Identification Number:
DI 23020 TN 7
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Priority Cases
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 230 – Special Issues
Subchapter 20 – Priority Cases
Transmittal No. 7, 11/24/2020

Audience

PSC: CS, DE, DEC, DTE, IES, RECONR;
OCO-OEIO: CR, ERE, FCR, FDE, RECONE, RECONR;
DQB: DE, PA, PE, TL;
OCO-ODO: DE, DEC, DS, RECONE, RECONR;
FO: CR TII, CR TXVI, CS, CSR, DRT, FR, OA, OS, RR;
ODD-DDS: ADJ, DHU;
RO: CDP;

Originating Component

ODP

Effective Date

Upon Receipt

Background

Office of Disability Policy (ODP) removed instructions that refer Disability Determination Services (DDS) users to the expedited terminal illness instructions (TERI) when processing Military Casualty/Wounded Warrior (MC/WW) and Veterans Affairs 100 Percent Permanent and Total (VAPT) cases. We removed these instructions to avoid confusion since these cases do not always meet the criteria for TERI. MC/WW and VAPT cases are considered priority cases and instructions are provided for priority processing through all levels of case development and adjudication. We highlighted the ways we expedite the processing of these cases. We removed wording that was not useful to technicians. We also added language as well as POMS references that would be useful to technicians.

Summary of Changes

DI 23020.050 Disability Determination Services (DDS) Instructions for Identifying, Developing, and Processing Military Casualty/Wounded Warrior (MC/WW) Cases

B.1 We changed the title of this section to MC/WW case receipt and assignment and added instructions, which were previously included in the referred TERI instructions.

B.3 We removed the section regarding expedited handling and the instructions to follow TERI procedures and added a statement to the introductory paragraph. The specific disability forms were removed.

B.5 We removed the TERI reference.

 

DI 23020.055 Disability Determination Services (DDS) Claims Processing Instructions for Claimants with Veteran’s Affairs 100 Percent Permanent and Total (VAPT) Disability Compensation Rating

We made this section consistent with DI 23020.050.

We removed the copy of the VAPT letter and included a link of where to find this letter.

 

 

DI 23020.050 Disability Determination Services (DDS) Instructions for Identifying, Developing, and Processing Military Casualty/Wounded Warrior (MC/WW) Cases

MC/WW cases are identified as priority cases under DI 23020.001 and are given priority processing through all levels of case development and adjudication. Receipt and assignment of MC/WW cases are expedited at the DDS.

A. Identifying MC/WW claims

MC/WW is a claim involving any current or former member of a military service who:

  • sustained an illness, injury, or wound while on active duty status on or after October 1, 2001; and

  • alleges a physical or mental impairment, regardless of how the impairment occurred, or where it occurred (i.e., United States or on foreign soil).

B. Receipting, flagging, documenting, and processing MC/WW cases

1. MC/WW case receipt and assignment

  • Receipt the case within two business days of field office (FO) transfer (seven business days for non-certified electronic folders).

  • Assign the case to an adjudicator for review by the next business day.

2. Flag MC/WW cases

a. Certified electronic folder (CEF)

If the FO has not added an MC/WW flag to the case, see the instructions on adding the flag, Certified Electronic Folder (CEF) Flags in DI 81020.085.

b. Paper modular disability folder (MDF)

For MDF cases not flagged by the FO, attach a printable flag to the front of the folder. For a printable flag, see the Exhibit of MC/WW Flag in DI 11005.006I and click the link for “View PDF Version.”

3. MC/WW case development and processing procedures

a. Medical development and documentation

  1. 1. 

    Fully address and develop all physical and mental allegations, including any possible impairment(s), either referenced or implied in any of the medical evidence, or other evidence in the claimant’s file.

  2. 2. 

    When requesting medical records from a Military Health System, follow these instructions:

    • For Developing Medical Evidence of Record (MER) from Military Health Sources, see DI 22505.023, and

    • For Developing Medical Evidence of Record (MER) from the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Medical Facilities, see DI 22505.022.

