TN 8 (08-23)

DI 27515.050 Continuing Disability Review (CDR) Issues in Collateral Estoppel Claims

A. When to raise a CDR issue

When evidence in the new claim raises a CDR issue (either potential medical improvement (MI) or a potential specific exception to MI), a CDR is required whether or not a common issue exists between the two claims and regardless of when the periodic review is scheduled. For information on MI in CDRs, see DI 28010.000. For information on the specific exceptions to MI that may raise a CDR in new claim, see DI 28020.001. For when to complete an age 18 redetermination instead of a CDR, see DI 28005.003.

IMPORTANT: The specific exception to MI for failure to cooperate only applies when the claimant refuses to cooperate with the new claim and the evidence demonstrates potential MI or the claimant no longer wishes to continue benefits.

NOTE: 

Neither the filing of a new claim nor an overdue diary alone is an event that raises a CDR issue. For events that may initiate a CDR, see DI 13001.005 and DI 28001.015.

B. Procedure

1. Collateral estoppel applies

Process the new claim in accordance with DI 27515.001H.

When evidence in the new claim raises a CDR issue, the Disability Determination Services (DDS) must apply collateral estoppel and adopt the prior favorable determination or decision in the new claim. The DDS will then transfer the claim to the field office (FO) to initiate a concurrent CDR.

The DDS must annotate “CDR is required” in Item 34 of the SSA-831 and add a message in eView to ask the FO to initiate the CDR.

2. Collateral estoppel does not apply

When collateral estoppel does not apply, the DDS must complete development and make a new determination. For more information on when collateral estoppel does not apply, see DI 27515.001E.

When evidence in the new claim indicates MI or a potential specific exception to MI, a CDR is required regardless of when the periodic review is scheduled. When a required age 18 disability redetermination has not yet been performed, conduct an age 18 redetermination instead of a CDR.

NOTE: 

An age 18 redetermination is not appropriate if the individual has otherwise had a favorable determination under the adult initial claims standard after attainment of age 18. For additional guidelines on identifying and reviewing a case for an age 18 redetermination, see DI 23570.010A.2.

When a CDR or age 18 redetermination issue is raised, the DDS must resolve the issue prior to making a determination on the new claim. The DDS will send an assistance request (AR) for the FO to initiate the CDR or age 18 redetermination and the FO to notify the beneficiary of the review on the existing entitlement. The DDS must adjudicate the new claim and the applicable CDR or age 18 redetermination on the existing entitlement at the same time to ensure that, in the event of a cessation, both claims will move through the appeals process together. Follow regional guidance for AR follow up timeframes.

In this situation, the Multiple Pending Cases (MPC) will consist of two different classification folders (initial and CDR). For instructions on MPC folders and processing an initial claim with a CDR, see DI 81010.030D.

When the prior favorable determination or decision is not in the certified electronic folder (CEF), the DDS will request the prior paper folder for the CDR when it was not requested by the FO.

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427515050
DI 27515.050 - Continuing Disability Review (CDR) Issues in Collateral Estoppel Claims - 08/21/2023
Batch run: 08/21/2023
Rev:08/21/2023