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

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~~Effective Dates: 12/12/2017 - Present~~
Effective Dates: 12/29/2017 - Present
TN 1 (12-17)
DI 28501.010 Processing Continuing Disability Review (CDR) Reopenings under Administrative Finality
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. Preparing Form SSA-833
On the revised SSA-833: Item 24: “This reopens and revises the prior cessation determination of (mm/dd/yy).”
On the prior SSA-833: Item 24: “See revised determination of (mm/dd/yy).”
b. Rationale preparation
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.
For more information about reopening rationale preparation, see DI 27536.001.
c. Determination notice preparation
The DDS does not prepare notices for fully favorable revisions.
d. Routing 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.
For more information on the PC SSN jurisdiction, see GN 01070.245.
2. Less than fully favorable revision
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
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.
For more information on numbered paragraphs, see NL 00708.100.
c. Routing instructions
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.
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
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.
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.
If the DDS sent the due process notice:
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.
If the DDS did not send the due process notice:
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.
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. Preparing Form SSA-832~~
a. Preparing Form SSA-833
~~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.~~
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-833.
b. Rationale preparation
Do not prepare a rationale if there is no change in determination.
c. Determination notice preparation
If individual is unaware of the reopening:
Do not send a determination notice.
If the individual is aware of the reopening:
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.
d. Routing instructions
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. 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).”
If the DDS did not send a determination notice on the original determination:
Prepare a revised determination following usual CDR determination procedures.
b. Determination notice preparation
The DDS does not send a determination notice for fully favorable revisions.
The FO must send a determination notice.
c. Routing instructions
Route the Title XVI only and concurrent folders to the FO.
For Title XVI only folders:
Attach an SSA-408 (Route Slip) with the remark “Title XVI CDR Favorable Reopening. Effectuation of Payment Required.”
For concurrent folders:
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.”
2. Less than fully favorable revision
a. Preparing Form SSA-832
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).”
b. Determination notice preparation
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
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).”
If the DDS did not send a determination notice on original determination:
Prepare a revised determination following usual CDR determination procedures.
b. Determination notice preparation
Prepare a determination notice with language from modified NL 00705.201.
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
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.
If the DDS did not send a due process notice:
Prepare one following the guidance in DI 27525.005B. The DDS cannot send the final determination notice until the predetermination notice is sent.
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.”
5. No change in basis or end result
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)
GN 04440.237 Determination Forms Technical Corrective Action (TCA)

POMS Reference

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