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DI 24503: Evaluating Evidence

Effective Dates: 01/25/2018 - Present

TN 2 (01-18)

A. Background for evaluating evidence

1. Significance of the filing date for evaluating evidence

For disability or blindness claims, some rules we use to evaluate medical and nonmedical evidence will depend on a claim’s filing date. Adjudicators at all adjudicative levels must identify whether the filing date of the claim is before March 27, 2017, or whether the filing date of the claim is on or after March 27, 2017.

For more information about how the Field Office (FO) determines the filing date of a claim, see GN 00204.007.

2. Specific evidence rules in which the filing date of a claim is relevant

The filing date of a claim is relevant for the following evidence rules:

  • The medical sources who are acceptable medical sources (AMS) only for claims filed on or after March 27, 2017. See DI 22505.003;

  • The definition of these categories of evidence: medical opinions, opinions, and other medical evidence. See DI 24503.005;

  • The rules for considering medical opinions and prior administrative medical findings. See DI 24503.025 and DI 24503.035;

  • The articulation requirements for medical opinions and prior administrative medical findings. See DI 24503.030 and DI 24503.035;

  • The articulation requirements for statements on issues reserved to the Commissioner. See DI 24503.040; and

  • The articulation requirements for decisions from other governmental agencies and nongovernmental entities. See DI 24503.045.

3. Medical Evidence regulation indicator

The purposes of the Medical Evidence regulation indicator (MedEv) in the eView and the electronic claims analysis tool (eCAT) headers are to:

  • Help adjudicators understand which set of rules to use; and

  • Direct systems at the Office of Hearings Operations (OHO) to produce correct notice language and display correct decisional screens that correspond to the filing date.

This indicator is set when the FO transfers the claim to the Disability Determination Services (DDS) and will appear in the eView and eCAT headers for all claim types.

  • For claims filed before March 27, 2017, the indicator should say “MedEv: Prior Rules.”

  • For claims filed on or after March 27, 2017, the indicator should say “MedEv: Current Rules.”

B. How to determine the filing date of a claim

1. Electronic claim using eView and eCAT

Generally, the earliest filing date displayed in the eView Medical Evidence indicator and in eCAT is the correct filing date to use to determine which set of rules to use to evaluate evidence in a claim. Therefore, in most claims, the eView indicator will display the correct filing date information to use to determine which rules apply when evaluating evidence.

However, the indicator may display incorrect filing date information when:

  • The claimant submits an application for a second claim after the FO transfers the first claim to the DDS, or

  • We previously made a determination or decision on a claim filed by the claimant.

Follow the guidance in subsection DI 24503.050D in this section to determine which set of rules to follow.

NOTE: DDS adjudicators should check to see if the FO added a new claim after transfer of the first claim to the DDS. This information may be in the Update-After-Transfer Utility, Certified Electronic Folder Alerts, or a SSA-5002 (Report of Contact). For more information, see “Certified Electronic Folder (CEF) Alerts” in DI 81020.080.

2. Paper claim

Follow the guidance in the filing date scenarios in subsection DI 24503.050D in this section to determine which set of rules to follow.

NOTE: Look at the available SSA-831s to determine if there are prior filings.

C. Adjudicator responsibilities related to the filing date of a claim

1. Policy responsibility

An adjudicator must use the correct set of rules related to the filing date of a claim to evaluate evidence before issuing a determination or decision.

  • Adjudicate claim(s) with a filing date prior to March 27, 2017, using the “prior rules.”

  • Adjudicate claim(s) with a filing date on or after March 27, 2017, using the “current rules.”

Follow the guidance in subsection DI 24503.050D in this section to determine which set of rules to follow.

2. Procedural responsibility for electronic claims

An adjudicator must ensure that the eView “MedEv” indicator shown displays the correct value based on the filing date of the claim before issuing the determination or decision.

If an adjudicator believes that the indicator’s value may be incorrect, contact the FO to resolve any issues, as appropriate.

If the indicator displays an incorrect value, the adjudicator must manually correct the indicator’s value in eView by clicking on the eView “MedEv” indicator hyperlink to change the value displayed. It is not possible to correct the “MedEv” indicator value shown in eCAT.

D. Filing date scenarios

The following instructions present the possible filing date scenarios with the corresponding rules that adjudicators must follow.

NOTE: We refer to the rules in place before March 27, 2017, as the “prior rules.” We refer to the rules in place on or after March 27, 2017, as the “current rules.”

1. Single claim

For the situations in DI 24503.050A.2, if the filing date of the claim is:

  • Before March 27, 2017, use the prior rules; or

  • On or after March 27, 2017, use the current rules.

2. Multiple claims

a. Concurrently-filed claims or when one claim is open when another new claim is filed

Except as stated in DI 24503.050D.2.b. in this section, use the earliest possible filing date of the claims to determine which set of rules to follow.

If the earliest filing date of the claims is:

  • Before March 27, 2017, use the prior rules; or

  • On or after March 27, 2017, use the current rules.

NOTE: If the first claim has been appealed when the second claim is filed, consolidate and escalate the second claim to the same level of appeal. For more information, see DI 12045.010.

b. When one claim is closed before another new claim is filed

If the earliest filing date of a new claim is after the earlier claim is closed and becomes final (i.e., the appeal period of the earlier claim(s) has ended), do not relate the claims. Use the filing date of the later claim.

