Effective Dates: 03/22/2005 - Present Previous | Next

TN 2 (01-21)

DI 27515.035 Different Determinations or Decisions for the Same Period in Separate Claims

A. Different determinations or decisions that are policy-compliant

Generally, the determination or decision for claims under different titles and benefit types should agree. However, different determinations or decisions may be appropriate because the rules for determining disability differ or because eligibility factors are not satisfied.

Examples include:

  • •

    Collateral estoppel does not apply due to a change in the listing and the evidence in the new claim results in a denial using the current rules,

  • •

    Collateral estoppel does not apply due to a changed vocational profile and the evidence in the new claim results in a denial at steps 4 or 5 of the sequential evaluation process, and

  • •

    Collateral estoppel does not apply due to a change in medical-vocational rules (i.e., removal of inability to communicate in English).

For information on when collateral estoppel does not apply, see DI 27515.001E and DI 27515.001F.1.b.

B. Different determinations or decisions that are not policy-compliant

The following applies to prior determinations or decisions made on or after July 29, 2020.

1. Collateral estoppel not applied in prior determination and decision

When the Disability Determination Services (DDS) determines that collateral estoppel should have applied in a prior determination or decision but was not applied, reopen the determination or decision to correct the error in accordance with DI 27501.005. For conditions and time limits to reopening a prior determination or decision, see DI 27501.001.

2. Collateral estoppel applied in a prior determination or decision

When the DDS determines that collateral estoppel was applied in a prior favorable determination or decision, but should not have been applied, collateral estoppel does not apply to the new claim. The DDS must complete development to make a new determination and raise a CDR on the current entitlement when evidence indicates medical improvement (MI) or a specific exception to MI. For CDR issues when collateral estoppel does not apply, see DI 27515.050B2.

a. Evidence supports a CDR continuance

When the DDS determines that the evidence obtained in conjunction with the erroneously adopted claim supports an allowance, issue a continuing disability review (CDR) continuance. The DDS must annotate "Collateral estoppel erroneously applied - evidence supports a favorable determination” in Item 24 of the SSA-832/833.

b. Evidence supports a CDR cessation

When the DDS determines that the evidence obtained in conjunction with the erroneously adopted claim does not support an allowance, issue a CDR cessation based on the error exception. The DDS must annotate "Collateral estoppel erroneously applied - evidence does not support a favorable determination” in Item 24 of the SSA-832/833.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427515035
DI 27515.035 - Different Determinations or Decisions for the Same Period in Separate Claims - 03/22/2005
Batch run: 01/13/2021
Rev:03/22/2005