Title XVI
Transmittal No. 3, 01/28/2019

Audience

PSC: CS, DE, DEC, DTE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, ERE, FCR, FDE, RECONE, RECONR, RECOVR;
OCO-ODO: BET, CR, CST, CTE, CTE TE, DE, DEC, DS, PETE, PETL, RCOVTA, RECONE, RECOVR;
ODD-DDS: REF;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;
OHO/OAO: OHAAC, OHACO (SAWDY), OHAHOs, OHAROs;

Originating Component

ODP

Effective Date

01/26/2019

Background

Beginning December 15, 2018, the Unprocessed Medical Cessation (UMC) workgroup will implement a system update adding functionality enhancements to the Social Security Administration’s (SSA) systems. These include additional screens, tickles and functionality in the Disability Control File (DCF), new information exported from the Electronic Disability Collection System (EDCS) to the DCF and improved case monitoring for the continuing disability review (CDR) appeals via Management Information (MI) Central. The design of the new instructions and processes reduce the need for manual action and further automate the medical CDR appeal process. This program manual online system update is part of the UMC modernization project and explains the new system actions required to process statutory benefit continuation request.

 

Summary of Changes

DI 12026.025 Field Office (FO) Processing of the Request for Reconsideration of a Medical Continuing Disability Review (CDR) Determination

We updated this policy section to includes revisions to the title, plain language and system inputs to reflect the new updates to the DCF and EDCS based on the UMC workgroup.

DI 12026.025 Field Office (FO) Processing Guidelines in Requesting a Reconsideration for a Medical Continuing Disability Review (CDR) Determination

A. Reviewing the CDR reconsideration appeal forms

The FO must ensure that the appropriate appeal forms are complete and filed timely (or establish “good cause” for extending the time limit to file an appeal). All forms must be stored in the electronic or paper folder as applicable.

1. SSA-789 (Request for Reconsideration – Disability Cessation Right to Appear)

When processing the Form SSA-789, the FO must:

  1. a. 

    Check that the form is complete is complete with the following information.

    1. 1. 

      The disabled individual indicated whether he or she wishes to appear at the disability hearing;

    2. 2. 

      The disabled individual has completed the block for interpreter and language needs, if applicable;

    3. 3. 

      The disabled individual or his or her representative payee does not need to sign the form; and

    4. 4. 

      The FO must date the form SSA-789 at the top of the form upon receipt.

      NOTE: A completed Modernized Supplemental Security Income Claims System (MSSICS) appeals output can act in place of the SSA-789 in Title XVI and concurrent cases if the disabled individual also provides clear written indication of dissatisfaction with the initial CDR determination.

  2. b. 

    If the SSA-789 is incomplete, complete the following actions.

    1. 1. 

      Call the disabled individual for the necessary information.

    2. 2. 

      If the disabled individual has no phone or the attempt is not successful, send a call-in/come-in letter and set a 15-day diary.

    3. 3. 

      The FO must document attempts to contact the disabled individual on an SSA-5002 (Report of Contact). The FO must place a copy of the SSA-5002 in the folder.

    4. 4. 

      If the disabled individual does not respond within the 15 days regarding whether he or she wants a hearing or needs an interpreter, forward the case to the disability determination services (DDS) for resolution.

    5. 5. 

      Provide the disabled individual with a copy of the SSA-789 if applicable.

    6. 6. 

      Provide the disabled individual with the English or Spanish version of the Form SSA-888 (Reconsideration/Disability Hearing Procedures). Versions of these documents are located in DI 33095.025 or DI 33095.030.

    7. 7. 

      Provide the disabled individual with the telephone numbers for the FO and DDS in his or her service area. Explain to the disabled individual that we prefer he or she to call the DDS with substantive questions or if he or she needs to report a change relating to the disability hearing.

      NOTE: The Social Security Administration (SSA) does not expect individuals to make long distance phone calls and individuals may call either the FO or DDS.

2.  SSA-795 (Statement of Claimant or Other Person)

The FO must provide the disabled individual with a copy of his or her statutory benefit continuation (SBC) election statement. For information about the SBC election statement, see DI 12027.010B.4.

3.  SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA))

The FO must ensure that the Form SSA-827 has the appropriate signature and date, in accordance with DI 11005.056.

4.  SSA-3441-BK (Disability Report – Appeal)

The FO must verify the Form SSA-3441-BK is complete. If the form is incomplete, the FO must take the following actions:

  1. a. 

