PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 275 – Reopenings, Res Judicata, and Collateral EstoppelSubchapter 40 – Reopening Notice InstructionsTransmittal No. 4, 09/24/2026
Audience
Originating Component
DP
Effective Date
Upon Receipt
Background
Disability Policy is updating the Program Operation Manual System (POMS) to clarify that when the Disability Determination Services (DDS) reverses a prior favorable determination to a later onset, the claimant does not qualify for a hearing at a Disability Hearing Unit (DHU). We also updated POMS to include information about appeals of adverse medical reopenings (AMR) of initial and reconsideration level claims which are eligible for a disability hearing. An individual has the right to request a disability hearing if they have been receiving disability benefits and we make an initial or revised determination based on medical factors that they are not disabled because the impairment(s) has ceased, did not exist, or, is no longer disabling.
Summary of Changes
DI 27540.040 Reopening and Revision at the Reconsideration Level
We revised DI 27540.040A adding a note indicating that an AMR for a less favorable onset is routed through the standard appeals process and is not afforded a hearing at DHU.
We revised DI 27540.040B to add instructions for Processing DDS AMRs at the reconsideration level.
The opportunity for a disability hearing at a Disability Hearing Unit (DHU) is afforded at the reconsideration level of appeal in cases involving:
favorable initial determinations that were reopened and adversely revised based on medical factors, e.g., reopenings that revise an allowance to a denial, or change an open period allowance to a closed period;
reopenings that change the basis for the cessation; or
favorable reconsidered determinations that have been reopened and that we propose to adversely revise to a denial or closed period based on medical factors.
favorable continuing disability review (CDR) continuances that were reopened and adversely revised based on medical factors, e.g., continuance to cessation or continuance to closed period.
IMPORTANT: Adverse medical reopenings (AMRs) for a later onset are not afforded a disability hearing at the DHU but go through the standard appeals process.
When an initial determination is reopened and adversely revised based on medical factors, as described above, the Disability Determination Services (DDS) sends the claimant a notice containing reconsideration appeal rights that include the opportunity for a disability hearing at the DHU.
When the DDS proposes an AMR of a reconsideration-level determination, the DDS will not issue the unfavorable determination. The DDS will forward the case to the DHU. The DHU sends a notice to the claimant advising them of the proposed revision and their right to request a disability hearing before a revised determination is issued.
See Also :
DI 29001.001 - The Right to a Disability Hearing at the Reconsideration Level at the Medical Continuing Disability Review (CDR) Reconsideration Level
DI 33001.001The Disability Hearing Process – Title II and Title XVI
DI 33020.025 - Reopenings by the Disability Hearing Officer (DHO)