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DI 28501.010: Processing Continuing Disability Review (CDR) Reopenings under Administrative Finality

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  • Effective Dates: 09/24/2013 - Present
  • Effective Dates: 12/12/2017 - Present
  • BASIC (03-86)
  • TN 1 (12-17)
  • DI 28501.010 Processing Charts: CDR Reopenings Under Administrative Finality (Revision of Prior Cessation)
  • DI 28501.010 Processing Continuing Disability Review (CDR) Reopenings under Administrative Finality
  • A. Title II only/concurrent reopening and revision cases
  • A. Reopening final determinations
  • The Disability Determination Services (DDS) may only reopen final determinations. A determination is “final” as of the date of the determination notice. For more information about reopening and revising a determination, see DI 27501.001.
  • NOTE: If the DDS did not send a determination notice, prepare a revised determination following the usual CDR determination procedures.
  • B. Processing an electronic CDR reopening
  • 1. Reopening an electronic CDR
  • To process a CDR reopening with a certified electronic folder (CEF) the DDS must:
  • * Make appropriate changes to the case (for example, correct an onset date, ending date, or basis code),
  • * Enter: “This reopens and revises determination of (mm/dd/yy).” on Item 24 of the revised Form SSA-832, (Cessation of Disability or Blindness Determination and Transmittal – Title XVI) or Form SSA-833, (Cessation of Disability or Blindness Determination and Transmittal – Title II),
  • * Enter: “See revised determination of (mm/dd/yy).” in Item 24 of the prior SSA-832 or SSA-833,
  • * Upload the revised SSA-832 or SSA-833, to Section A – Payment Documents/Determinations (Yellow Front) of the CEF,
  • * Add “Do Not Process” next to the prior SSA-832 or SSA-833, in Yellow Front section of the CEF,
  • * Prepare any necessary rationales. The rationale should include:
  • * an explanation of the basis for the revision,
  • * information about any scheduled medical re-examination diaries,
  • * an explanation of periodic review, and
  • * any other information significant to the case.
  • * Prepare and release appropriate notice, if applicable, based on guidance given in DI 28501.010C or DI 28501.010D in this section.
  • NOTE: The DDS does not prepare notices for fully favorable revisions.
  • Add “Do Not Process” next to any incorrect notices.
  • Once the reopening is complete, the system automatically completes several actions including annotating prior claims with “reopened” in the Claims Action History Page and displaying a message on a prior folder that has been reopened along with any intervening claim(s) that has been reopened, “Decision(s) in this folder have been reopened. For more information about processing electronic reopenings, see DI 81020.115.
  • 2. Routing instructions
  • Consider several different factors when choosing the routing location for an electronic CDR reopening, including the following:
  • * type of case,
  • * type of action needed, and
  • * whether the determination is favorable or unfavorable.
  • For more information on how to route an electronic CDR reopening, see DI 28501.030B.
  • C. Processing Title II only reopening and revision cases with a paper modular disability folder (MDF)
  • Process the Title II paper MDF cases based on the revised determination.
  • 1. Fully favorable revision
  • a. Notice released on original determination
  • a. Preparing Form SSA-833
  • Prepare revised SSA-833-U5 with appropriate rationale
  • On the revised SSA-833: Item 24: “This reopens and revises the prior cessation determination of (mm/dd/yy).”
  • Item 29: ODO/DL
  • On the prior SSA-833: Item 24: “See revised determination of (mm/dd/yy).”
  • Item 24: This revises the previous determination of (date).
  • b. Rationale preparation
  • In current cases add disclaimer paragraph “842.”
  • The reopening rationale must:
  • * state the conditions for reopening the prior determination(s) (for example, new and material evidence or error on the face of the evidence),
  • * explain why the prior determination is incorrect,
  • * discuss the finding pertinent to the reopening determination (for example, medical or vocational), and
  • * if new and material evidence is the basis for reopening, discuss how the evidence is material to the prior period. Also, discuss how the evidence changes the findings covered by the prior determination.
