TN 3 (11-21)

DI 28035.025 Disability Determination Services (DDS) Reconstruction of Prior Folder Not Possible

A. Background

The DDS ensures that current documentation is complete and, in the absence of current substantial gainful activity (SGA) or Group II medical improvement exceptions, prepares a determination to continue disability if:

  • Disability is not continued based on current medical or medical-vocational evidence; and

  • Reconstruction of the prior medical records as described in DI 28035.020 is not possible.

REMINDER: The adjudicator will ensure a completed SSA-538-F6 (Childhood Disability Evaluation Form) is in file in all Title XVI child cases.

B. Documentation for not reconstructing prior folder

When the DDS determines not to reconstruct a prior lost or destroyed paper comparison point decision (CPD) folder, the DDS must document the reason on Form SSA-5002 or similar document. See Report of Contact Form SSA-5002 below.

Lost Folder Reconstruction Documentation

C. Title XVI and extended period of eligibility (EPE)

In Title XVI and EPE impairment severity determinations, the adjudicator will prepare a continuance of disability determination if there are no Group II medical improvement exceptions. The performance of SGA is not a basis for an unfavorable Title XVI continuing disability review (CDR) determination. For additional information on medical improvement exceptions, see DI 28005.015, DI 28005.020, and DI 28020.900.

D. Complete the SSA-832/833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI/Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title II)

The adjudicator completes Forms SSA-832/833 according to instructions in DI 28084 including:

  • In item 12, enter reason for continuance code 37 (Disability Continues - Data From Most Recent Prior Favorable Determination Insufficient to Determine Medical Improvement) for Title II (DI 28084.020); and for Title XVI enter reason for continuance code 77 (Disability Continues - Data From Most Recent Prior Favorable Determination Insufficient to Determine Medical Improvement); and

  • In item 34, enter list code 256 (Lost Folder Case) for the SSA-832/833 for both cessations and continuances.

E. Schedule a medical reexamination diary

The adjudicator schedules the medical reexamination diary based on the type of impairment(s) involved and whether changes in the impairment could result in a cessation when the MIRS is applied in future CDRs.

F. Title XVI conversion cases

The adjudicator must carefully evaluate Title XVI conversion cases, as there may be two CPD folders. If evidence from one CPD (e.g., the State CPD) is not available and a continuance is processed under other rules, (e.g., under the Federal criteria), include a determination of continuance under these provisions (e.g., insufficient evidence to assess medical improvement under the State criteria).

The adjudicator will process the current continuance under both Federal and State criteria, and use the current CDR as the CPD for both Federal and State parts in future reviews. Medical improvement regulations provide that current documentation must provide the basis for any future reviews. For additional information on conversion cases, see DI 28010.105B.4.

G. References

  • DI 28005.015 Step-by-Step Discussion of the Adult Continuing Disability Review (CDR) Evaluation Process

  • DI 28005.020 The CDR Evaluation Process --Title XVI Child - General

  • DI 28020.001 General - Groups I and II of Exceptions to Medical Improvement (MI)

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

  • DI 28084.020 Reason for Continuance Codes (Item 12)

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428035025
DI 28035.025 - Disability Determination Services (DDS) Reconstruction of Prior Folder Not Possible - 01/12/2016
Batch run: 11/17/2021
Rev:01/12/2016