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DI 28501.030: Routing Reopened Continuing Disability Review (CDR) Cases

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  • Effective Dates: 05/24/2016 - Present
  • Effective Dates: 12/12/2017 - Present
  • BASIC (03-86)
  • TN 1 (12-17)
  • DI 28501.030 Routing Reopened Cases
  • DI 28501.030 Routing Reopened Continuing Disability Review (CDR) Cases
  • A. General
  • A. Guidelines for routing a reopening of a prior CDR determination
  • The following routing guides apply to cases in which the prior determination is reopened and revised under the rules of administrative finality, based on a return either preadjudicative/postadjudicative from ODO/PSC-DRS, DAB, or OA-DDQO on a returnable error or based on receipt of additional evidence.
  • Use the following routing guidelines when the prior CDR determination is reopened and revised under the rules of administrative finality.
  • B. Reopening based on returnable error on receipt of additional evidence — Federal case Review
  • B. Certified electronic folder (CEF)
  • Route the case back to ODO/PSC-DRS, DAB or OA-DDQO. (The proper office can be determined by referring to the SSA-1774-U4 file box code.)
  • Route cases based on decision (DEC) codes as follows, unless selected for review by the Office of Quality Review (OQR):
  • C. Reopening based on receipt of additional evidence
  • Route the folder to the appropriate office as indicated in 1. and 2. below. In either instance, indicate the type of reopening (favorable or unfavorable) on the routing form.
  • 1. Favorable reopening
  • * Title II only—route to ODO/PSC-DRS via Form SSA-408.
  • * Title XVI on concurrent II/XVI—route to DAB for review of QA cases or the DO for non-QA review via Form SSA-408. (Advise the DO to route a concurrent reopening to ODO/PSC-DRS after effectuating the title XVI determination.)
  • 2. Unfavorable reopening
  • Situation
  • Due to implementation of P.L. 98-460, follow the instructions given for payment continuation cases.
  • * Title II only—route to DAB for review of QA cases and ODO/PSC-DRS for non-QA cases via Form SSA-408 after DDS direct systems input of cessation to terminate benefits, whichever is appropriate.
  • * Title XVI or concurrent II/XVI—route to DAB for review of QA cases or DO for non-QA cases via Form SSA-833-U3 after following the applicable procedures in DI 28084.001 through DI 28084.065 (e.g., annotating the SSA-833-U3, “Input N07 or N08 for title XVI benefit termination. Wire for title II benefit termination.”
  • Destination
  • Case Note
  • DEC = CO
  • Title II – No action necessary
  • Processing Center (PC) 1 through 8
  •  
  • Title XVI – No action necessary
  • L0(zero)E
  •  
  • Concurrent – No action necessary
  • PC 1 through 8
  •  
  • Title II, Title XVI, Concurrent – Action necessary
  • Field Office (FO)
  • Describe the necessary action
  • DEC = CE
  • Title II, Title XVI, Concurrent
  • FO
  •  
  • NOTE: To determine the appropriate destination for PC 1 through 8, see DI 32010.001B.
  • NOTE: If unsure of the necessary action for the CDR case, route the case to the FO so they can determine the best course of action and proper routing procedure.
  • C. Modular Disability Folder (MDF)
  • Situation
  • Destination
  • SSA-408 (Route Slip) Entry
  • Favorable Reopening
  • Returnable Error
  • Office of the Originating Error Return
  • Indicate type of case
  • Title II Only – Additional Evidence
  • PC 1 through 6 (Disability Procession Branch (DPB)), or PC 7-8
  • “Title II CDR Favorable Reopening, Attn: Disability Examiner/Disability Processing Specialist”
  • Title XVI Only –Additional Evidence
  • FO
  • “Title XVI CDR Favorable Reopening. Effectuation of Payment Required.”
  • Concurrent (two folders)
  • FO
  • “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 through 6 (DPB) or PC 7 through 8.”
  • Add, “Attn: Disability Examiner/Disability Processing Specialist”
  • Concurrent (one folder)
  • FO
  • “Concurrent Title II/XVI CDR Favorable Reopening. Payment effectuation for Title XVI is required. Upon completion, route folder to PC 1 through 6 (DPB) or PC 7 through 8.”
  • Add, “Attn: Disability Examiner/Disability Processing Specialist”
  • Less than Fully Favorable Reopening
  • Returnable Error
  • Office of the Originating Error Return
  • Indicate type of case
  • Title II, Title XVI, or Concurrent
  • FO
  • Indicate type of case
  • “CDR Adverse Reopening”
  • NOTE: Route cases selected for quality assurance (QA) review to OQR.
  • NOTE: For adverse reopening determinations, an individual may elect to continue receiving benefits through the administrative law judge (ALJ) level. For more information, see DI 28001.070 Benefit Continuation – Policy).
  • D. If case has an MDF and a CEF
  • Always send the MDF comparison point decision (CPD) folder to the same office that you transfer the CEF. For both folders, include messages about what action is necessary, if any. Follow the routing instructions as given in DI 28501.030B in this section. If OQR selects a case for review, route as appropriate.
  • E. References
  • DI 32010.080 Continuing Disability Review (CDR) Favorable Reopening and Revision Cases – Routing Instructions (Paper Cases Only)
  • DI 32010.085 Continuing Disability Review (CDR) Adverse Reopening Cases – Routing Instructions (Paper Cases Only)
  • DI 81020.250 Closing and Routing Electronic Disability Review (eCDR) Cases
  • DI 81030.090 Certified Electronic Folder (CEF) Alerts, Flags and Messages
  • GN 04440.201 General Rules for Routing and Correcting Deficient Cases
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