  • b. Notice not released on original determination
  • For more information about reopening rationale preparation, see DI 27536.001.
  • Prepare corrected SSA-833-U5 with appropriate rationale
  • c. Determination notice preparation
  • Item 29: DDS/DL
  • The DDS does not prepare notices for fully favorable revisions.
  • Item 24: This revises the previous determination of (date).
  • d. Routing instructions
  • Prepare notices in accordance with current applicable instructions.
  • Route the folder to the:
  • * Office of Disability Operation (ODO) for appropriate notice preparation if the individual is age 54 and under, or
  • * Program Service Center (PSC) processing center (PC) 1 through 6 for appropriate notice preparation if the individual is older than age 54 or deceased.
  • 2. Less favorable revision
  • For more information on the PC SSN jurisdiction, see GN 01070.245.
  • Notice instructions will be provided in a later transmittal.
  • 2. Less than fully favorable revision
  • 3. Revision to later cessation
  • A less than fully favorable revision does not include a change from “blind” to “disabled.” For more information on how to reopen basis change only case, see DI 28501.010B.4.
  • A less favorable reopening of a cessation may include:
  • * a cessation to an earlier cessation date;
  • * an allowance to a denial;
  • * an allowance to a closed period; and
  • * a previously established on set to a later onset of disability.
  • If the reopening changes an allowance to a denial, an allowance to a closed period, or establishes a later onset, follow instructions in subchapter DI 27500.000. These reopenings would use the SSA-831. Such reopenings are rare because of the time limits for reopening. When a favorable determination is precluded from reopening because the period for reopening has expired, process in accordance with CDR procedures. For more information on conditions for reopening a final determination or decision, see DI 27505.001.
  • a. Preparing Form SSA-833
  • On the revised SSA-833:
  • * Item 24: “This reopens and revises the previous determination of (mm/dd/yy).”
  • * Item 29: DDS/DL (Completion of Item 29 is optional if DDS prepares and releases notices.)
  • On the prior SSA-833: Item 24: “See revised determination of (mm/dd/yy).”
  • b. Determination notice preparation
  • (Notice released on original determination.)
  • Prepare an appropriate determination notice using DI 27540.010B.2. Attach a rationale as described in DI 28501.010C.1.b. in this section and include a personalized disability explanation as described in DI 26530.055 and DI 28095.040.
  • Notice instructions will be provided in a later transmittal
  • For more information on numbered paragraphs, see NL 00708.100.
  • SSA-833-U5 Completion
  • c. Routing instructions
  • Prepare revised SSA-833-U5
  • * Item 29: Enter: DDS/DL
  • Route the folder to the field office (FO) for the appeals period. Attach an SSA-408 (Route Slip) with the remark “CDR Adverse Reopening.” For more information about routing Title II only less than favorable decisions, see DI 28501.030C.
  • Item 24: Enter: This revises the previous determination of (date)
  • 3. Revision to later cessation date
  • a. Preparing Form SSA-833
  • If the DDS sent a due process notice:
  • On the revised SSA-833:
  • * Item 24: “This reopens and revises the previous determination of (mm/dd/yy).”
  • * Item 29: DDS/DL (Completion of Item 29 is optional if DDS prepares and releases notices.)
  • On the prior SSA-833: Item 24: “See revised determination of (mm/dd/yy).”
  • If the DDS did not send the due process notice:
  • Prepare a revised determination following usual CDR determination procedures; see DI 28084.055.
  • b. Determination notice preparation
  • Prepare a determination notice with language modified from NL 00705.201. Use lead-in paragraph 4170 instead of paragraph 4159. If the DDS previously sent a required predetermination due process notice because statutory benefit continuation (SBC) does not apply, do not use paragraph 4059. Attach a rationale as described in DI 28501.010C.1.b. in this section and include a personalized disability explanation as described in DI 26530.055 and DI 28095.040.