  3. 3. 

    Properly complete all required disability assessment forms.

b. Work development and documentation

  • Work activity is primarily the responsibility of the FO. However, DDS is responsible for reviewing the FO documentation to ensure they documented the work activity appropriately. If not, DDS should contact the FO for clarification.

  • DDS is responsible for the documentation when work activity is clearly not substantial gainful activity (SGA). For guidance, see Clearly Not SGA in section DI 10501.025, and for Special Employment Situations, see DI 10505.025.

c. Activities of daily living (ADL) development and documentation

Obtain information about the claimant’s ADLs to determine the functional effects of the physical and mental impairment(s) on the claimant’s ability to work.

  1. 1. 

    ADLs with mental impairment allegations

    ADLs are important in developing claims involving mental impairments, such as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Adjudicators should be alert to the possibility of PTSD and TBI conditions even if they are not alleged. For information on developing claims involving mental impairments, refer to the following sections:

    • DI 34001.032 Mental Disorders,

    • DI 24583.005 Evaluating Mental Impairments Using the Psychiatric Review Technique (PRT)

  2. 2. 

    ADLs with physical impairment allegations

    ADLs are particularly useful in assessing how well a claimant with a traumatic injury is functioning at the time of the disability determination. For claims involving amputations(s), adjudicators should fully document the claimant’s ability or inability to use prosthetic devices effectively.

    For additional information when developing ADLs with physical impairment allegations, refer to Evaluating Lay Evidence in DI 24515.012.

  3. 3. 

    Third-party ADLs

    The development of third-party ADLs is highly encouraged in all cases, especially those involving mental impairments and traumatic injuries. For guidance, see the following sections:

d. Obtain the permanent address of the claimant

Many of these military service members may be in transit and their addresses may have changed since the FO received their claims. For additional information on jurisdiction, see Disability Determination Services (DDS) and Social Security Administration (SSA) Jurisdictions for Initial and Subsequent Cases in DI 20101.001.

e. Evaluating closed periods of disability

Be alert to the possibility of a closed period of disability as many of these claimants could have extended hospital and rehabilitation stays.

For additional information on closed periods of disability, see the following POMS sections:

4. Form SSA-831 (Disability Determination and Transmittal) completion

Follow regular processing instructions for completion of the SSA-831-C3/U3 in sections DI 26510.001 through DI 26510.095. For blindness cases, see completion of the SSA-831-U5 in sections DI 26010.001 through DI 26010.070. In addition, enter a listing code of 108 in item 26 of the SSA-831 for all MC/WW cases.

5. Denied MC/WW cases

While not mandatory, it is recommended that all denied MC/WW cases receive a special review by the DDS Quality Assurance Unit or unit supervisor.

DI 23020.055 Disability Determination Services (DDS) Claims Instructions for Identifying, Developing, and Processing Veteran’s Affairs 100 Percent Permanent and Total (VAPT) Disability Cases

VAPT is a case involving any veteran of a military service who has a VA 100% P&T disability compensation rating and is alleging a physical or mental impairment, regardless of how the impairment occurred. VAPT cases are identified as priority cases under DI 23020.001 and are given priority processing through all levels of case development and adjudication. Receipt and assignment of VAPT cases are expedited at the DDS.

A. Identifying VAPT claims

SSA receives listings of veterans with a VAPT disability compensation rating status directly from the Department of Veterans Affairs (VA); therefore, the claimant has no burden to provide proof of their disability compensation rating to expedite the claim. Our data exchange with the VA is sufficient 100% VAPT verification.

The field office (FO) will normally identify and flag VAPT disability compensation cases.

In rare situations, a claimant may self-identify as rating 100% VAPT, but there is no system alert. For these cases, the veteran must provide proof of 100% VAPT. See DI 11005.012 for an example of the VA Notification Letter.

