Identification Number:
DI 27515 TN 3
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Collateral Estoppel
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 275 – Reopenings, Adoptions and Refilings
Subchapter 15 – Collateral Estoppel
Transmittal No. 3, 04/01/2021

Audience

PSC: CA, CS, DE, DEC, DTE, IES, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, ERE, FCR, FDE, RECONE;
OCO-ODO: BET, CR, DE, DEC, DS, PAS, PETE, PETL, RCOVTA, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

04/02/2021

Background

QAT - no IRD or AC approval needed

Summary of Changes

DI 27515.005 Changes to the Listing of Impairments and Collateral Estoppel

Update body system name, updated msk and immune to reflect new pub date due to substantial revision to functional criteria

DI 27515.005 Changes to the Listing of Impairments and Collateral Estoppel

A. Changes to the Listing of Impairments

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:

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

  • One of the other restrictions in DI 27515.001E applies.

B. Changes to the Listing of Impairments - table

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.

Impairments/Listings Involved Date of Change

Instruction

1.00 Musculoskeletal System

All musculoskeletal disorders except amputation of both upper extremities at or above the wrists, hemipelvectomy, or hip disarticulation (listings 1.20A or 1.20B)

04/02/2021

When the basis of the prior favorable determination or decision was meeting or equaling a 1.00 listing other than prior listing 1.05Aor 1.05D before 04/02/2021 , collateral estoppel does not apply and a new determination is required.

2.00 Special Senses and Speech
Complete homonymous hemianopsia (listing 2.05) 05/24/2002 When the basis for the prior favorable determination or decision was meeting or equaling listing 2.05 before 05/24/2002, collateral estoppel does not apply and a new determination is required.
3.00 Respiratory Disorders
Asthma with attacks occurring at least once every 2 months or 6 times in a year (listing 3.03B) 10/07/2016 When the basis for the prior favorable determination or decision was meeting or equaling listing 3.03B before 10/07/2016, collateral estoppel does not apply and a new determination is required.
4.00 Cardiovascular System

All cardiovascular disorders

04/13/2006

When the basis for the prior favorable determination or decision was meeting or equaling a 4.00 listing before 04/13/2006, collateral estoppel does not apply and a new determination is required.

5.00 Digestive System

All digestive disorders

12/18/2007

When the basis of the prior favorable determination or decision was meeting or equaling a 5.00 listing before 12/18/2007, collateral estoppel does not apply and a new determination is required.

7.00 Hematological Disorders

All hematological disorders

05/18/2015

When the basis of the prior favorable determination or decision was meeting or equaling a 7.00 listing before 05/18/2015, collateral estoppel does not apply and a new determination is required.

9.00 Endocrine Disorders
Obesity (listing 9.09) 10/25/1999 When the basis for the prior favorable determination or decision was meeting or equaling listing 9.09 before 10/25/1999, collateral estoppel does not apply and a new determination is required.

All endocrine disorders except listing 9.08C and 9.09

06/07/2011

When the basis for the prior favorable determination or decision was meeting or equaling a 9.00 listing other than listing 9.08C, before 06/07/2011, collateral estoppel does not apply and a new determination is required.

Listing 9.08C was evaluated under the criteria for listings 2.02, 2.03, or 2.04, which have not substantively changed or become more restrictive.

See the entry for Obesity for instructions on listing 9.09.

10.00 Congenital Disorders that Affect Multiple Body Systems (or Multiple Body Systems before 04/15/2013)
Any disorder in the Multiple Body System

07/02/1993

When the basis for the prior favorable determination or decision was meeting or equaling a 10.00 listing before 07/02/1993, collateral estoppel does not apply and a new determination is required.

11.00 Neurological Disorders
All neurological disorders except amyotrophic lateral sclerosis (ALS)

09/29/2016

When the basis for the prior favorable determination or decision was meeting or equaling an 11.00 listing, other than listing 11.10, before 09/29/2016, collateral estoppel does not apply and a new determination is required.

12.00 Mental Disorders

All mental disorders

01/17/2017

When the basis for the prior favorable determination or decision was meeting or equaling a 12.00 listing before 01/17/2017, collateral estoppel does not apply and a new determination is required.

13.00 Cancer (Malignant Neoplastic Diseases)

Uterus - carcinoma or sarcoma with total pelvic exenteration (Listing 13.25C)

12/15/2004

When the basis for the prior favorable determination or decision was meeting or equaling listing 13.25C before 12/15/2004, collateral estoppel does not apply and a new determination is required.

14.00 Immune System Disorders

All immune system disorders except human immunodeficiency virus (HIV) infection and listings met or equaled on the basis of the inability to ambulate effectively or to perform fine and gross movements effectively

06/16/2008

When the basis for the prior favorable determination or decision was meeting or equaling a 14.00 listing, other than 14.04B, 14.04C2, 14.05A, 14.08, or 14.09A, before 06/16/2008, collateral estoppel does not apply and new determination is required.

Human immunodeficiency virus (HIV) infection (listing 14.11)

Systemic sclerosis, polymyositis, dermatomyositis, or inflammatory arthritisresulting in the inability to ambulate effectively or to perform fine and gross movements effectively (listings 14.04B, 14.04C2, 14.05A, 14.09A)

01/17/2017

 

04/02/2021

When the basis for the prior favorable determination or decision was meeting or equaling listing 14.08 before 01/17/2017, collateral estoppel does not apply and a new determination is required.

When the basis for the prior favorable determination or decision was meeting or equaling listings 14.04B, 14.04C2, 14.05A, or 14.09A before 04/02/2021, collateral estoppel does not apply and a new determination is required.

C. Changes to the Listing of Impairments precludes collateral estoppel

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.


DI 27515 TN 3 - Collateral Estoppel - 4/02/2021