  • For more information on numbered paragraphs, see NL 00708.100.
  • c. Routing instructions
  • Route the folder to the FO for the appeals period. Attach an SSA-408 (Route Slip) with the remark “CDR Adverse Reopening.” For more information about routing Title II only less than favorable decisions, see DI 28501.030C.
  • 4. Basis change only
  • (Notice released on original determination.)
  • a. Preparing Form SSA-833
  • On the revised SSA-833:
  • * Item 24: “This reopens and revises the previous determination of (mm/dd/yy).”
  • * Item 29: DDS/DL (Completion of Item 29 is optional if DDS prepares and releases notices.)
  • On the prior SSA-833: Item 24: “See revised determination of (mm/dd/yy).”
  • b. Determination notice preparation
  • Verify that the DDS sent a due process notice.
  • Notice Preparation
  • NOTE: The DDS cannot process the claim before 15 days (10 days, plus 5 days for mailing time) expires unless you receive a written statement from the beneficiary stating that he or she will not be submitting additional evidence.
  • Prepare and release a notice affirming the original determination (e.g., see DI 27540.000 ff). In concurrent cases, add disclaimer paragraph “842.” Attach the personalized rationale.
  • If the DDS sent the due process notice:
  • SSA-833-U5 Preparation
  • Prepare a determination notice using language from NL 00705.261. Attach the personalized rationale as described in DI 28501.010C.1.b and include a personalized disability explanation as described in DI 26530.055 and DI 28095.040.
  • Prepare revised SSA-833-U5
  • * Item 29: Enter: DDS/DL
  • If the DDS did not send the due process notice:
  • Item 24: Enter: This revises the previous determination of (date).
  • Prepare a notice following the guidance in DI 27525.005B. The DDS cannot send the final determination notice until after the due process notice is sent.
  • Route to DO unless referring office requests return of folder.
  • For more information on numbered paragraphs, see NL 00708.100.
  • c. Routing instructions
  • Route the folder to the FO unless the referring office requests return of the folder.
  • 5. No change in basis or end result
  • a. Beneficiary aware of reopening status - notice released on original determination
  • * Document file with any additional evidence.
  • * Prepare and release SSA-L951 with language from DI 27540.010. In concurrent cases add disclaimer paragraph “842.”
  • a. Preparing Form SSA-832
  • If there is no change in the basis or end result, the DDS must document the file with any additional evidence received since the original determination. Do not revise the SSA-832.
  • b. Rationale preparation
  • Prepare personalized attachment explaining the basis of the revised determination.
  • * Route folder to referring office, or to appropriate office.
  • Do not prepare a rationale if there is no change in determination.
  • b. Beneficiary unaware of reopening status - notice released on original determination
  • * Document file regarding additional evidence
  • * No notice is required
  • * Route folder to referring or other appropriate office.
  • c. Determination notice preparation
  • SSA-833-U5 Preparation
  • If individual is unaware of the reopening:
  • Prepare revised SSA-833-U5
  • Do not send a determination notice.
  • Item 29: Enter: DDS/DL
  • If the individual is aware of the reopening:
  • Item 24: Enter: This revises the previous determination of   (date)   .
  • Prepare the determination notice using language from NL 00705.256. Attach a rationale as described in DI 28501.010C.1.b and include a personalized disability explanation as described in DI 26530.055 and DI 28095.040.
  • Route to DO unless referring office requests return of folder.
  • d. Routing instructions
  • B. Title XVI only/concurrent reopening and revision cases
  • Route the folder to the referring or other appropriate office.
  • D. Processing Title XVI only and reopening and revision cases with paper MDF
  • 1. Fully favorable revision
  • a. Notice released on original determination
  • a. Preparing Form SSA-832
  • If the DDS sent a determination notice on the original determination:
  • On the revised SSA-832:
  • * Item 24: “This reopens and revises the previous determination of (mm/dd/yy).”
