PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 205 – Folder ManagementSubchapter 05 – Prior Folder InformationTransmittal No. 4, 07/28/2020
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.
Summary of Changes
DI 20505.010 Disability Determination Services (DDS) Locates a Prior Paper Folder
Language in B.1 was revised for clarity and consistency with revised collateral estoppel policy.
"The claimant filed a current Title II claim and has a prior SSI allowance (Unless SSI was a conversion claim); (See DI 27515.000 – Collateral Estoppel)."
was revised to
"The claimant filed a subsequent claim and collateral estoppel potentially applies (DI 27515.015)."
Before sending a claims folder to the DDS, the FO determines whether the claimant has previously filed for any type of benefit or payment and documents prior claims activity on the EDCS 3367 or paper SSA-3367 (Disability Report – Field Office). For electronic folder instructions, see DI 81020.030 – Prior Folder Material.
DDS may need to review actions on claims when there is a prior determination. This chapter explains how to determine the need for a prior folder and DDS procedures for the retrieval of a prior folder.
If the FO did not request a prior paper folder and DDS determines the prior paper folder is necessary in order to adjudicate a current claim; DDS must take additional action to obtain the prior paper folder. These situations should be infrequent and are usually due to the need to establish longitudinal medical history or a mental impairment.
Routinely request the prior folder (if the FO has not already submitted a request) in the following situations:
The claimant filed a subsequent claim and collateral estoppel potentially applies (DI
Evidence in the current claim suggests a possible reopening; (See DI 27500.000 – Reopening, Adoptions, and Refilings);
An acquiescence ruling requires DDS to consider the prior Administrative Law Judge or Appeals Council findings when making a disability determination arising under the same or different Title of the Social Security Act (The Act.);
Evidence in file indicates fraud or similar fault may be involved in the current or prior claim;
A prior allowance exists and benefits were ceased for non-medical reasons.
Do not routinely request the prior folder in the following situations:
There is no possible reopening issue (DI 27500.000); or
The potential onset date occurs after the disability earnings requirement is last met; or
The alleged onset date occurred within the past year and medical evidence submitted does not indicate the presence of an impairment(s) which might warrant an onset more than one year ago; or
The claimant engaged in substantial gainful activity (SGA) during the l-year period preceding the filing date of the current application.