BASIC (01-12)

This section addresses the summary decision rationale for reopenings. A summary decision rationale may still be prepared when required by Disability Determination Services (DDS) management (e.g., training purposes). Use an SSA-4268 Explanation of Determination to prepare the reopening rationale. For simplified rationale instructions, see DI 27536.001.

A. Rationale elements

For a detailed discussion of the elements, see Rationale Preparation Policy DI 26515.001.

B. Incorporating evidence

Incorporate the sources of evidence used in the prior determination by using the following introductory paragraph “The statement of evidence in the prior determination of (MM/DD/YYYY), except as modified herein, is hereby incorporated by reference, but not the inferences, the findings, or the conclusions based thereon.”

C. Rationale format

Following the incorporation paragraph, proceed according to the format below.

1. Cite any new or additional medical evidence.

2. Describe the claimant's allegations and discovered impairments.

3. Discuss the technical issues involved in the case. Include the statement “This determination reopens and revises the previous determination(s) dated (MM/DD/YYYY).”

4. Specify all reopened determinations.

5. State the conditions for reopening the prior determination (e.g., new and material evidence, error on the face of the evidence).

6. State why the prior determination was incorrect.

7. Discuss the findings (e.g., medical, vocational) produced by the sequential evaluation process.

8. Explain each finding pertinent to the case. If new and material evidence is the basis for reopening, discuss how the evidence is material to the period covered by the prior determination.

9. Explain how the evidence revises the findings covered by the prior determination.

10. Explain the basis for the revised disability determination.

11. Include the following statements as applicable:

    • Fully favorable determination – “Disability is therefore established as of (MM/DD/YYYY) and continues to date”

    • Partially favorable determination (i.e., closed period) – “Disability is therefore established as of (MM/DD/YYYY) and continued through (MM/DD/YYYY)”