Effective Dates: 9/26/2024 - Present

Identification Number:
DI 13005 TN 29
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Medical Issues
Type:POMS Full Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 130 – Continuing Disability

Subchapter 05 – Medical Issues

Transmittal No. 29, 09/26/2024

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

Upon Receipt

Background

This Program Operations Manual System (POMS) update revises instructions for the Disability Determination Services (DDS) processing of subsequent disability claims when potential collateral estoppel issues apply as revised in DI 11011.001.

Summary of Changes

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

Revised subsection "B" with new business process.

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 or a CDR 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 FO procedures involving potential collateral estoppel claims, see DI 11011.001.

B. Policy for Title II and Title XVI subsequent claims

The FO has jurisdiction for applying collateral estoppel (CE) when the criteria is met; and adopting the prior disability determination or decision would be fully favorable in a new initial claim or reconsideration. For additional information on the FO responsibilities in a CE case, see DI 11011.001A. 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 CDR and an denial in the initial disability determination.

In some cases, however, the subsequent claim may raise a CD issue. In these cases, the FO must follow procedures for identifying and processing possible medical recovery issues raised at the FO level and initiating a CDR as necessary, see DI 13001.005 and DI 13005.030. If the FO has an SSA-3368-BK (Disability Report -Adult) for the new claim and determines the need for a CDR, do not complete the form SSA-454-BK (Continuing Disability Review Report) and follow the procedures in DI 13005.030. To initiate the CDR, the FO must use the form SSA-3368-BK 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 the FO performs a CDR involving Section 1619 eligibility, the FO must carefully apply the disability evaluation criteria applicable to this unique population, see SI 02302.006. To 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 29 - Medical Issues - 9/26/2024