    Re-contact the individual if the SSA-3441-BK received was not fully completed or any information seems to be incorrect.

  2. b. 

    Note auditory observations made during any telephone conversation with the individual.

  3. c. 

    Document additional information that you received from the disabled individual in the Electronic Disability Collect System (EDCS), the Form-3367 (Disability Report - Field Office), or on an electronic or paper Form SSA-5002 (Report of Contact).

    1. 1. 

      For Title II cases, see MS MCS 008.007 (Report of Contact (RPOC)); and

    2. 2. 

      For Title XVI cases, when documenting the report of contact in:

      1. a. 

        MSSICS, see MS MSSICS 022.010 (Report of Contact (DROC)).

      2. b. 

        Non-MSSICS, prepare a paper Form SSA-5002 to document the additional information and add this form to the electronic or paper folder.

5.  SSA-3881-BK (Questionnaire for Children Claiming SSI Benefits)

In Title XVI childhood disability cases, the FO must verify the Form SSA-3881-BK is complete. If the form is incomplete, take the same actions described in DI 12026.025A.4 in this section.

B.  System inputs to document the reconsideration appeal

The FO must record information in the system to document the appeal and any SBC information. For more information about SBC system inputs, see DI 12027.010C. Depending upon the claim type, use the following instructions to record a CDR appeal.

1. Title II

For Title II cases, the FO must complete the following:

  1. a. 

    Document the CDR appeal information, including SBC election, in EDCS.

    NOTE: A post-entitlement online system (POS) input is no longer necessary

  2. b. 

    In EDCS, complete and transfer the CDR appeal to DDS or the Disability Hearing Unit (DHU). The Disability Control File (DCF) and Master Beneficiary Record (MBR) will automatically update as a result of the EDCS transfer.

  3. c. 

    Upon receipt of the CDR appeal determination from the DDS or DHU, review the MBR to ensure the applicable information was received from EDCS and the DCF updated automatically. No POS action will be required. Verify the SBC termination, if applicable. The MBR should automatically update within 5 days.

  4. d. 

    If the MBR does not automatically update in 5 days, the FO must proceed with manual actions to update the MBR. For additional information on manually updating the MBR, see DI 12026.025C.2 in this section.

2. Title XVI

For Title XVI cases, the FO must complete the following:

  1. a. 

    Use MSSICS to update the Supplemental Security Record (SSR) to document the filing of the medical cessation appeal as well as the SBC election, if applicable.

    NOTE: If a direct SSR update is required, it will cause an EDCS exclusion. For additional information on EDCS exclusions, see DI 12026.025C in this section.

  2. b. 

    Use EDCS to review and ensure that the appeal and the SBC election data propagated successfully from MSSICS. In EDCS, the appeal data should mirror the information that was entered in the MSSICS appeal data.

  3. c. 

    In EDCS, complete and transfer the medical cessation appeal to DDS or DHU.

  4. d. 

    Upon receipt of the medical cessation determination from the DDS or DHU, review the SSR to ensure applicable information was received from EDCS and updated the DCF. Review the SSR for pertinent fields (for example, PSY or DIAR) that trigger automated cessation, if applicable.

  5. e. 

    Review the SSR to ensure the SBC benefits are properly terminated, if appropriate.

  6. f. 

    If the SSR do not automatically update in 5 days, the FO must proceed with manual actions to update the SSR. To manually update the SSR, see DI 12026.025C.2 in this section.

3.  Concurrent (Title II and Title XVI)

For concurrent (Title II and Title XVI) cases, the FO must complete the following:

  1. a. 

    First, use MSSICS to document the medical cessation appeal data on the SSR prior to entering EDCS.

    NOTE: If the case is a concurrent appeal, the FO must first complete MSSICS prior to opening the appeal in EDCS.

  2. b. 

    Review EDCS to verify the concurrent establishment of the appeal segments. Proceed with addressing additional appeal questions that will capture the Title II appeal data.

  3. c. 

    In EDCS, complete and transfer the medical cessation appeal to the DDS or DHU. Ensure both the Title II and Title XVI segments are included in the case transfer.

  4. d. 

    Upon receipt of the medical cessation determination from the DDS or DHU:

    1. 1. 

      Review both the SSR and MBR to ensure medical cessation appeal determination automatically posted; and

    2. 2. 

      That SBC benefits have ended for both titled programs.

      NOTE: No POS action is required for the Title II claim.

  5. e. 

    The MBR and SSR should both update within 5 days.

