TN 2 (01-21)

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.

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 indicates he or she no longer wishes to continue benefits.

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

For more information on CDRs, see:

  • DI 13010.012 Protection from Medical Review Based on Work Activity.

  • DI 13010.135 Title II Continuing Disability Considerations in Blindness Cases.

  • DI 55025.010 Processing the Medical Continuing Disability Review (CDR) for Beneficiaries with Tickets.

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.

When evidence indicates MI or a potential specific exception to MI, a CDR is required regardless of when the periodic review is scheduled. When a CDR 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 a CDR and notify the beneficiary of the CDR on the existing entitlement. The DDS must adjudicate the new claim and the CDR 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 time-frames.

In this situation, the official folder will be paper because the FO will add the CDR as an Electronic Disability Collect System (EDCS) exclusion. For more information on processing multiple claims when at least one of the claims is an EDCS exclusion, see DI 81010.030C.

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 - 01/12/2021
Batch run: 01/13/2021
Rev:01/12/2021