DI 11005: Disability Interviews
TN 52 (06-18)
A. Claims development
To ensure expeditious handling of Veterans Affairs 100 Percent Permanent and Total (VAPT) cases, complete the claimant’s disability application as thoroughly as possible to avoid unnecessary recontact.
The claimant’s residence address, not their mailing address determines the Disability Determination Services’ (DDS) jurisdiction.
For determining residence address, see DI 11010.255.
1. Modernized Claims System/Modernized Supplemental Security Income Claims System (MCS/MSSICS)
Enter all claims using MCS or MSSICS, or both.
Take full (not deferred) Title XVI applications.
2. Electronic Disability Collection System (EDCS)
Follow the normal interviewing guidelines in DI 11005.000, which includes recording the information into EDCS.
For instructions on establishing a claim in EDCS and EDCS exclusions, see DI 81010.020.
3. Curtailing completion of the disability report
If you have any doubt as to whether the claim will result in an allowance, it is in the claimant’s best interest to complete an entire SSA-3368-BK (Disability Report – Adult). This action may help to avoid unnecessary recontact.
If the claimant’s impairment(s) does not meet a presumptive disability category but seems particularly severe, and curtailing completion of the disability report might be appropriate, refer to:
DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms
DI 81010.020F. Curtailing completion of the EDCS 3368 or EDCS 3820
The appropriate Regional Center for Disability Programs for guidance on curtailment, if necessary.
4. Verification (proof) of VAPT
We receive the VAPT rating status directly from the VA; therefore, the claimant has no additional burden to provide proof to expedite the claim. The data exchange with the VA is sufficient to verify VAPT.
In rare situations, a veteran may self-identify as having a VAPT rating, but there is no system alert. For these cases, the veteran must provide proof of a VAPT rating. Acceptable proof of a veteran’s rating is normally a VA notification letter to the veteran. For cases without the VA100% P&T systems alert, make a copy of the VA Notification Letter and retain a copy in file. Do not expedite a case without verification or proof of the VAPT rating.
B. Additional VAPT considerations
1. Disability insurance benefit (DIB) offset
Military disability benefits do not offset DIB if all military service is after December 31, 1956. For more information on military disability benefits, see DI 52130.015.
2. Closed period of disability
Be alert to the possibility of a closed period of disability. Based on the evidence, a disability adjudicator may find that the claimant disabled for a continuous period of at least 12 months, but at the time of adjudication, the claimant is no longer disabled. In order to establish a closed period, the evidence must show a period of disability that has a definite beginning and ending date. In this situation, if he or she meets all other requirements, the claimant may be entitled to a closed period of disability.
For additional information on closed period of disability, see DI 25510.010 and DI 25510.015.
Evaluating a closed period of disability always requires careful consideration of the medical improvement review standard. Additionally, adjudicators cannot establish a closed period of disability based on a finding of substantial gainful activity (SGA) alone, as the claimant may be entitled to work incentives. For return to work issues, see DI 13010.110.
3. Potential onset date (POD)
When appropriate, develop for an earlier POD. The POD may be the same, earlier or later than the alleged onset date (AOD). When evaluating a claimant’s work, make sure to consider work incentives (e.g., impairment-related work expenses (IRWE), subsidies, special conditions) when determining the reasonable worth of the work. When the POD is earlier than the AOD, develop and document any work issues after the AOD, or after the POD, using form SSA-821-BK (Work Activity Report – Employee), or the SSA-820-BK (Work Activity Report – Self-Employment).
Complete the SSA-823 (Report of SGA Determination-For SSA Use Only) in all initial claim determinations that require an SSA-820-BK or SSA-821-BK.
DI 10505.035 Documenting Employment Cases Using FORMS SSA-821-BK (Work Activity Report-Employee) and SSA-823 (Report of SGA Determination-For SSA Use Only),
DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only),
DI 10005.005 Field Office (FO) Disability Development, and
DI 11005.045 Completing the 3367 (Disability Report-Field Office).
C. Claim documentation
1. Development worksheet (DW01) screen in MCS/MSSICS
Establish a UNIT code of “___P&T” on the DW01 screen for claimants who meet the VAPT definition in DI 11005.007.
Use the first three characters of the unit code per local instructions (e.g., unit number, initials).
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Establish an ISSUE of “VAPT Case” to track the case, following the instructions about tracking TERI cases in DI 11005.601D.3.d.
Although VAPTs are expedited following the same procedures as terminal illness (TERI) cases, do not use the TERI flag unless the claim meets the TERI guidelines in DI 11005.601 The Disability Interview-- Identifying Terminal Illness (TERI) Cases; i.e., there is evidence that the claimant’s condition is terminal.
