The Social Security Administration (SSA) is required by law to periodically review the continuing eligibility of all disability beneficiaries and recipients. In performing this review (which we call a continuing disability review, or CDR), the severity of the beneficiary/recipient's medical condition at the time of the most recent favorable medical decision finding that the individual was disabled or continues to be disabled (i.e., CPD) is compared to the severity of the individual's current medical condition. Although the majority of CPD folders are electronic, there may be occasions where the CPD folder is a paper folder. In such cases, the Disability Determination Services (DDS) needs to review the prior paper folder containing the medical evidence supporting the favorable CPD to conduct a CDR. Below, we provide instructions for obtaining that prior paper folder.

The procedures in this subsection discuss the actions regarding the paper CPD folder.

DI 13015.070 Title II or Title XVI – FO Interview – Medical Folder Not Located - “Currently Disabled” Step

DI 13015.080 Unable to Locate Medical Folder after Initial FO Search - Detective Work

DI 13015.090 Not “Currently Disabled” - Full Replacement Folder Requested by DDS

DI 40525.020 Initially Obtaining the CPD Medical Folder

The DDS will determine whether an attempt should be made to create a replacement folder.

They will consider:

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  the potential availability of old records in light of their age,

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  whether the source(s) of the evidence is/are still in operation,

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  what portions of that missing file are relevant to the most recent favorable determination/decision for example:

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    work history,

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    medical evidence from treating sources,

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    school records, or

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    results of consultative examinations, and

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  whether reconstruction efforts will yield substantial evidence of the basis for the most recent favorable medical decision.

Regardless of the DDS decision to pursue reconstruction, the Social Security Administration (SSA) will not find that the individual has medically improved based solely on the original medical evidence being lost, but SSA can redevelop that missing medical evidence and make a medical improvement review standard (MIRS) determination.

When the medical evidence of record does not establish the beneficiary/recipient is "currently disabled" and the DDS determines that folder reconstruction is warranted, the DDS will send an assistance request (AR) to the FO. The AR will contain:

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  The CPD date;

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  Instructions on the development needed;

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  Instructions on the forms needed; and

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  The applicable time period(s).

The DDS will establish the date of the CPD in lost folder situations per DI 28015.005B.2. and DI 28035.015. DDS would apply similar logic to determine the CPD in cases where the last favorable decision was made by an Administrative Law Judge (ALJ).

For non-CEF or cases where EDCS UAT is not appropriate, use the most expeditious way to coordinate actions in these situations, e.g. telephone, email, or fax, with email being the preferred method for assistance requests and subsequent documentation.

NOTE: The DDS allows 30 days for the FO to obtain the information requested. If the FO does not obtain the information after 30 days, the DDS will proceed to the determination.

When the FO receives an AR from the DDS requesting a replacement folder, the FO should proceed as follows:

1. 1. 

   Contact the beneficiary/recipient for a supplemental interview addressing the beneficiary/recipient's medical condition and treating sources at the CPD (as determined by the DDS).

2. 2. 

   Cover the 12-month period prior to the CPD in the supplemental interview, unless the DDS has given other instructions.

3. 3. 

   If you obtain any additional queries, keep the queries with pertinent data and circle/highlight the pertinent information, e.g., on the NUMI, circle/highlight any name change and scan into the EF.

4. 4. 

   Follow any instructions provided by the DDS in creating a full replacement folder. The DDS should be specific regarding the period of time (since onset or CPD) over which development is needed, and provide any known information about the physicians, clinics, or hospitals so the FO can make the CDR interview more successful.

5. 5. 

   Develop or obtain any additional disability forms, data, or queries requested by the DDS. See DI 11005.016 for Forms used in Disability Claims.

6. 6. 

   If more than six months have passed since the file was previously documented, inquire about activities of daily living, complete the observations, and provide any other information relevant to the current disposition. Obtain information without being redundant or recording unnecessary information, e.g., onset and working history already contained/reflected in the file.

7. 7. 

   If additional claimant contact is necessary, inform the claimant by phone/notice what period of time is involved and what information is needed. For example, advise the claimant that doctor records or hospitalization data are needed from the CPD/onset date, and provide that date. This will allow the disabled individual or the individual's representative payee time to obtain data before the interview.

8. 8. 

   Scan the information obtained into the EF or document on an SSA-5002 as appropriate.

9. 9. 

   When the folder reconstruction is finished, complete the AR and add the reply to the certified electronic folder for DDS development of the CPD evidence and the preparation of a CDR determination using MIRS. See DI 13005.045A, DI 11010.620A.2., and DI 81010.100B.2.

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  DI 10505.035 Documenting Employment Cases Using Forms SSA-821-BK (Work Activity Report - Employee) and SSA-823 (Report of SGA Determination - For SSA Use Only)

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  DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only)

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  DI 11005.016 Forms Used in Title II & Title XVI Disability Claims

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  DI 13005.040 Completion of the Form SSA-454-BK (Continuing Disability Review Report) in Adult and Title XVI Child Continuing Disability Review (CDR) Cases

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  DI 13015.070 Title II or Title XVI – FO Interview – Medical Folder Not Located - “Currently Disabled” Step

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  DI 28015.005 Two Mechanisms to Relate Medical Improvement (MI) to the Ability to Work

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  DI 28035.020 Disability Determination Services (DDS) Reconstruction of Prior Folder

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  DI 28035.025 Disability Determination Services (DDS) Reconstruction of Prior Folder Not Possible: Initially Obtaining the CPD Medical Folder

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  DI 40525.020 Initially Obtaining the CPD Medical Folder

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