If the DDS receives a subsequent disability claim, the DDS may adopt a prior favorable
determination or decision for the subsequent claim when none of the exceptions in
DI 27515.001E apply. However, we must carefully apply collateral estoppel, when a CDR was conducted
in a previously allowed claim. Deciding continuing disability (CD), involves consideration
of different issues than those that are involved in deciding disability in an initial
claim, see DI 13005.005. This can result in a finding of CD in a case that could be a denial, if the consideration
issues were deciding an initial disability decision.
Therefore, the basis for the continuance must be determined before applying collateral
estoppel in any case. The DDS must review the most recent favorable determination
or decision based on meeting or equaling a listing or medical-vocational rules to
determine whether collateral estoppel applies. For more information, see DI 27515.001F.1. Collateral estoppel does not apply (and the DDS must make a new determination) when
the most recent medical continuance in the previously adjudicated claim was based
on a lost folder. The basis for the continuance may be determined from the SSA-832
(Cessation or Continuance of Disability or Blindness Determination and Transmittal
– Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination
and Transmittal – Title II).
In some cases, however, the subsequent claim may raise a CD issue. In these cases,
the FO must explain the possibility of a CDR on the original claim, see DI 11011.001C. Do not complete the form SSA-454-BK (Continuing Disability Review Report) and follow
the procedures in DI 13005.030. Use the form SSA-3368-BK (Disability Report –Adult) with the subsequent claim for
both the new claim and the CDR case. On the form SSA-5002 (Report of Contact) document
the possibility of a CDR and explain the step of the CDR process to the disabled individual,
see DI 13005.030. Process the subsequent claim following existing procedures. For FO electronic case
procedures, see DI 81010.000.
Once we perform a CDR involving Section 1619 eligibility, we must carefully apply
the disability evaluation criteria applicable to this unique population, see SI 02302.006. Carefully review any shifts in eligibility between the regular disability provisions
and Section 1619, see SI 02302.010.
NOTE: For subsequent claims routing and jurisdiction procedure for the FO, see DI 11055.055B. For the DDS procedures involving the prior claim, see DI 20505.010.