  6. f. 

    If the MBR and SSR do not automatically update in 5 days, the FO must proceed with manual actions to update the MBR and SSR, see DI 12026.025C.2 in this section.

4. System input exclusions

If there is a system input exclusion for a Title II case, the FO must complete the actions in DI 12026.025C.2 in this section to record the appeal information. For a Title XVI system exclusion, the FO must attempt to seed the cases that are outside of MSSICS, see MS 00302.001. If the seeding attempt is unsuccessful, the FO should attempt to load the appeal using a direct SSR update before establishing the case in EDCS. If the FO is still unable to seed the case in MSSICS and there is an error when loading the appeal into EDCS, the FO should not load the case into EDCS. The case will then become a paper case and the FO must follow the paper folder instructions in DI 12026.025C.2 in this section. For manual DCF inputs and screen displays, see CDR 001.000, CDR 001.014, CDR 001.025 and CDR 001.026.

C. Folder preparation for the CDR appeal

1. Electronic continuing disability review (eCDR) appeals

The eCDR includes electronic folder (EF) case processing for initial continuing disability reviews (CDRs) and Age-18 redeterminations. If the disabled individual is appealing a CDR we processed in EDCS, process the reconsideration electronically. For processing appeals using eCDR in electronic folder cases:

  • Refer to DI 81010.255 (Electronic Continuing Disability Review (eCDR) Cessation Reconsiderations); and

  • Refer to DI 81010.257 (Electronic Continuing Disability Review (eCDR) Cessation Appeals-ALJ Hearing).

2. eCDR appeal exclusions

When the FO is unable to load the CDR reconsideration appeal cases into MSSICS or EDCS, the MBR and SSR are unable to automatically update the DCF. Cases that are not in the EDCS will not be visible for tracking and are only available for tracking in MI Central.

The FO must record a CDR reconsideration appeal with an exclusion for a Title XVI case using the following actions:

  1. a. 

    For MSSICS cases, input the CDR reconsideration information in MSSICS. For more information, see MS MSSICS 020.001 (Appeals - Overview); and

  2. b. 

    For non-MSSICS cases, use MSSICS direct SSR update to establish the CDR reconsideration, see MS 00302.001. For more information, see MS 00302.001 (Direct SSR Update - Overview).

To record a CDR reconsideration appeal with an exclusion for a Title II only case, use the EDCS Exclusion Appeal (EEAI) screen to input the appeal request in the DCF. To see additional information on completing the EEAI screen inputs, see CDR 001.025. The DCF will pass the appeal request and SBC information to the T2R background program, which will automatically update the MBR. The Title II case will not require a POS input.

For the Title II case reconsideration, once the appeal information is loaded to the DCF, the case will become visible in MI Central. EDCS will not be able to automatically update the location of the appeal case. At the time of the cessation or continuance determination, the DCF will automatically receive the determination and will automatically update the MBR. The Title II case will not require a POS input.

For a Title II case hearing appeal, after inputting the appeal request using the EEAI screen, the DCF will automatically create an ALJT2EX tickle. These cases will not appear in the DCF pending file or in MI Central. When there is a medical decision on the hearing appeal, the FO must receipt in the tickle on the DCF. A hearing affirmation, abandonment, dismissal, or withdrawal will continue to automatically post to the MBR. Hearing reversals will require a POS input to update the MBR.

3. Paper folders (Modular disability folder (MDF) and brown (non-MDF) folder)

Process the paper folder as follows:

a. Folder(s) available in the FO

Place the request for reconsideration, any supporting forms, and any evidence provided by the individual in his or her official disability folder. For document filing instructions see DI 70005.005B.

b. Folder(s) unavailable in the FO

Request the CDR folder and annotate on the request that there is a disability hearing pending. The following references provide information about requesting an MDF:

  • Title II - DI 40525.100 (Processing Center Action Control System (PCACS) Coordination).

  • Title XVI (except foreign cases) - SM 01601.415 (Case Control Data – CCTL), and SM 01201.035 (Alert Response (AR) Codes on the SSA-8028).

  • Foreign Case - DI 12026.020B.5. (Field Office (FO) Responsibilities when an Individual Wants to Request a Continuing Disability Review (CDR) Reconsideration).

  • Obtain any needed prior folder(s) - DI 13015.080 (Unable to Locate Medical Folder after Initial FO Search - Detective Work).

