A CAL case is part of a fast-track process designed to quickly identify claimants with an impairment on the list of CAL conditions. This process allows us to expedite determinations and decisions on these cases. Although CAL cases are processed more quickly, the claimant must still be disabled as defined in the Social Security Act, and we evaluate the claim using the same sequential evaluation process as all other claims.

The CAL initiative is not a separate program from Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI); all the same entitlement or eligibility requirements for these programs still apply. We have identified a specific list of impairments that are very severe, typically have a poor prognosis, and are highly likely to result in an allowance. For the list of CAL conditions, see DI 23022.080.

A CAL case in the Electronic Disability Collect System (EDCS) is identified either electronically by selection software or manually when the claimant alleges an impairment that is on the list of CAL conditions. Electronic identification occurs when the selection software reviews the claimant’s alleged impairments from the SSA-3368 Disability Report – Adult or SSA-3820 Disability Report – Child and displays a CAL indicator in the electronic folder if a matching condition is found (by name, synonym, or abbreviation).

If a CAL condition is identified after the case has been transferred or during case development, the Disability Determination Services (DDS), Disability Quality Review (DQR), or hearings and appeals staff can manually add the CAL indicator at the appropriate adjudicative level, including initial, reconsideration, hearing, and Appeals Council. CAL does not apply to continuing disability review (CDR) cases.

All adjudicators should be familiar with the current CAL criteria, found in the list of CAL conditions in DI 23022.080. If you identify a potential CAL condition during a disability interview or while reviewing an iClaim, promptly begin full development of non-medical evidence and complete the full Title XVI claims path for SSI cases.

When transferring a case in EDCS to the DDS, the selection software determines whether the case is identified for processing as a CAL case. If a CAL condition is identified, the FO receives one of the following on-screen message boxes in EDCS:

• •

  "This case has been marked as a Compassionate Allowance case. Full non-medical development is required." or,

• •

  "This case has been marked as a Quick Disability Determination and Compassionate Allowance case. Full non-medical development required."

Process CAL cases in the same manner as a Quick Disability Determinations (QDD) case. If you identify a potential CAL case during your interview or review of an online application, follow these steps:

1. 1. 

   Follow instructions for processing QDD cases in DI 11005.603C - DI 11005.603F.

2. 2. 

   If the claimant alleges cancer, obtain the type and stage (if known) and record this information on the ADIB screens on the Disability Condition section of the Modernized Claims System (MCS) DISB or Disability Clearance page in the Consolidated Claims Experience (CCE), or both.

3. 3. 

   For Title XVI cases, revisit the possibility of Presumptive Disability/Blindness (PD/PB) payments if one of the PD/PB conditions is met. For PD/PB instructions see DI 11055.230.

4. 4. 

   Annotate CAL as an issue on the MCS DW01 or CCE Development Worksheet page with a tickle date of 20-days and initiate non-medical development.

After FO transfer, an electronic alert will be sent to the FO when CAL is added to a case not previously identified as CAL, or removed from a case previously identified as CAL.

If a CAL case is denied, it retains priority status at all levels of adjudication.

To determine if a denied claim was processed as CAL, look for the "CAL: Y" indicator on the eView header or the issue CAL on the MCS DW01 or CCE Development Worksheet page.

When processing an appeal in a CAL case, follow these steps:

1. 1. 

   Follow processing guidelines in the following sections:

   • •

     DI 12005.000 Reconsiderations - Initial Claims,

   • •

     DI 12010.000 Hearings Level Review - Initial Claims, and

   • •

     DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS).

2. 2. 

   Fax additional medical records of up to 15 pages, if they are in the claimant's possession, into eView or Evidence Portal per DI 11005.603C.4.

3. 3. 

   Notify DDS hearings or appeals level of the need for CAL processing by annotating the remarks section of the EDCS Transfer page.

If a case is pending at the AC and a subsequent claim is filed, and identified as a CAL upon transfer of the new claim through EDCS to the DDS, the AC is notified via the following message in eView:

"Another case with this SSN: (insert SSN) has been identified as Compassionate Allowance because of the following conditions: <insert conditions>."

Conversely, if a case is pending at the AC and a subsequent case is removed from CAL processing by the DDS, the AC is notified via the following message in eView:

"Another case with this SSN: (insert SSN) has been removed from the Compassionate Allowance process."