  • * Item 29: DO/DL – if the DDS sent a determination notice on the original determination. (Completion of Item 29 is optional if DDS prepares and releases notices.)
  • On the prior SSA-832:
  • Item 24: “See revised determination of (mm/dd/yy).”
  • Prepare revised SSA-832-U5 with appropriate rationale
  • If the DDS did not send a determination notice on the original determination:
  • Item 29: DO/DL's
  • Prepare a revised determination following usual CDR determination procedures.
  • Item 24: This revises the previous determination of   (date)   .
  • b. Determination notice preparation
  • Prepare notice typing instructions, designated as such, on report of contact and place on top of the permanent file.
  • The DDS does not send a determination notice for fully favorable revisions.
  • The notice is prepared on Form SSA-L8100-U2
  • The FO must send a determination notice.
  • Lead-in paragraph: This determination is based on another review of your claim.
  • c. Routing instructions
  • Include appropriate information regarding the basis of the revision, scheduled medical re-examination diaries established, periodic review, trial work period service months completed, if applicable, etc. In concurrent cases, add disclaimer paragraph “841.”
  • Route the Title XVI only and concurrent folders to the FO.
  • Route to DO via SSA-408 with remark: Title XVI revision to continuance
  • For Title XVI only folders:
  • DO must prepare allowance notice
  • Attach an SSA-408 (Route Slip) with the remark “Title XVI CDR Favorable Reopening. Effectuation of Payment Required.”
  • Systems data input (mo/day/yr)
  • For concurrent folders:
  • b. Notice not released on original determination
  • Attach an SSA-408 (Route Slip) with the following remarks: “Concurrent Title II/XVI CDR Favorable Reopening. Payment effectuation for Title XVI is required. Upon FO completion of Title XVI payment effectuation, route folder to PC 1-6 (DPB) or PC 7-8” and “Attn: Disability Examiner/Disability Processing Specialist.”
  • Prepare revised SSA-832-U5 with appropriate rationale
  • 2. Less than fully favorable revision
  • Item 29: DDS/DL
  • a. Preparing Form SSA-832
  • Item 34: This revises the previous determination of   (date)  
  • On the revised SSA-832:
  • * Item 24: “This reopens and revises the previous determination of (mm/dd/yy).”
  • * Item 29: DDS/DL (Completion of Item 29 is optional if DDS prepares and releases notices.)
  • Prepare revised notices in accordance with current applicable instructions
  • On the prior SSA-832:
  • * Item 24: “See revised determination of (mm/dd/yy).”
  • 2. Less favorable revision
  • b. Determination notice preparation
  • Notice instructions will be provided in a later transmittal.
  • Prepare a determination notice for the appropriate type of determination using DI 27540.015.B.2. Attach a rationale as described in DI 28501.010C.1.b. in this section.
  • c. Routing instructions
  • Route the folder to the FO for the appeals period. Attach an SSA-408 (Route Slip) with remark “CDR Adverse Reopening.”
  • 3. Revision to later cessation
  • (Notice released on original determination)
  • a. Preparing Form SSA-832
  • If the DDS sent a determination notice on original determination
  • On the revised SSA-832:
  • * Item 24: “This reopens and revises the previous determination of (mm/dd/yy).”
  • * Item 29: DDS/DL (Completion of Item 29 is optional if DDS prepares and releases notices.)
  • On the prior SSA-832: Item 24: “See revised determination of (mm/dd/yy).”
  • Notice instructions will be provided in a later transmittal.
  • If the DDS did not send a determination notice on original determination:
  • A personalized attachment will be prepared explaining the basis of the revised determination.
  • Prepare a revised determination following usual CDR determination procedures.
  • SSA-832-U5 preparation
  • b. Determination notice preparation
  • A revised SSA-832-U5 will be prepared
  • * Item 29: Enter: DDS/DL
  • Prepare a determination notice with language from modified NL 00705.201.
  • Item 34: Enter: This revises the previous determination of (date).
