SSA - POMS: DI 81020.025 - Processing Electronic Reconsideration Cases

A. Processing reconsideration cases when SSA-3441 not received from claimant

When a claimant files a request for appeal, but does not provide the necessary forms, including the SSA-3441 (Disability Report – Appeal), the Field Office (FO) transfers the case to the Disability Determination Services (DDS) for a disability determination. See Processing a Reconsideration Request for a Medically Denied Initial Disability Claim - DI 12005.005D and DI 12005.005E.

1. FO identifies cases without a claimant-completed SSA-3441

The FO annotates in EDCS that a 3441 was not received. These cases are identified by an alert on the Alerts and Message tab in eView titled “5002: 3441 not received” along with the description, “See Case Documents tab for detailed information.” Under the Case Documents tab, there is an SSA–5002(report of contact) documenting the reason for appeal and the FO attempt(s) to obtain the 3441.

2. SSA-3441 received after case transfer to DDS

a. FO receives SSA-3441

If the FO receives a paper SSA-3441 after transferring the electronic reconsideration case, the FO updates the Certified Electronic Folder (CEF) by:

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Creating a barcode and faxing the SSA-3441 into the CEF; and
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Adding a message with no expiration date stating, “Claimant’s SSA-3441 received MM/DD/YY, faxed into CEF.”

NOTE: The alert and SSA–5002 indicating SSA-3441 not received remains in the CEF.

b. DDS receives SSA-3441

If the DDS receives a paper SSA-3441 after receipting the electronic reconsideration case, the DDS updates the CEF by:

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Creating a barcode coversheet and scanning the disability report into the CEF;
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Adding a message, with no expiration date, stating “Claimant’s SSA-3441 received MM/DD/YY scanned into CEF;” and
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Retain the alert and imaged SSA-5002 indicating SSA-3441 not received in the CEF.

B. Implied request for reconsideration

The FO may receive documentation other than an SSA-561 (Request for Reconsideration) from a claimant requesting an appeal of the initial medical determination. If the FO receives a written request for an appeal, treat the document as an Implied Request for Reconsideration. The FO faxes the Implied Request into the CEF.

The DDS must review the Implied Request and use it in place of the SSA-561.

NOTE: The DDS must review the CEF for this document and use it in lieu of the SSA-561 when completing the medical evaluation.

C. Appeals of less than fully favorable (LTFF) initial determinations

An LTFF determination appeal occurs when the claimant files an appeal based on one or more of the following:

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Closed period (CP),
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Adverse established onset date, or
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Medical diagnosis.

If the DDS receives a reconsideration claim of an LTFF determination, follow current procedures for processing reconsideration cases. If an appeal is filed while a medically reactivated claim is pending in the DDS, follow procedures in DI 81020.117 Processing Medical Reactivations.

D. Adopting medical assessments

If applicable, the medical consultant (MC) or psychological consultant (PC) may adopt any of the initial level medical assessment(s) when evaluating reconsideration cases. To determine if the initial level medical assessment(s) may be adopted, see:

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DI 24510.066B, for information on adopting the prior SSA-4734-BK (Physical Residual Functional Capacity Assessment), or SSA-4734-F4-SUP (Mental Residual Functional Capacity Assessment);
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DI 24583.005.G.1., for information on adopting the prior SSA-2506-BK (Psychiatric Review Technique); and
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DI 25230.001B.6. for information on adopting the prior SSA-538.

To adopt the prior initial-level medical assessment(s):

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Prepare an SSA-416 (Medical Evaluation)

The MC or PC may complete an SSA-416and include the reconsideration adoption statement: “I have reviewed all the evidence in file, and the medical assessment of (date) is affirmed as written.” The reviewing MC or PC must sign and date the SSA-416 using the approved electronic signature function. The SSA-416 must be applied to the Disability Determination Explanation (DDE), that is uploaded to the CEF prior to the case closure.

EXCEPTION: The SSA-416 cannot be used to affirm an SSA-538, a new SSA-538 must be prepared. For more information on affirming the initial level SSA-538 at the reconsideration level, see DI 25230.001B.64.
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Prepare a new SSA-416, SSA-4734, SSA-4734-F4-SUP, SSA-2506, or SSA-538 and include the reconsideration adoption statement, “I have reviewed all the evidence in file, and the [medical assessment] of [date] is affirmed as written.” The MC or PC must sign and date the medical assessment using the approved electronic signature function. The medical assessment must be applied to the DDE, which is uploaded to the CEF prior to the case closure.

Social Security

Program Operations Manual System (POMS)

DI 81020.025 Processing Electronic Reconsideration Cases