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  Enter all claims using MCS, MSSICS and CCE as applicable..

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  Take full (not deferred) Title XVI applications.

Follow the normal interviewing guidelines, which includes recording the information into EDCS see DI 11005.000.

For instructions on establishing a claim in EDCS and EDCS exclusions, see DI 81010.020.

If you have any doubt as to whether the claim will result in an allowance, it is in the claimant’s best interest to complete an entire SSA-3368-BK (Disability Report – Adult). This action may help to avoid unnecessary recontact.

If the claimant’s impairment(s) does not meet a presumptive disability category but seems particularly severe, and curtailing completion of the disability report might be appropriate, refer to:

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  DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms

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  DI 81010.020F. Curtailing completion of the EDCS 3368 or EDCS 3820

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  The appropriate Regional Center for Disability Programs for guidance on curtailment, if necessary.

We receive the VAPT rating status directly from the VA; therefore, the claimant has no additional burden to provide proof to expedite the claim. The data exchange with the VA is sufficient to verify VAPT.

In rare situations, a veteran may self-identify as having a VAPT rating, but there is no system alert. For these cases, the veteran must provide proof of a VAPT rating. Acceptable proof of a veteran’s rating is normally a VA notification letter to the veteran. For cases without the VA100% P&T systems alert, make a copy of the VA Notification Letter and retain a copy in file. Do not expedite a case without verification or proof of the VAPT rating.

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Military disability benefits do not offset DIB if all military service is after December 31, 1956. For more information on military disability benefits, see DI 52130.015.

Be alert to the possibility of a closed period of disability. Based on the evidence, a disability adjudicator may find that the claimant is disabled for a continuous period of at least 12 months, but at the time of adjudication, the claimant is no longer disabled. In order to establish a closed period, the evidence must show a period of disability that has a definite beginning and ending date. In this situation, if the claimant meets all other requirements, they may be entitled to a closed period of disability.

For additional information on closed period of disability, see DI 25510.010 and DI 25510.015.

Evaluating a closed period of disability always requires careful consideration of the medical improvement review standard. Additionally, adjudicators cannot establish a closed period of disability based on a finding of substantial gainful activity (SGA) alone, as the claimant may be entitled to work incentives. For return to work issues, see DI 13010.110.

When appropriate, develop for an earlier POD. The POD may be the same, earlier or later than the alleged onset date (AOD). When evaluating a claimant’s work, make sure to consider work incentives (e.g., impairment-related work expenses (IRWE), subsidies, special conditions) when determining the reasonable worth of the work. When the POD is earlier than the AOD, develop and document any work issues after the AOD, or after the POD, using form SSA-821-BK (Work Activity Report – Employee), or the SSA-820-BK (Work Activity Report – Self-Employment).

Complete the SSA-823 (Report of SGA Determination-For SSA Use Only) in all initial claim determinations that require an SSA-820-BK or SSA-821-BK.

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  DI 10505.035 Documenting Employment Cases Using FORMS SSA-821-BK (Work Activity Report-Employee) and SSA-823 (Report of SGA Determination-For SSA Use Only),

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  DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only),

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  DI 10005.005 Field Office (FO) Disability Development, and

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  DI 11005.045 Completing the 3367 (Disability Report-Field Office).

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  Establish a UNIT code of “___P&T” on the MCS DW01 screen or CCE Development Worksheet page for claimants who meet the VAPT definition in DI 11005.007.

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  Use the first three characters of the unit code per local instructions (e.g., unit number, initials).

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  Establish an ISSUE of “VAPT Case” to track the case.

When sending a VAPT claim to the DDS, take the following steps:

Obtain a DDS Query (DDSQ) two days after the claim is transmitted to verify DDS received the claim. For paper cases, obtain a DDSQ seven days after the claim is transmitted. If the claim is not on the DDSQ, contact the DDS by email or fax to verify receipt.

Complete and add the VAPT flag to the front cover of the claims paper folder. (See an exhibit of the flag in DI 11005.012G in this section.)

1. a. 

   Reconsideration request process: Refer to DI 12005.005 and DI 12005.010 .

2. b. 

   Hearing request process: Follow assembly and routing instructions in DI 12010.010 .

3. c. 

   Request for Appeals Council (AC) review: Follow instructions in DI 12020.001 .