TN 1 (05-11)

DI 28035.020 Disability Determination Services (DDS) Reconstruction of Prior Folder

Citations: Regulations - 20 CFR 404.1594(c)(3) (v), 20 CFR 416.994(b)(2) (iv)(E) , and 20 CFR 416.994a(d)

NOTE: For eCDR instructions, see DI 81020.232.

A. Disability Determination Services (DDS) policy for determining when to reconstruct a prior folder

When evaluating medical improvement, the Disability Determination Services (DDS) may discover that some of the evidence considered in making the comparison point decision is unreadable, unintelligible, or missing (e.g., a piece of evidence referred to in the rationale is no longer in file). Reconstruction of the prior evidence may be appropriate in such situations. Ensure that there are relevant medical records from the comparison point decision (CPD) so that the basis for the CPD is clear. To determine if medical records are adequately reconstructed, follow the documentation procedures in the following sections:

B. DDS procedures for reconstructing a prior folder

Attempt to reconstruct the prior folder when:

1. Comparison point decision (CPD) date is known

If the beneficiary is not currently disabled and the CPD date is established:

  • Attempt to reconstruct portions of the missing file used in the CPD and relevant to the most recent favorable determination (e.g., work history, medical records from treating sources, school records, consultative examinations, and vocational evidence);

  • Review the SSA-3368 (Disability Report – Adult) or SSA- 3820 (Disability Report – Child). If the SSA-3368 or SSA-3820 is not in file, see DI 28035.020A.1.b.

a. SSA-3368 (or SSA-3820) is in folder

If the SSA-3368 (or 3820) is in the folder:

  • contact all medical and other relevant sources from prior to the established CPD date;

  • determine if the reconstructed records adequately allow for consideration of the Medical Improvement Review Standard (MIRS);

If the reconstructed records adequately allow for consideration of the MIRS:

  • prepare a determination; and

  • enter list code 256 (Lost Folder Case) in item 34 of the SSA-832/833(Continuance or Cessation of Disability or Blindness Determination and Transmittal- Title XVI/Continuance or Cessation of Disability or Blindness Determination and Transmittal – Title II)

A favorable determination becomes the CPD date for the next CDR.

NOTE: In some cases, particularly in mental impairment cases where a longitudinal history could be helpful, you may secure additional medical evidence from before or after the CPD date.

b. SSA-3368 (or SSA3820) is not in folder

If the SSA-3368 is not in the folder, prepare an assistance request (AR) to the FO asking them to obtain an SSA-3368 (or SSA-3820). The AR must contain:

  • the CPD date;

  • instructions on the development needed;

  • instructions on the forms needed;

  • the applicable time period(s)

You should allow the FO 30 days to obtain the information requested.

NOTE: For instructions on preparing an AR in an eCDR case, see DI 81020.100.

2. CPD date is unknown

If the beneficiary is not currently disabled and the CPD date is not established:

  • document the file on an SSA-5002 (Report of Contact) explaining why the CPD date is not established; and

  • prepare a continuance according to the instructions in DI 28035.025.

C. MIRS and reconstructed evidence

In order for you to apply the MIRS to reconstructed evidence, there should be adequate evidence from the time of the CPD so that the basis for the CPD is clear.

1. Medical records can be adequately reconstructed

If you receive adequate evidence to reconstruct the medical records:

  • prepare a determination under the MIRS (for adult cases, see DI 28005.005 and for title XVI child cases, see DI 28005.025);

  • enter list code 256 (Lost Folder Case) in item 34 of the SSA-832/833-U3 (Continuance or Cessation of Disability or Blindness Determination and Transmittal – Title XVI/Continuance or Cessation of Disability or Blindness Determination and Transmittal – Title II)

A favorable determination becomes the CPD date for the next CDR.

2. Medical evidence cannot be adequately reconstructed

If you do not receive adequate evidence to reconstruct the folder and apply the MIRS, follow the instructions in DI 28035.025.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428035020
DI 28035.020 - Disability Determination Services (DDS) Reconstruction of Prior Folder - 10/03/2012
Batch run: 10/03/2012
Rev:10/03/2012