Identification Number:
DI 81010 TN 40
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:FO Procedures - Electronic Process
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 810 – Electronic Disability Guide (eDG) Procedures for the Electronic Process
Subchapter 10 – FO Procedures - Electronic Process
Transmittal No. 40, 04/08/2021

Audience

PSC: CA, CS, DE, DEC, DTE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, CTE, ERE, FCR, FDE, FDEC, RECONE, RECONR, RECOVR;
DQB: DE, PA, PE, TL;
OCO-ODO: BET, BTE, CR, CTE, CTE TEDE, DEC, DS, PAS, PETE, PETL, RCOVTA, RECONE, RECONR, RECOVR;
ODD-DDS: ADJ, DHU;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;
OHO/OAO: HQ;

Originating Component

ODP

Effective Date

Upon Receipt

Background

Office of Disability Policy revised this section to clarify that the field office (FO) should make every effort to send the Comparison Point Decision (CPD) folder with a Continuing Disability Review (CDR) case to both the Disability Determination Services (DDS), the Office of Hearings and Operations (OHO), and Office of Appeals Council (OAO). We introduced new procedures for the FO to send the CPD folder not only to the DDS but to OHO and OAO as well even if the CPD folder was located after the DDS,OHO, or OAO made a final decision. Current reopening and due process policies apply.

 

Summary of Changes

DI 81010.242 Unable-to-Locate (UTL) Paper Comparison Point Decision (CPD) Folder

In section A, the Background, we reworded some of the language to provide clarification. We added OHO and OAO as adjudicating components. We added language about the FO procedures in this section for locating the CPD paper folder for CDR cases before and after transfer. We added POMS reference DI 13015.092 to clarify that regardless of the outcome of the CDR determination, the CPD folder should always travel with the CDR until a final determination is made on the CDR and the appeals period has expired.

We added a NOTE and POMS reference for locating CPD paper folder for Age 18 redeterminations.

We removed "Claims Representative" and replaced it with "Claims Specialist" throughout the entire section.

In section B.1, we reworded some language to provide clarity.

In section B.1. NOTE, we spelled out Personal Communications for PCOM acronym. We captitalized Main Menu.

In section B.2, we added information about how to generate the Unable to Locate 5002 in the Automated Folder Location Website.

In section B.2, we reworded some of the language in the bulleted list to provide clarify. We removed the claim type acronyms, but kept Disability Insurance Benefits (DIB) as a claim type example.

In section B.2, we clarified that the FO should only upload the queries that were used to locate the CPD paper folder. We removed the table of queries since most of those queries do not provide folder location information.

In section B.2, we removed EDCS since documenting in this section is referring to uploading form 5002 into the electronic folder.

In section B.3, we reworded language to clarify that if the FO cannot locate the CPD paper folder, to advise the claimant that he or she may be contacted for additional information. We added OHO and OAO. We also provided some POMS references for lost or destroyed folders.

In section C, we spelled out electronic disability collect system (EDCS). We added where in DI 81010.230B.2 the FO could get information about annotating in EDCS that the CPD folder is lost.

In the NOTE of section C, we reworded language to specifically clarify that EDCS requires an entry in the CPD date field, and about the date possibly not being accurate.

In section D, we added OHO and OAO as destination offices.

In section D, bullet number 4, we clarified that eView will highlight the question about the paper folder.

In section D, bullet number 6, we added a POMS reference about DDS procedures for reconstructing a prior folder.

In section D, we also removed the latter part of the 7th bullet.

In section D, we removed the 8th bullet since the FO faxes paper form 454 into the electronic folder.

In section D, we removed the last bullet since everything for the CDR is in the electronic folder, and there is nothing to mail to the DDS.

In section E, we broke down this one section into four procedures.

  • Procedure number 1 is for when an initial CDR is still pending with the DDS, OHO, and OHO.

  • Procedure number 2 added missing steps to include the FO reactivating closed CDR case in EDCS/eView before mailing CPD folder. These procedures only apply to CDR cases closed out by the DDS since the FO can reactivate DDS determinations in EDCS/eView. We also removed decision and replaced it with determination. We added Processing Medical Reactivations POMS reference DI 81020.117, and verbiage instructing the FO reach out to the DDS, DPB, or FDU before medically reactivating a claim. I also added POMS references DI 28501.001 and DI 28080.001 about DDS policies for reopening and due process for CDRs.