2. VAPT flag
a. Certified electronic folder
If the VAPT flag does not automatically propagate to the claim in EDCS, follow instructions in DI 81010.080B to create a “Disabled Veteran rated 100% permanent and total” flag in EDCS. The flag will alert the DDS to expedite processing of the claim.
b. Paper modular disability folder (i.e., EDCS exclusion)
Attach a VAPT flag to the front of the folder before sending to the DDS. (See an exhibit of the VAPT flag in DI 11005.012H. in this section.)
D. Sending a VAPT to the DDS and tracking status
For information on determining the DDS with jurisdiction of the claim, see DI 11010.255.
1. Sending a VAPT claim to the DDS
When sending a VAPT claim to the DDS, take the following steps:
a. EDCS claims:
Annotate the EDCS remarks section with the words “VAPT Case.” For instructions on transferring an EDCS case, see DI 81010.085.
b. EDCS exclusions:
Send the paper case in a priority mail envelope with a “VAPT Case” designation on the outside of the envelope. For a listing of EDCS exclusions and limitations, see DI 81010.030.
2. Verifying DDS receipt and tracking status of the claim
Obtain a DDS Query (DDSQ) two days after the claim transfer to verify DDS received the claim. For paper cases, obtain a DDSQ seven days after the claim transfer. If the claim is not on the DDSQ, contact the DDS by telephone or fax to verify receipt.
Use the guidelines and procedures for tracking TERI cases in DI 11005.601D.3.d.
E. DDS makes a determination
For favorable DDS determinations, expedite payment action for Title II and Title XVI claims. If a Title II allowance is an earnings computation processing exclusion, take the following actions:
Complete an A101/EF101 and route to the appropriate processing center (PC).
Annotate the A101/EF101 in remarks indicating that it is a VAPT case.
Monitor the claim(s) through all stages of development and adjudication.
NOTE: PCs follow the special handling procedures for TERI cases. For identifying TERI cases, see DI 11005.601E. The PC Inquiry and Expediting staff is responsible for payment processing.
F. VAPT appeals process
All VAPT appeals receive priority handling and should be coded as instructed in DI 11005.012C.1 through DI 11005.012C.2 in this section.
1. EDCS claims process
a. Reconsideration request process
Process the request using the same instructions for initial claims.
b. Hearing request process
Follow these steps for processing hearing requests:
Send the request directly to the Office of Hearings Operations (OHO) as indicated in DI 81010.085 .
If there is no VAPT flag attached to the case in EDCS, attach the flag to alert OHO to expedite appeal processing (See DI 11005.012C.2.a. in this section).
c. Request for Appeals Council (AC) review process
To process requests for AC review:
Send the request directly to the AC as indicated in DI 81010.150 and DI 12020.001.
If the VAPT flag did not automatically propagate to the case in EDCS, attach the flag to alert the AC to expedite review (for information on VAPT flagging, see DI 11005.012C.2 in this section).
2. EDCS exclusions process
Complete and add the VAPT flag to the front cover of the claims paper folder. (See an exhibit of the flag in DI 11005.012.H. in this section.)
Reconsideration request process: Refer to DI 12005.005 and DI 12005.010 .
Hearing request process: Follow assembly and routing instructions in DI 12010.010 .
Request for Appeals Council (AC) review: Follow instructions in DI 12020.001 .
G. Exhibit of VAPT flag
To flag VAPT cases, use the following printable flag.
H. References
DI 10005.005 Field Office (FO) Disability Development
DI 10505.001 Evaluation and Development of Employment
DI 10505.020 Evaluation Guides
DI 10505.023 Military Service
DI 10505.035 Documenting Employment Cases Using Forms SSA-821-BK (Work Activity Report-Employee) and SSA-823 (Report of SGA Determination-For SSA Use Only)
DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only)
DI 11005.000 Disability Interviews
DI 11005.003 Field Office (FO) Instructions for Identifying Claims, Applicable Terms, and Scheduling Appointments for Military Casualty (MC)/Wounded Warrior (WW) Cases
DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms
DI 11005.045 Completing the SSA-3367 (Disability Report-Field Office)
DI 11005.601 The Disability Interview – Identifying Terminal Illness (TERI) Cases
DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determinations Services (DDS)
DI 12005.005 Processing a Reconsideration Request for a Medically Denied Initial Disability Claim
DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial
DI 12020.001 Appeals Council (AC) Review
DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing
DI 13010.110 Return to Work Within A Year Of Onset (Title XVI)
DI 25510.010 Establishing a Closed Period of Disability and Protecting a Closed Period Freeze Under Title II
DI 25510.015 Closed Period of Disability Under Title XVI
DI 52130.015 Military Disability Benefits
DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases
DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations
DI 81010.080 Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS)
DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS)
DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)
GN 00301.310 The Non Disability Repository for Evidentiary Document (NDRed) Application—Overview
GN 01040.100 Listing Codes
MSOM EVID 001.002 Shared Processes Menu (SPMN)
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