  • Unable to locate the prior folder - GN 03105.010 (Reconstruction of Destroyed or Missing Paper Claims Folders), DI 20502.030 (Folder Reconstruction), and DI 28035.000 (Processing of Lost Folders/Medical Evidence). Routing the CDR appeal folder

D. Routing the CDR appeal folder

To establish where to route the CDR appeal folder, first determine the case type.

1. Cases other than career railroad or foreign cases

Route the folder to the servicing FO’s DDS.

2. Career railroad case

Route the folder(s) to the Great Lakes Program Service Center (GLPSC):

  • Follow the procedures for processing railroad cases in DI 29005.020 (GLPSC - Career Railroad and Railroad Annuitant Cases).

  • Include the DHU copy of the SSA-789 in the disability folder(s) and route the folder to:

  • GLPSC, Disability Processing
    P.O. Box 87755
    Chicago, IL 60680-0955

3. Foreign case

Do not forward documents or information to the DDS associated with the servicing FO.

  • Include all documents and information in the disability folder and route the folder to the Office of Earnings and International Operations (OEIO). Do not forward a copy of the SSA-789 to the DDS.

  • Forward all materials to:

  • Social Security Administration
    Office of Earnings and International Operations
    P.O. Box 17775
    Baltimore, Maryland 21235-7775

E. Processing other issues when a reconsideration disability hearing is pending

1. Requesting a change in time or place of the disability hearing

If the disabled individual contacts the FO, rather than the DHU or the disability hearing officer (DHO) take the actions according how the individual makes contact.

a. Individual visits the FO

Ensure the individual completes and signs an SSA-769-U4 (Request for Change in Time/Place of Disability Hearing). For an exhibit of the form and instructions for its completion, see DI 12095.055.

b. Individual telephones the FO

Obtain the information you need to complete the SSA-769-U4 and have the disabled individual (or his or her representative payee) come in to sign this form, or mail the form for signature and return to the FO. The FO must document the information obtained in the telephone conversation electronically (RPOC/DROC), or on a paper SSA-5002 (Report of Contact) and it fax into Non-Disability Repository for Evidentiary Documents (NDRED).

  1. 1. 

    For Title II, see MS MCS 008.007 (Report of Contact (RPOC))

  2. 2. 

    For Title XVI, document the report of contact in:

    • MSSICS, see MS MSSICS 022.010 (Report of Contact (DROC))

    • Non-MSSICS, prepare a paper SSA-5002 and place a copy of the document into the CDR appeal folder.

c. Request for a change in time or place of the disability hearing

Alert the DDS to all requests to change the time or place of disability hearing. Scan or place the forms and information about the request to change the time or place of disability hearing in the individual’s official folder. Forward the material to the DDS using an SSA-408 (Route Slip) if the folder is paper and is already at the DDS.

NOTE: When the disabled individual requests to change the disability hearing and it is less than 10 days before the scheduled hearing date, notify the DDS by telephone or email. Forward the forms and information about the change request based on direction from the DDS (fax, hand-deliver or scan to folder).

2. Substantial gainful activity (SGA) issues in a Title II case

In processing Title II cases with SGA issues, develop and resolve work issues discovered during DDS or DHU review using procedures in DI 10501.025, DI 13010.012, and DI 13010.025.

  1. a. 

    If the work is SGA:

    • Prepare an initial SGA determination if conditions meet the requirements for FO processing, and trial work period (TWP), extended period of eligibility (EPE), or extended Medicare does not apply.

    • Advise the individual in the SGA cessation determination notice that we will not conduct a disability hearing on the medical cessation issue because we found him or her “not disabled” due to work. For information on processing SBC, see DI 12027.040 and DI 12027.050.

    • Send a copy of the SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal) to the DHU to cancel the hearing process.

  2. b. 

    If the work is not SGA, or is SGA but EPE or extended Medicare applies:

    • Complete FO actions using existing SGA and EPE procedures.

    • Return case to DDS or DHU for action on medical issue(s).

      NOTE: The FO must upload all work CDR documentation to EDCS for electronic cases, and forward documentation to the DDS or DHU for paper cases because the DDS and DHU does not have access to other FO programs where this information could be stored.

3. Subsequent material or information received in the FO

Most material and information received is in writing. However, the FO must document any information obtained verbally on an SSA-5002 (Report of Contact) or other appropriate SSA form. Upload all new material or information received after the case left the FO into the electronic folder if possible. Check the case control system to establish if the folder is located at the DDS or DHU, and complete the following the instructions:

a. New evidence

When the FO receives subsequent evidence, including sources:

  • If the official folder is paper, use an SSA-408 (Route Slip) to forward the material to the DDS or DHU.