REMINDER: Evidence from the new claim might constitute new and material evidence to justify reopening the earlier closed claim. See the instructions for reopening claims in DI 24503.050D.3. in this section.

REMINDER: Collateral estoppel may apply. For more information, see DI 24503.050D.4.

c. Example A: Title II claim is closed before a Title XVI claim is filed

Use the filing date of the Title II claim for the Title XVI claim if the Title XVI claim’s earliest filing date is within 60 days after the Title II claim is decided or if the Title II claim is pending appeal. In contrast, use the filing date of the Title XVI claim if its earliest filing date is 61 days or more after a Title II claim is decided, there is no appeal filed on the Title II claim, and collateral estoppel does not apply.

d. Example B: A claim under one social security number (SSN) is closed before a new claim(s) is filed under a different SSN

Although claims filed by the same individual under different SSNs can relate to each other, a new claim(s) involving a different SSN filed by the same individual will not relate to the earlier claim(s) if the earlier claim(s) is closed and collateral estoppel does not apply. This scenario can occur if an individual who is receiving childhood disability benefits (CDB) or disabled widow benefits (DWB) then files for disability or blindness benefits on his or her own earnings record. Decide the new claim(s) using the rules that apply to its filing date, not that of the claims in pay status. Ensure that the Medical Evidence indicator shows the correct filing date value for the new claim(s).

3. Reopening

If you reopen a claim, use the original filing date of the earlier claim as the filing date for the reopened claim.

Do not reopen a claim if all of the following apply:

  • The claim uses the “prior rules,” and

  • New and material evidence is the reason that justifies reopening of the claim, and

  • The new and material evidence is objective medical evidence from a medical source who is an acceptable medical source only for claims filed on or after March 27, 2017, and

  • That objective medical evidence would be used to establish the existence of an impairment at step 2 of the sequential evaluation process.

NOTE: The “current rules” do not constitute a change of position or a change of criteria to justify reopening a claim. However, you may set an onset in the prior adjudicated period for the new claim without reopening the prior determination or decision. The filing date of the new claim would determine the month payments could begin.

For more information about reopening, see:

  • DI 27501.005 Reopening and Revising a Determination or Decision

  • DI 27505.001 Conditions for Reopening a Final Determination or Decision

4. Collateral estoppel

If a claimant files a claim that meets the criteria for adoption of a prior medical determination or decision that has already been decided (i.e., collateral estoppel), use the filing date rules in effect for the earlier determination or decision. To determine the filing date for the earlier claim, see the Form SSA-831-U3, Items 3 and 34, (Disability Determination and Transmittal).

See:

5. Res judicata

If a claimant submits a Title II claim on or after March 27, 2017, for the same period as a previous Title II claim filed prior to March 27, 2017, and there is no new and material evidence, res judicata applies. The medical evidence rules changes are not considered less restrictive and therefore do not affect the ability to apply res judicata. For more information, see Disability Determination Services (DDS) Medical Evaluation Criteria to Determine Applicability of Res Judicata in DI 27516.010.

6. Claims under the Office of Quality Review (OQR) jurisdiction

The OQR will return a claim(s) under its jurisdiction to the adjudicative component with cited deficiencies and corrective action when the claimant files a subsequent claim with a protective filing date that changes the set of evidence rules that the adjudicative component should use for the claim(s).

The OQR will return the claim(s) to the adjudicative component to allow the adjudicative component to adjudicate the earlier claim(s) under the appropriate rules. For more information, see Adjudicating Component Actions on Deficient Cases in subchapter DI 30005.000.

7. Continuing disability review (CDR)

Use the current rules in all CDRs except for the situation listed below.

EXCEPTION: Use the prior rules at CDR only if all the following apply:

  • This is the first CDR for the claim(s) after March 27, 2017, and

  • There is no medical improvement related to the ability to work, and

  • All full medical determination(s) made in the claim(s) under review were made using the prior rules.

NOTE: This first CDR will establish a new CPD after March 27, 2017. Decide the subsequent CDR(s) using the current rules.

REMINDER: When a claim was initially allowed because the claimant’s impairment met a listing, and the listing is now obsolete, if you get to step 4 of the CDR sequential evaluation process, you will need to evaluate the claim under the obsolete listing. See DI 28005.015.

NOTE: The “MedEV” indicator in some CDRs will erroneously display “Prior Rules” when in fact the current rules apply. Be aware of this possibility and remember to change the indicator value when appropriate.

For more information, see The CDR Evaluation Process in subchapter DI 28005.000.

8. Age 18 redetermination

When determining which set of evidence rules to follow, we consider an age 18 redetermination to be a new claim (not a CDR) filed on the day a person attains age 18. Therefore, if the individual’s date of birth is before March 28, 1999, use the prior rules for the age 18 redetermination. If the individual’s date of birth is on or after March 28, 1999, use the current rules for the age 18 redetermination.

For more information, see DI 23570.000.

9. Expedited reinstatement (EXR)

When determining which set of evidence rules to follow, we consider a request for EXR to be a new claim filed on the day we receive the request. Therefore, if we receive the request for EXR on or after March 27, 2017, use the current rules.

For more information, see DI 13050.000.

E. References

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DI 24501: General - Medical Evaluation
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DI 245: Medical Evaluation
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