Identification Number:
DI 13005 TN 15
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Medical Issues
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 130 – Continuing Disability
Subchapter 05 – Medical Issues
Transmittal No. 15, 05/13/2021

Audience

PSC: BA, CA, CS, DE, DEC, DTE, ICDS, IES, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, CR, ERE, FCR, FDE, PETL, RECONE, RECONR;
OCO-ODO: BET, BTE, CR, CST, CT, CTE, CTE TE, DE, DEC, DS, PAS, PETE, PETL, RCOVTA, RECONE, RECOVR;
ODD-DDS: DHU, REF;
FO/TSC: AWIC, CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

ODP

Effective Date

04/16/2021

Background

This revision updates this section to comply with the procedural changes in DI 11011.001 in reference to the collateral estoppel policy and does not introduce any new policies.

Summary of Changes

DI 13005.032 Continuing Disability Review (CDR) and Subsequent Claims Filed During Personal Contact

This section complies with our plain language guidelines and includes cross-references to instructions, where appropriate. This section was revised to reflect the changes to the policy in DI 11011.001.

DI 13005.032 Continuing Disability Review (CDR) and Subsequent Claims Filed During Personal Contact

A. Introduction to personal contact during a CDR with a subsequent claim

The field office (FO) is responsible for explaining the possible impact of a subsequent disability claim on current benefits. For example, the filing of a disabled widow(er) beneficiary (DWB) claim by a disabled individual should not raise a continuing disability issue on the disability claim. For procedures involving potential collateral estoppel claims, see DI 11011.001C.

B. Policy for Title II and Title XVI subsequent claims

If the DDS receives a subsequent disability claim, the DDS may adopt a prior favorable determination or decision for the subsequent claim when none of the exceptions in DI 27515.001E apply. However, we must carefully apply collateral estoppel, when a CDR was conducted in a previously allowed claim. Deciding continuing disability (CD), involves consideration of different issues than those that are involved in deciding disability in an initial claim, see DI 13005.005. This can result in a finding of CD in a case that could be a denial, if the consideration issues were deciding an initial disability decision.

Therefore, the basis for the continuance must be determined before applying collateral estoppel in any case. The DDS must review the most recent favorable determination or decision based on meeting or equaling a listing or medical-vocational rules to determine whether collateral estoppel applies. For more information, see DI 27515.001F.1. Collateral estoppel does not apply (and the DDS must make a new determination) when the most recent medical continuance in the previously adjudicated claim was based on a lost folder. The basis for the continuance may be determined from the SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title II).

In some cases, however, the subsequent claim may raise a CD issue. In these cases, the FO must explain the possibility of a CDR on the original claim, see DI 11011.001C. Do not complete the form SSA-454-BK (Continuing Disability Review Report) and follow the procedures in DI 13005.030. Use the form SSA-3368-BK (Disability Report –Adult) with the subsequent claim for both the new claim and the CDR case. On the form SSA-5002 (Report of Contact) document the possibility of a CDR and explain the step of the CDR process to the disabled individual, see DI 13005.030. Process the subsequent claim following existing procedures. For FO electronic case procedures, see DI 81010.000.

Once we perform a CDR involving Section 1619 eligibility, we must carefully apply the disability evaluation criteria applicable to this unique population, see SI 02302.006. Carefully review any shifts in eligibility between the regular disability provisions and Section 1619, see SI 02302.010.

NOTE: For subsequent claims routing and jurisdiction procedure for the FO, see DI 11055.055B. For the DDS procedures involving the prior claim, see DI 20505.010.


DI 13005 TN 15 - Medical Issues - 4/16/2021