B. Receipting, flagging, documenting, and processing VAPT cases

1. VAPT case receipt and assignment

  • Receipt the case within two business days of the FO transfer (seven business days for non-certified electronic folders).

  • Assign the case to an adjudicator for review by the next business day.

2. Flag VAPT cases

a. Certified electronic folder (CEF)

If the FO has not added a VAPT flag to the case, see the instructions on adding the flag, Certified Electronic Folder (CEF) Flags in DI 81020.085.

b. Paper modular disability folder (MDF)

For MDF cases not flagged by the FO, attach a printable flag to the front of the folder. For a printable flag, see the Exhibit of VAPT Flag in DI 11005.012G.

3. VAPT case development and processing procedures

a. Medical development and documentation

1. Fully address and develop all physical and mental allegations, including any possible impairment(s), either referenced or implied in any of the medical evidence, or other evidence in the claimant’s file.

2. When requesting medical records from a Military Health System, follow these instructions:

•For Developing Medical Evidence of Record (MER) from Military Health Sources, see DI 22505.023, and

•For Developing Medical Evidence of Record (MER) from the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Medical Facilities, see DI 22505.022.

3. Properly complete all required disability assessment forms.

b. Work development and documentation

1. Work activity is primarily the responsibility of the FO. However, DDS is responsible for reviewing the FO documentation to ensure they documented the work activity appropriately. If not, DDS should contact the FO for clarification.

2. DDS is responsible for the documentation when work activity is clearly not substantial gainful activity (SGA). For guidance, see Clearly Not SGA in section DI 10501.025, and for Special Employment Situations, see DI 10505.025.

c. Activities of daily living (ADL) development and documentation

Obtain information about the claimant’s ADLs to determine the functional effects of the physical and/or mental impairment(s) on the claimant’s ability to work.

1. ADLs with mental impairment allegations

ADLs are important in developing claims involving mental impairments, such as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Adjudicators should be alert to the possibility of PTSD and TBI conditions even if they are not alleged. For information on developing claims involving mental impairments, refer to the following sections:

DI 34001.032 Mental Disorders,

DI 24583.005 Evaluating Mental Impairments Using the Psychiatric Review Technique (PRT)

2. ADLs with physical impairment allegations

ADLs are particularly useful in assessing how well a claimant with a traumatic injury is functioning at the time of the disability determination. For claims involving amputations(s), adjudicators should fully document the claimant’s ability or inability to use prosthetic devices effectively.

For additional information when developing ADLs with physical impairment allegations, refer to Evaluating Lay Evidence in DI 24515.012.

3. Third-party ADLs

The development of third-party ADLs is highly encouraged in all cases, especially those involving mental impairments and traumatic injuries. For guidance, see the following sections:

DI 22511.011 Contacting Claimants and Collateral Sources,

DI 22511.007 Sources of Evidence, and

DI 22511.013 Technical Requirements When Securing Collateral Evidence.

d. Obtain the permanent address of the claimant

Many of these military service members may be in transit and their addresses may have changed since the FO received their claims. For additional information on jurisdiction, see Disability Determination Services (DDS) and Social Security Administration (SSA) Jurisdictions for Initial and Subsequent Cases in DI 20101.001.

e. Evaluating closed periods of disability

Be alert to the possibility of a closed period of disability as many of these claimants could have extended hospital and rehabilitation stays.

For additional information on closed periods of disability, see the following POMS sections:

DI 25510.010 Closed Period Under Title II, and

DI 25510.015 Closed Period Under Title XVI.

4. Form SSA-831 (Disability Determination and Transmittal) completion

Follow regular processing instructions for completion of the SSA-831-C3/U3 in sections DI 26510.001 through DI 26510.095, For blindness cases, see completion of the SSA-831-U5 in sections DI 26010.001 through DI 26010.070.

5. Denied VAPT cases

While not mandatory, it is recommended that all denied VAPT cases receive a special review by the DDS Quality Assurance Unit or unit supervisor.


DI 23020 TN 7 - Priority Cases - 11/24/2020