PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 290 – Reconsideration of Continuing Disability Review (CDR) Cases, and Reopenings Applicable to Disability Hearings (Pre-DHU Processing)Subchapter 05 – Development of EvidenceTransmittal No. 8, 08/28/2024
Audience
Originating Component
ODP
Effective Date
Upon Receipt
Background
The agency recently revised the collateral estoppel policy and procedures. This revision aligns the pre-hearing policy with the updates in DI 27515.001.
Summary of Changes
DI 29005.022 New Application and Request for Reconsideration
We updated POMS instructions to cover procedures for when the DDS returns the new claim to the Field Office for a determination on collateral estoppel.
An individual may file a new application or request reconsideration of an initial denial at the same time they request reconsideration of a disability cessation, or while such a request is pending. When common issue exists, the field office (FO) escalates the new claim to the disability determination services (DDS) and the DDS processes the new claim with the reconsideration. A reconsideration of an initial denial is handled in the same manner as a new application.
IF...
THEN...
A fully favorable reconsideration determination is not issued, but a new period of disability is established based on the new claim and the new claim is fully favorable.
The pre-hearing (PH) unit will process the new claim independent of the reconsideration case, using initial case instructions,
Document the case folder to show the period of disability established based on the new application, and
Prepare the reconsideration for transmittal to the disability hearing unit (DHU). Be sure the folder sent to the DHU has copies of the evidence in the new case.
A fully favorable reconsideration determination is not issued, and a new period of disability cannot be established on the new claim or the new claim is not fully favorable.
Prepare both the reconsideration case and the new claim for transmittal to the DHU.
A fully favorable reconsideration determination is issued, and a new period of disability cannot be established on the new claim or the new claim is not fully favorable.
This is potential collateral estoppel. The PH unit will issue the reconsideration determination and complete a No Determination (ND) on the new claim with the remark "FO determination requested." See DI 27515.001 for additional instructions on message or SSA-5002 (Report of Contact) completion.
A fully favorable reconsideration determination is issued, and the new claim is fully favorable.
The PH unit will issue both determinations.
Exception: If the cases are the same type and the same benefit and both determinations are fully favorable, this is considered a duplicate claim. The PH unit will issue the reconsideration determination and complete a No Determination (ND) on the new claim with the remark "Not processed- duplicate claim." Forward the cases to the field office (FO) following normal operating instructions.
DI 51501.001 Procedural Change for Subsequent Disability Applications Effective July 28, 2011
DI 27515.000 Collateral Estoppel
DI 29025.001 Disability Determination Services (DDS) Action When Fully Favorable Reconsidered Determination Is Not Issued
DI 33015.060 New Application Filed and Request for Reconsideration of Disability Cessation Pending