Effective Dates: 05/17/2023 - Present Previous | Next

TN 5 (05-23)

DI 28035.001 Disability Determination Services (DDS) Initial Receipt and Development of Lost or Destroyed Folders/Medical Evidence for Continuing Disability Review (CDR) Cases

IMPORTANT: These instructions incorporate policy and procedure for both electronic continuing disability review (eCDR) and eCDR exclusion (paper) cases when there is a lost or destroyed folder involved.

A. Background on CDR Cases

The law requires that Social Security Administration (SSA) periodically reviews the continuing entitlement and eligibility of all Title II and Title XVI individuals. In performing this review, we compare the severity of the individuals' current medical condition(s) to the severity of the most recent favorable medical decision (i.e., comparison point decision (CPD)).

There may be situations when SSA is unable to locate a folder or, a folder has been destroyed. In either of these situations, the field office (FO) follows specific procedures for attempting to find the folder. For FO procedures to locate a folder, see DI 13015.070 and DI 13015.080.

B. Field Office (FO) requirements for lost or destroyed cases prior to transfer

Before transferring a CDR case to the DDS, the FO must make every effort to locate the CPD folder(s). The CPD folder could be a certified electronic folder (CEF) or a paper folder. A CEF cannot be a lost or destroyed folder because it is stored electronically. For further instructions regarding FO search and detective work that may be necessary to locate a medical folder see DI 13015.080.

NOTE: If the CDR is an Age-18 Redetermination, the CPD folder is not required. Age-18 Redeterminations are evaluated under adult listings and are considered a "new initial claim." However, if it is readily available, the FO will obtain it and forward it to the DDS.

For information on associating the CEF CPD folder with an electronic continuing disability review (eCDR), see DI 81010.235.

1. Paper CPD

If the CPD is a paper folder, the FO mails the CPD folder to the DDS when it transfers the case to the electronic disability collect system (EDCS). If the FO cannot locate the paper CPD folder, the FO must document all attempts to find the folder, including follow-up requests, on Form SSA-5002 (Report of Contact) or similar document.

The Form SSA-5002 or similar document must:

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    Identify the type(s) of file the FO attempted to locate (Title II Disability Insurance Benefits (DIB), Childhood Disability Benefits (CDB), Disabled Widow(er) Benefits (DWB), Supplemental Security Income (SSI), etc. and list the locations searched or eliminated based on queries;

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    Document a follow-up to the original search request(s) was completed;

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    Address the issue of cross-referenced social security numbers (SSN), or document there are no cross-referenced SSNs;

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    Address pertinent name changes by the individual and that the office searching for the folder was aware of and searched under all names involved.

2. Developmental evidence

The FO obtains the following developmental evidence:

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    Form SSA-454 (Report of Continuing Disability Interview) - the FO must key the Form SSA-454 into EDCS;

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    Form SSA-3368 (Disability Report - Adult) for Age-18 Redeterminations - the FO must key the SSA-3368 into EDCS, unless there is an eCDR exclusion. See (DI 81010.210 for eCDR exclusion cases;

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    Form SSA-3881 (Questionnaire for Children Claiming SSI Benefits) and the age-appropriate Function Forms (Forms SSA- 3375 through SSA-3379 for child CDRs;

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    Form SSA-827 (Authorization to Disclose Information to the Social Security Administration), see DI 11005.056 for signature requirements; and

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    Supporting documentation (e.g., queries, individual-supplied documents) including Form SSA-5002 or similar document documenting the attempts to locate a missing CPD if necessary.

After the FO completes development, it transfers the case to the DDS.

NOTE: FOs should accurately complete the paper folder indicators prior to EDCS transfer per DI 81010.235.

C. DDS procedures for receipting CDR cases

DDS must review CDR cases for CPD folder documentation, which can be any of the following:

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    A linked CEF CPD (which indicates that the folder is electronic);

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    A paper CPD folder;

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    Form SSA-5002 or similar document which documents all FO search activity for a lost or destroyed folder;

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    Supporting documentation (e.g., queries); or

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    CPD date established by the FO (which should be the date 12 months prior to the CDR interview).

    NOTE: The FO keys a CPD date into EDCS that is 12 months prior to the interview for lost or destroyed folder cases. However, it is the DDS's responsibility to establish the actual CPD date.

If the FO forwards a CDR folder that does not contain documentation of efforts to locate the CPD folder, the DDS transfers the case back to the FO. The adjudicator includes this reason "Attempts to locate the CPD folder are not documented."

If the DDS receipts the case before discovering the missing CPD development, the adjudicator transfers the case back to the FO.

The FO should key the SSA-454-BK into EDCS; however, if it does not, the DDS can scan it into the CEF, per DI 81020.210.

NOTE: To ensure proper credit in workload assistance cases, when requesting assistance from another disability-processing component, DDS must use the Transfer (TR) decision code rather than the No Determination (ND) decision code. The DDS must route the claim using TR regardless of whether the DDS has already performed substantive work on the case. See SM 06001.355 and DI 81020.127.

D. DDS procedures for developing prior medical evidence

1. Residual file material

The DDS no longer creates or maintains paper residuals. All prior medical evidence should be available electronically.

2. Title XVI conversion:

Attempt to locate the prior State records because two CPDs may apply. The actions taken vary on a State-by-State and case-by-case basis. For additional information, see DI 28010.020.

E. DDS procedures for developing current evidence

When developing current evidence, the adjudicator will:

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    Review Form SSA-454;

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    Develop all current medical evidence and any necessary non-medical evidence (12 months before the date when the SSA-454 is signed to the present date); and

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    Order a consultative examination, if necessary.

For additional case development procedures, see DI 28030.020.

F. References

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    DI 28010.020 Comparison Point Decision (CPD)

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    DI 28030.020 Development of Medical Evidence

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    DI 81020.127 Processing "No Determination" (ND) Cases

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    DI 81020.205 Receipting an Electronic Continuing Disability Review (eCDR)

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    DI 81020.210 Scanning the SSA-454-BK (Continuing Disability Review Report) into the CEF

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    DI 81020.225 Linking and Unlinking the Comparison Point Decision (CPD) Folder

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    SM 06001.355 Transfer Cases

 

To Link to this section - Use this URL:
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DI 28035.001 - Disability Determination Services (DDS) Initial Receipt and Development of Lost or Destroyed Folders/Medical Evidence for Continuing Disability Review (CDR) Cases - 05/17/2023
Batch run: 05/17/2023
Rev:05/17/2023