  • Procedure number 3 is for when there is a CDR appeal pending with the DDS, OHO, or OAO.

  • Procedure number 4 is for when a CDR is closed out by a hearing office or Appeals Council. The FO cannot reactivate hearing or appeals council level cases in EDCS/eView, so added procedures for mailing CPD folder with routing slip and remarks that the HO or Appeals Council should review CPD paper folder and reactivate closed CDR case in eView for possible reopening. I also added language about the HO or Appeals Council referencing their reopening and due process policies.

DI 81010.242 Unable-to-Locate (UTL) Paper Comparison Point Decision (CPD) Folder

A. Background

When the Field Office (FO) sends a Continuing Disability Review (CDR) case or appeal to the Disability Determination Services (DDS), the Office of Hearings Operations (OHO), or the Office of Appellate Operations (OAO), the FO provides the folder that contains medical evidence used to make the most recent favorable medical decision, otherwise known as the Comparison Point Decision (CPD) folder. Further information regarding the CPD folder can be found in DI 81010.215.

It is extremely important that the FO make every possible effort to locate the CPD paper folder because it contains the evidence necessary to decide whether the individual will continue to receive benefits. Adjudicating the CDR without the CPD evidence may result in the continuation of benefits to a person whose entitlement would have ended had that evidence from the CPD folder been available. When the CPD paper folder cannot be located, the FO must utilize the procedures in this section before transferring the CDR case to the DDS, OHO, OAO. If the FO locates the CPD paper folder after the CDR case has been transferred or a CDR determination has been made, the FO must utilize the procedures in this section. The CPD paper folder should travel with the CDR case until a final determination is made on the CDR and the appeals period has expired, see DI 13015.092.

NOTE: 

For instructions on locating the CPD paper folder for Age-18 Redeterminations, see DI 11070.010B. However, the CPD folder is not required for Age-18 Redeterminations as it is required in other types of CDRs.

B. Searching for the paper CPD folder

1. Obtain systems queries

If the CPD folder is not found, obtain the proper queries to search for the folder. Instructions are located in DI 13015.080. A time saving tool to obtain queries, possible folder location, and submission of folder requests, the Automated Folder Location Web Site, is available on the home page of the Seattle Intranet (SEANET) site and in the Workload Action Center (WAC).

NOTE: 

You have to be logged into Personal Communications (PCOM) on the Main Menu to obtain these queries.

2. Document information in the certified electronic folder (CEF)

The FO must document all attempts to locate the CPD paper folder on the form SSA-5002 (Report of Contact). The Unable to Locate SSA-5002 can be generated in the Automated Folder Location Website by clicking on "Get UTL form" on the lower left. At a minimum, the Unable to Locate SSA-5002 must cover the following details:

  • Identify the title and claim type of the file the FO has been looking for (e.g., Title II Disability Insurance Benefits (DIB)).

  • List the office locations that the FO has searched for the file or that have been eliminated based on queries.

  • Check cross reference SSNs or document that there are no cross-reference SSNs.

  • Address any pertinent name changes by the claimant and annotate that the FO searched for the file under all names involved.

Save the SSA-5002 in the electronic CDR folder in eView. The Claims Specialist (CS) must also upload all the pertinent queries that were used to search for the CPD paper folder into the CEF.

3. Requesting additional information

If the FO cannot locate the CPD folder after following the instructions described above, it will advise the claimant that he or she may be contacted for additional information by the FO, DDS, OHO, or OAO. For additional guidance on procedures for lost or destroyed folders, see DI 28035.001 for DDS, GN 03105.040 for OHO, and GN 03105.060 for OAO.

C. Creating a mini-record in the electronic disability collect system (EDCS) for lost CPD folder cases

Follow the instructions in DI 81010.230B.2 for lost paper CPD folder cases.

NOTE: 

Enter the “CPD date” field in EDCS as the date 12 months prior to the CDR interview. This date is a required input and may be inaccurate. Per DI 28035.015, the DDS is responsible for establishing the actual CPD date when there is a lost folder involved.

D. Transferring the case in EDCS

When transferring a CDR case in EDCS:

  • Select the “Transfer” tab at the top of the EDCS page.

