DI 44001.140 Continuing Disability Reviews (CDR) for Railroad (RR) Cases

The Social Security Act Section 221(i)(1) requires SSA to perform a periodic review to determine if an individual’s disability continues after entitlement is established. To carry out this requirement, SSA conducts a CDR at selected time intervals.

CDRs of career RR workers or dependent RR survivor disability annuitants are excluded from disability determination services (DDS) processing. These CDRs will be the jurisdiction of Great Lakes Program Service Center-Disability Processing Branch (GLPSC-DPB).

Field offices (FOs) will transfer any CDRs for career RR and dependent RR survivor disability annuitants to the GLPSC-DPB, location V32, for processing following their initial screening and development to initiate the CDR.

A. Initial level CDR

The GLPSC-DPB disability processing specialist (DPS) follow the same basic criteria, development, and evaluation guidelines provided for the DDS unless specifically instructed otherwise for RR claims. For DDS guidelines for determining if disability continues see DI 28005.001.

The DPS develop and process CDRs following the guidelines established in the MIDAS legacy system. The DPS adds a remark in Item 24 of the SSA-832/SSA-833 as follows: either “Career RR Case” or “Dependent RR Survivor Disability Annuitant.”

Once the medical consultant /psychological consultant and the DPS have approved the CDR determination, the DPS coordinates the determination with the Railroad Retirement Board (RRB) per DI 44001.125.

B. Reconsideration level CDR

The GLPSC-DPB also adjudicates requests for reconsideration of CDR cessations (SSA-789 (Requests for Reconsideration – Disability Cessation)) filed by career RR/dependent RR survivor disability annuitants, following the same basic guidelines as the DDS. For a complete description of the provisions and the guidelines for case development and evaluation see DI 29005.020. GLPSC-DPB coordinates all reconsideration determinations with the RRB per DI 44001.125.

1. Fully favorable determination warranted

If the GLPSC-DPB finds that a fully favorable determination is warranted, process the reconsideration determination with the usual procedures in reconsideration case processing. The DPB prepares and releases the forms SSA-833/SSA-832, notice of determination, and other applicable forms for effectuation, following the guidelines established in the MIDAS legacy system.

2. Fully favorable determination not warranted

If GLPSC-DPB cannot issue a fully favorable determination on reconsideration of a medical cessation or an adverse reopening, the Federal Disability Hearing Unit (DHU) must conduct a disability hearing. For additional information about the right to a disability hearing at the reconsideration level, refer to DI 29001.001.

a. Preparing case for Federal DHU

The DPB prepares a case for the disability hearing following the same basic guidelines provided for the DDS in DI 29025.001, unless specifically instructed otherwise for RR cases. Also, see “Processing a Reconsideration Appeal of an Electronic Continuing Disability (eCDR) Cessation” DI 81020.255.

b. Routing case to Federal DHU

Refer to DI 33025.010 for routing instructions.

3. Processing cases received from Federal DHU

Upon completion of the disability hearing, the disability hearing officer (DHO):

•

Completes the SSA-833-C3/U3 or SSA-832-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal),
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Prepares and releases the Notice of Disability Hearing Decision, and
•

Dispatches the folder to the GLPSC-DPB under cover of an SSA-408 (Route Slip) annotated with appropriate identifying remarks.

NOTE:

DHO decisions are excluded from any pre-effectuation review or reversal by the GLPSC-DPB. The DHO's decision is subject only to a quality review by the Office of Medical and Vocational Expertise’s Federal DDS and a subsequent review by the quality review branch (QRB) of Office of Disability Hearings (ODH). However, if DPB detects an error, or if additional evidence is received that may affect the determination, DPB prepares a memorandum citing the problem and forward the case to the QRB of ODH for resolution. Regarding the expiration of specific time limits provided in the Act and or regulations for reopening and revising the DHO's determination refer to DI 27505.000.

a. Cessation reversed to a continuance by DHO

The DHO return reversal cases to GLPSC-DPB for coordination with the RRB and processing. GLPSC process the continuance, take all necessary actions to reinstate benefits, continue to adjust benefits as applicable, and notify the beneficiary of any adjustment actions in accordance with existing procedures.

b. Cessation affirmed by DHO

The DHO return these cases to GLPSC-DPB for coordination with the RRB and processing. GLPSC process the determination and prepare all of the necessary input forms taking into consideration the current payment status, overpayments, auxiliaries, and additional beneficiary notices. After processing all actions, GLPSC dispatches the claims folder to the servicing FO for retention during the appeals period.

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DI 44001.140 - Continuing Disability Reviews (CDR) for Railroad (RR) Cases - 03/23/2010
Batch run: 01/15/2019
Rev:03/23/2010

Program Operations Manual System (POMS)