The claims must have a common issue (i.e., whether the individual is disabled or blind). A common issue only exists when two or more claims share an overlapping period.

The same rules for determining disability apply to the common issues at the time the new claim is decided.

There is no reason to question the correctness of the prior determination or decision.

A prior favorable determination or decision is not adopted when the rules for determining disability applicable in the new claim are different from the rules that were applied in the prior determination or decision.

Examples include:

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  Blindness requirements for Title II versus Title XVI (see DI 11055.001 and DI 26005.005A),

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  Childhood disability versus adult disability,

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  Change in medical-vocational rules (e.g., the removal of the inability to communicate in English), and

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  A substantial change to the Listing of Impairments (see DI 27515.005B).

A prior favorable determination or decision is not adopted when it is clearly incorrect or the error exception for continuing disability reviews (CDR) applies. For information on applying the prior error exception to medical improvement (MI), see DI 28020.350.

A prior favorable determination or decision is not adopted when Title XVI disability is due to conversion unless there has been a subsequent CDR continuance under Federal criteria. For information on title XVI conversion claims, see DI 33025.005 and DI 23525.001.

To determine if the claim was allowed or continued under federal criteria, the DDS must review:

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  The SSA-831 (Disability Determination and Transmittal) or the SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal - Title XVI) for the prior Title XVI determination, or

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  The Supplemental Security Income Display (SSID) query. In the SSID query, the rollback indicator (RB) field is coded 4 when the claim was allowed or continued under Federal criteria.

A prior determination or decision is not adopted when the claimant has a changed vocational profile. For information on when a changed vocational profile applies, see DI 27515.010.

A prior determination or decision is not adopted when the current entitlement of that record is terminated status (i.e., Ledger Account File (LAF) code or Payment Status (PSY) field code begins with T).

To determine the current entitlement, the DDS must review:

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  The LAF code on the Master Beneficiary Record (MBR) for Title II (see SM 00550.020).

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  The PSY field code on the SSID for Title XVI (see SM 01305.001G).

For information on:

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  When the query(ies) must be included in the folder, see DI 27515.001H.2 in this section.

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  Understanding SSID queries, see DI 28030.010C.

A prior favorable determination or decision is not adopted when the basis for the prior favorable determination or decision is unknown.

A currently entitled individual may have undergone one or more CDRs before filing a new claim for a different type of benefit. The DDS must review the basis for the prior favorable determination or decision to determine whether collateral estoppel applies. For how to determine the basis for the CDR continuance using the SSA-832 and SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal - Title II), see DI 28084.020C.

The DDS must review the most recent prior favorable determination or decision based on meeting or equaling a listing or medical-vocational rules to determine whether collateral estoppel applies. The DDS must ensure none of the restrictions in DI 27515.001E in this section apply.

Evidence obtained in the new claim may indicate medical improvement (MI) or that an exception to MI applies. MI or a specific exception to MI raises a CDR issue in the claimant’s existing entitlement regardless of whether collateral estoppel applies, or a new determination is favorable or unfavorable. For CDR issues in collateral estoppel claims, see DI 27515.050.

The DDS may adopt a prior Age 18 redetermination when:

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  The prior favorable determination or decision was made after age 18, and

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  None of the restrictions in DI 27515.001E in this section apply.

For information on:

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  When an Age 18 redetermination is required, see DI 27515.050B.2 and DI 23570.020D.2

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  Screening out Age 18 redeterminations, see DI 28003.005C.3.

The "Potential Collateral Estoppel Issues Apply" case flag is used for management information (MI) purposes and to alert subsequent reviewers that collateral estoppel potentially applies.

The MBR and/or SSID query(ies) have adjudicative significance to the new determination and should be included in the folder (see DI 81020.050B). If the FO did not include the MBR or SSID query(ies) in the folder in accordance with DI 11011.001C, the DDS must add the query(ies) to Section Q (Queries) of the folder or request that the FO add the query(ies) through an AR when:

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  Collateral estoppel applies, or

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  Collateral estoppel does not apply because the claimant is not currently entitled to benefits on the prior claim.

For more information on:

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  Faxing into the EF using bar codes, see DI 81010.090.

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  DDS responsibilities for electronic case documentation, see DI 81020.065A.

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  Uploading queries, see Uploading a Query to eView on A-Z Disability Training Index.

If the FO technician or DDS adjudicator does not have access to a printer or scanner, the entire query(ies) should be added by other means, such as copying and pasting it to a word document and uploading it to Section Q (Queries) of the folder.

When collateral estoppel applies, the DDS may, with some exceptions, make the determination without medical consultant (MC) or psychological consultant (PC) review and signature. For additional information, see DI 24501.001B.2 and DI 24501.002A.

When collateral estoppel applies, and the potential onset date in the new claim is earlier than the EOD in the prior favorable determination or decision, the DDS must complete development for the period not previously adjudicated to determine the EOD. This will require adjudication in the usual manner for the earlier period, including MC or PC review and signature. For more information on medical evaluation, see DI 24501.002.