  • Use lead-in paragraph 4038 instead of paragraph 4159. Attach a rationale as described in DI 28501.010C.1.b.
  • For more information on numbered paragraphs, see NL 00708.100.
  • c. Routing instructions
  • Route the folder to the FO for the appeals period. Attach an SSA-408 (Route Slip) with remark “CDR Adverse Reopening.”
  • 4. Basis change only
  • Notice Preparation
  • * The notice will be prepared on SSA-8052-C2. Include the first two guide paragraphs from DI 27540.030. Include appeals paragraph 878 followed by the third guide paragraph from and DI 27540.000 ff.
  • If the original decision was correct but the regulation basis code originally established was not, revise the determination to reflect the correct basis code.
  • a. Preparing Form SSA-832
  • On revised SSA-832:
  • * Item 24: “This reopens and revises the previous determination of (mm/dd/yy).”
  • * Item 29: DDS/DL (Completion of Item 29 is optional if DDS prepares and releases notices.)
  • On the prior SSA-832: Item 24: “See revised determination of (mm/dd/yy).”
  • b. Determination notice preparation
  • Verify that the DDS sent a due process determination notice.
  • If the DDS sent the due process notice:
  • If title II only, prepare the determination notice using language from NL 00705.261. If title XVI only, prepare the determination notice using language from NL 00705.266. In concurrent cases, add disclaimer paragraph 842. If the revision is less favorable, attach a rationale as described in DI 28501.010C.1.b. in this section.
  • In concurrent cases add disclaimer paragraph “841.” Attach a personalized rationale if the revision is less favorable.
  • * Return the folder to the DO
  • If the DDS did not send a due process notice:
  • SSA-832-U5 Preparation
  • Prepare one following the guidance in DI 27525.005B. The DDS cannot send the final determination notice until the predetermination notice is sent.
  • A revised SSA-832-U5 will be prepared
  • * Item 29: Enter: DDS/DL
  • For more information on numbered paragraphs, see NL 00708.100.
  • Item 24: Enter: This revises the previous determination of   (date)   .
  • c. Routing instructions
  • Route the folder to the FO for the appeals period. Attach an SSA-408 (Route Slip) with remark “CDR Adverse Reopening.”
  • 5. No change in basis or end result
  • Notice released on original determination
  • If there is no change in the basis or end result, the DDS must document the file with any additional evidence received since the original determination.
  • a. Preparing Form SSA-832
  • If there is no change in determination, do not revise the SSA-832.
  • b. Rationale preparation
  • Do not prepare a rationale if there is no change in determination.
  • c. Determination notice preparation
  • If the individual is not aware of the reopening:
  • In concurrent or Title XVI only cases, a determination notice is not required.
  • If the individual is aware of the reopening:
  • In Title XVI only cases, prepare a determination notice using language from NL 00705.256. Attach a rationale as described in DI 28501.010C.1.b.
  • d. Routing instructions
  • Route the folders to the referring office.
  • E. References
  • DI 32010.001 General – Continuing Disability Review (CDR) – Routing Instructions
  • DI 32010.080 Continuing Disability Review (CDR) Favorable Reopening and Revision Cases – Routing Instructions (Paper Cases Only)
  • DI 81020.115 Processing Reopenings
  • DI 81020.250 Closing and Routing Electronic Continuing Disability Review (eCDR) Cases
  • DI 81030.120 Reopenings – Certified Electronic Folders (CEF)
  • GN 04440.236 Notices Requiring a Technical Corrective Action (TCA)
  • Recipient aware of reopening status
  • * Document file regarding any additional evidence
  • * Prepare and release SSA-L8052-U1/C2 using language from DI 27540.000.
  • In concurrent cases add disclaimer paragraph “841.”
  • * Route folder to referring office
  • Recipient Unaware of Reopening Status
  • * Document file regarding any additional evidence
  • * No notice is required
  • * Route folder to referring office
  • GN 04440.237 Determination Forms Technical Corrective Action (TCA)
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