DI 13015.092 Comparison Point Decision (CPD) Folder Lost During the Course of Adjudication

A. Introduction for Lost paper CPD folder for an electronic Continuing Disability Review (eCDR) at OQR

In eCDR cases that have a paper CPD folder, the paper CPD folder is transferred with the eCDR until a final determination is made on the CDR and the appeals period has expired. See Electronic Continuing Disability Review (eCDR) Short Term Process Overview, DI 81020.200.

This section explains the actions to take on an eCDR case when the paper CPD folder is lost during the course of adjudication, i.e., between the Disability Determination Services (DDS) or other adjudicating component determination, and the Office of Quality Review (OQR) review, or between the DDS determination and a subsequent level of appeal review. This section outlines the necessary actions to be taken by OQR, DDS, and the field office (FO) to locate the missing file or reconstruct the lost paper CPD folder.

B. Procedure for Lost paper CPD folder when OQR receives an eCDR for review

1. OQR receives eCDR transfer but not the paper CPD folder

If, after 10 days, OQR does not receive the paper CPD folder associated with an eCDR, OQR makes every attempt to locate the paper CDR folder, including contacting the DDS or adjudicating component, and other possible OQR locations. Document all attempts to locate the paper CDR folder on an SSA-5002 (Report of Contact), and place in the eCDR file.

2. OQR reviews eCDR folder when unable to locate paper CPD folder

If the paper CPD folder is not located after an extensive search, OQR reviews the eCDR file per the instructions in DI 28035.010, Review of Current Medical Evidence, to determine if the CDR will be continued based on a “currently disabled” determination. If the proposed determination is a continuance, process the case to continue eligibility.

3. Case is not continued and no medical improvement review standard is considered

If continuing disability is not established, follow the procedures in DI 28035.020, Reconstruction of Prior Medical Evidence Folder.

If the case is not continued without considering medical improvement, or the proposed determination is a cessation, OQR contacts DDS or the adjudicating component and requests they search for the missing paper folder. The DDS or adjudicating component must document their search attempt on an SSA-5002 (Report of Contact), and place it in the electronic folder. During the search for the paper CPD folder, OQR will maintain jurisdiction of the eCDR case. If the DDS or adjudicating component locates the prior paper CPD folder, they will forward the folder to the OQR field site for association with the eCDR folder.

4. OQR action when paper CPD folder is not found by adjudicating component

If DDS or the adjudicating component cannot locate the paper CPD folder after 10 days, OQR does a controlled return to the DDS or adjudicating component. OQR changes the paper folder indicator (PFI) to Unable to Locate (UTL) prior to clearance. The DDS or adjudicating component follows the current UTL procedures in DI 28035.020 and contacts the FO with an assistance request (AR) to reconstruct the paper CPD folder.

5. DDS or adjudicating component actions when CPD date is unknown

When the CPD date is unknown, the DDS or adjudicating component documents the file on an SSA-5002 explaining why the CPD is not established, and prepares a determination to continue benefits. For further information see DI 28035.025.

6. FO actions to reconstruct prior paper CPD folder

The FO makes a final attempt to locate the folder by following the procedures in DI 13015.080. If the folder is still not located, the FO re-interviews the claimant and completes a paper form SSA-3368-BK (Disability Report-Adult), obtains signed forms SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA)), and any other forms the DDS, adjudicating component or FO deems appropriate. The FO sends the paper SSA-3368-BK and SSA-827s to the DDS. The SSA-3368-BK is marked, “CDR LOST FOLDER-Full Reconstruction Completed.”

7. DDS or adjudicating component actions to reconstruct the prior paper CPD folder

The DDS or adjudicating component follows the reconstruction procedures in DI 28035.020C and DI 28035.020D. DDS or adjudicating component annotates in remarks that the evidence received is reconstructed CPD evidence and they make a new determination. The CDR is sent back to OQR for review. The PFI will show “UTL” even if the file is reconstructed, because it is not the original folder of record.

8. DDS or adjudicating component cannot reconstruct CPD file

If the DDS or adjudicating component cannot reconstruct the CPD evidence and it is necessary to make a determination, follow the lost folder procedures in DI 28035.025 and process a continuance as appropriate, even if the original decision proposed was a cessation.

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