  • If we issued a reconsideration determination and the case left the DHU, forward the material to the DDS (or alert them to the presence of subsequent material in the EF) to determine the relevance of the material and the action to take.

    NOTE: An exception to this routing applies if the case is at an administrative law judge (ALJ) or Appeals Council (AC) location. In these instances, forward the material for folder association and review to the Office of Hearing Operation (OHO) or AC office where the folder is located.

b. Change of address or telephone number

When an individual reports a change of address or telephone number after the release of the folder, the FO will:

  • Update the Title II and Title XVI records (for example, MBR, MSSICS and EDCS) with the new information.

  • Send an update after transfer (UAT) to the DDS or DHU with the individual’s new address or telephone number.

  • If the official folder is paper, use an SSA-408 to forward the change of address information to the DDS or DHU (include the office code for the FO servicing the individual's current address).

  • Notify the DHU by telephone if a disability hearing is scheduled and the change of address involves a change in the DDS or DHU site. Send an e-mail confirmation of the phone call to the DHU.

    NOTE: The DHU forwards or associates the email confirmation to the folder.

4. Individual fails or refuses to submit additional information for the reconsideration

The FO must transmit or forward the folder to the DDS if the individual fails or refuses to complete the necessary forms or provide additional evidence needed to support the request. Indicate what information is lacking using a Form SSA-5002 and associate this form with the appeal folder. If the DDS does not have enough information to make a medical determination, it will follow guidelines as outlined in DI 23005.001, DI 23007.004, or DI 23007.005.

5. Individual wishes to withdraw a request for reconsideration of a disability cessation or adverse medical reopening

The FO should never suggest an individual to request a withdrawal of his or her CDR reconsideration.

a. Contact the office where the case folder is located

The FO must e-mail or call the appropriate office (DDS or DHU) and request it return the case folder to the FO. Request that the DHU postpone the hearing process, pending disposition of the withdrawal.

NOTE: The DDS or DHU forwards requests for withdrawal sent directly to them to the FO.

b. Title II case

The FO must follow the general withdrawal instructions in GN 03102.200B.4.

  • Career Railroad Cases - GLPSC handles requests for withdrawals.

  • Foreign Cases - OEIO handles requests for withdrawals.

c. Title XVI case

The FO must follow the general withdrawal instructions in SI 04020.020.

d. Request for withdrawal approved

Ensure that we terminated benefits, and the individual repaid SBC payments, before approving the withdrawal. For more information on conditions for withdrawal, see GN 00206.005. Send a copy of the individual’s notice approving the withdrawal to the DHU to cancel the hearing process.

e. Request for withdraw not approved

When processing a denied request for withdrawal:

  • Return the case to the DDS or the DHU.

  • Include, or upload, a copy of the notice informing the individual that the FO did not approve his or her request.

f. Cancellation of the request for withdrawal

When an individual wants to cancel his or her request for withdrawal:

  • If the individual files a cancellation of withdrawal within 60 days from the date the individual received the notice of approval of withdrawal, process the case as though no withdrawal took place.

  • Reinstate any previously approved SBC benefits retroactive to the month benefits stopped unless the individual indicates otherwise.

  • Include a copy of the individual's cancellation of the withdrawal in the folder. Ensure the individual's (and any representative’s) name, address, and telephone number, are on the request for cancellation.

  • Return the folder to the DDS that had the case on the date we received the request for withdrawal. Individual dies before we make the reconsideration determination

6. Individual dies before we make the reconsideration determination

The FO must put the death information on the individual’s record(s), and forward or upload the proof of death to the folder. Review the folder(s) to determine leads to anyone who may be entitled or adversely affected by the cessation determination.

  • Title II cases could include a surviving spouse, auxiliary beneficiaries, or a representative of the estate.

  • For Title XVI cases, refer to SI 02101.003 (SSI Underpayment Due - individual Deceased - General).

    NOTE: A death certificate has the cause(s) of the death, which can aid the DHO in making a determination if the cause of death was related to the individual’s disability.

a. Substitute party involved

If a substitute party involves a change in the hearing location, see instruction in DI 12026.025E.3.b. in this section. When a substitute party is involved:

  • Secure an SSA-770-U4 (Notice Regarding Substitution of Party Upon Death of Claimant – Reconsideration of Disability Cessation). Use this form when allowing the substitute party to pursue the appeal of a deceased individual. For instructions about this form, see DI 12095.065.