  • When the transfer page appears, select the box under “All Actions Completed” if the case is ready to send to the DDS, OHO, or OAO.

  • Key in the DDS, OHO, or OAO code in the Destination Office box if it has not propagated, and check the “Transfer disability folder to DDS/ALJ” box.

  • When the “Transfer disability folder to DDS/ALJ” box is checked, eView will highlight the question regarding the paper folder.

  • Select the “Unable to Locate” button.

  • Key the following remark on the Routing Form: “CDR Lost Folder/Medical Evidence. Follow DI 28035.020 Disability Determination Services (DDS) Reconstruction of Prior Folder . Advise if full reconstruction is necessary.”

  • Select “OK” to transfer the case.

    NOTE: 

    Upon transfer, the CS will receive a Confirmation Message stating: “You are transferring a CDR record to <office code> - <office code name>. The paper folder containing the last favorable disability determination has been destroyed or cannot be located. All search efforts are documented in file.”

E. Delayed receipt of paper CPD folder

1. If the CPD paper folder is found or later received by the FO and the initial CDR case is pending at DDS, OHO, or OAO, the CS must send the CPD folder to the DDS, OHO, or OAO where the case is pending. In such cases, the CS should:

  • Create a message in eView stating: “The prior CPD paper folder has been located and is being mailed by the FO to the DDS,OHO, or OAO on MM/DD/YYYY.”

  • Attach an SSA-408 (Route Slip) to the CPD paper folder addressed to the DDS, OHO, or OAO and include the following: “CPD paper folder found; please associate with CDR sent MM/DD/YYYY.”

  • Mail CPD paper folder to DDS, OHO, or OAO.

2. If the CPD paper folder is found or later received by the FO and the DDS has made a final determination, return the folder to the DDS as it may change the determination. In such cases, the CS should:

  • Contact the DDS, DPB, or FDU before sending the medical reactivation. The DDS, DPB, or FDU must agree with the FO to medically reactivate the claim. See DI 81020.117.

  • Reactivate the closed CDR case in EDCS/eView, and add form SSA-5002 stating, "CPD paper folder found and CDR case previously closed. CDR case reactivated by FO on MM/DD/YYYY. Please review for possible reopening and close reactivated case when completed."

  • Transfer the CDR case in EDCS.

  • Attach an SSA-408 to the CPD paper folder addressed to the DDS and include the following remark: “CPD paper folder found and CDR case previously closed. Case reactivated by FO on MM/DD/YYYY. Please review for possible reopening and close reactivated case when completed.”

  • Mail CPD paper folder to DDS.

The DDS should process a reactivated CDR case utilizing existing procedures and policies. For CDR reopening overview, see DI 28501.001. For due process for CDRs, see DI 28080.001.

3. If the CPD paper folder is found or later received by the FO, and there is an appeal pending, the CS must send the CPD folder to the DDS, OHO, or OAO where the appeal is pending, see DI 13015.092. In such cases, the CS should:

  • Create a message in eView stating: "The prior CPD folder has been located and is being mailed by the FO to the DDS, OHO, or OAO on MM/DD/YYYY."

  • Attach an SSA-408 (Route Slip) to the CPD paper folder addressed to the DDS, OHO, or OAO and include the following remark: "CPD paper folder found; please associate with CDR appeal sent on MM/DD/YYYY."

  • Mail CPD paper folder to DDS, OHO, or OAO.

4. If the CPD paper folder is found or later received by the FO and OHO or OAO has made a final decision, return the folder to the hearing office or Appeals Council as it may change the decision. In such cases, the CS should:

  • Add form SSA-5002 in eView with a message stating, "CPD paper folder found and CDR decision made on MM/DD/YYYY. Hearing Office or Appeals Council must reactivate closed CDR case, and review for possible reopening and close reactivated case when completed."

  • Attach an SSA-408 to the CPD paper folder addressed to OHO or OAO and include the following remark: "CPD paper folder found and CDR decision made on MM/DD/YYYY. Hearing Office or Appeals Council must reactivate closed CDR case, and review for possible reopening and close reactivated case when complete."

  • Mail CPD paper folder to the hearing office or Appeals Council as appropriate.

OHO and OAO should follow current reactivation procedures, and refer to their reopening and due process policies.


DI 81010 TN 40 - FO Procedures - Electronic Process - 4/08/2021