  • Inform the substitute party that a hearing may not be necessary if we are able to issue a favorable determination based on available evidence.

  • Telephone the DHU and report the individual's death. If the substitute party informed the FO that he or she wishes to appear at the disability hearing scheduled for the individual, inform the DHU to not postpone the hearing. Also, provide the DHU with the substitute party's name, address, and telephone number. Otherwise, the DHU will postpone any hearing scheduled pending receipt of the SSA-770-U4.

  • If the folder is electronic, upload the completed SSA-770-U4 and any additional medical information (for example, recent hospitalizations, physician's report) into the EF.

    NOTE: If the DHU is different from the one that previously had the folder, create a message to the DHU stating: “Substitute party requested disability hearing in your area.”

  • If the folder is paper, prepare an SSA-408 (Route Slip) and route the completed copies of the SSA-770-U4 to the component with the folder and to the appropriate DHU. Include any additional medical information.

    NOTE: If the DHU is different from the one that previously had the folder, annotate the SSA-408 to show: “Substitute party requested disability hearing in your area - Attached forwarded for folder association.”

b. Substitute party wishes to withdraw a request for reconsideration

When a substitute party wishes to withdraw the request for reconsideration:

  • Route the completed SSA-770-U4 according to instructions in DI 12026.025E.6.a. in this section.

  • If the office with the case returns the case to the FO for action on the withdrawal, the FO will ensure that the conditions meet the requirement for withdrawal, see GN 00206.005. Follow the general withdrawal instructions in GN 03102.200B.

c. Substitute party not located

Document that you were unable to locate a substitute party electronically (RPOC/DROC), or on a paper SSA-5002 (Report of Contact) and fax the documentation into NDRED. Include the name and address of any known next of kin of the individual in the documentation.

  1. 1. 

    For Title II, see MS MCS 008.007 (Report of Contact (RPOC)).

  2. 2. 

    For Title XVI, document the report of contact in:

  • MSSICS - See MS MSSICS 022.010 (Report of Contact (DROC))

  • Non-MSSICS - prepare a paper SSA-5002 to document the information obtained. Forward the SSA-5002 for folder association.

d. References for electronic cases

For electronic cases:

  • FOs processing appeals using eCDR should refer to DI 81010.255.

  • DDS processing appeals using eCDR should refer to DI 81020.255.

e. Remand, common issue, and escalated cases

For information about:

  • Remand cases

    See GN 04440.247C.1. (Reviewing Informal Remand Cases).

  • Common issue cases

    See DI 12045.005 (Claims Under Different Titles - Common Issue – General).

  • Escalated cases

    Send escalated cases, or material for folder association, to the DHU rather than the DDS when the case is currently at the DHU or when the DHU made the reconsidered determination.

F. References

  • DI 10501.025 Clearly Not SGA

  • DI 12027.010 Processing Statutory Benefit Continuation (SBC)

  • DI 13010.012 Protection from Medical Review Based on Work Activity

  • DI 13015.005 Failure To Cooperate (FTC)/Whereabouts Unknown (WU) Procedures

  • DI 20502.030 Folder Reconstruction

  • DI 23040.001 DDS: Interpreters for Individuals with Limited English Proficiency (LEP) or Individuals Requiring Language Assistance

  • DI 29005.020 GLPSC - Career Railroad and Railroad Annuitant Cases

  • DI 70005.005 Overview of the Paper Modular Disability Folder (MDF)

  • DI 81001.005 Certified Electronic Folder (CEF) Overview

  • DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)

  • DI 81010.200 Electronic Continuing Disability Review (eCDR) Short Term Process Overview

  • DI 81010.255 Electronic Continuing Disability Review (eCDR) Cessation Reconsiderations

  • DI 81010.257 Electronic Continuing Disability Review (eCDR) Cessation Appeals-ALJ Hearing

  • DI 81020.025 Processing Electronic Reconsideration Cases

  • DI 81020.255 Processing a Reconsideration Appeal of an Electronic Continuing Disability (eCDR) Cessation

  • GN 00304.000 Proof of Death – Table of Contents

  • GN 03101.020 Good Cause for Extending the Time Limit to File an Appeal

  • GN 03102.200 Claimant Requests Reconsideration


DI 12026 TN 3 - Reconsideration - Disability Hearing for a Medical Cessation/Adverse Medical Reopening Determination - Title II and Title XVI - 1/26/2019