Audience:

:

Citations:

Social Security Act, section 205(b);

20 CFR, 404.907-404.992, 404.992, 404.993, 404.999a-404.999d, 404.1546, 416.946,416.1407-416.1422, 416.1492-416.1493, 416.1495-416.1499,422.140

TN 1 (03-16)

Citations:

20 CFR, 404.907-404.922, 404.987-404.993, 404.999a-404.999d, 404.1546, 416.946, 416.1407-416.1422, 416.1492, 416.1493, 416.1495-416.1499, 422.140

Social Security Act, section 205(b);

A. Introduction to the disability hearing at the reconsideration level of the CDR process

1. Reconsideration process notes

This subchapter addresses the disability hearing for CDR reconsideration or reopening processes.

2. Reminder items for the reconsideration process

When reading these instructions, remember:

• terms such as medical cessations and medical factors include, when appropriate, vocational considerations;

• references to the disability determination services (DDS) also means the Federal components that process DDS cases and non-State cases (foreign and railroad cases) in a manner similar to the DDS; and

• the instructions for the disability hearing units (DHU) are in chapter DI 33000.000.

NOTE: Although these procedures apply to the State and Federal disability hearing process, some modifications may be necessary to conform to State business practices. However, modifications may not conflict with the Federal regulations governing the disability hearings.

3. Levels of appeal of a CDR determination

Individuals have the right to appeal an unfavorable CDR determination. There are four levels of appeal:

1. Reconsideration. This includes:

   • pre-hearing - review by an adjudicative team, or designated person, who was not involved in the initial unfavorable determination; and

   • disability hearing - review within a DHU by a disability hearing officer (DHO).

2. Hearing by an administrative law judge (ALJ);

3. Review by the Appeals Council (AC); and

4. Federal Court review.

These instructions focus only on the reconsideration level.

B. Policy on the disability hearing process

1. Availability of the disability hearing

The disability hearing is available at the reconsideration level of appeal in:

• CDR medical cessation cases;

• CDR reopenings that change only the basis for the cessation;

• Adverse reopenings at the initial level; i.e., cases involving favorable initial CDR determinations which were reopened and revised (to unfavorable or only partially favorable determinations) based on medical factors;

• Adverse reopenings of cases involving favorable reconsideration CDR determinations which have been reopened and which we propose to adversely revise based on medical factors.

NOTE: For additional information on when the disability hearing applies, see DI 29005.022.

2. Included in disability hearing process

The disability hearing applies to cases previously cited, including the medical issues in cases involving:

• Medicare for qualified government employees (MQGE),

• an extended period of eligibility (EPE),

• prisoner cases,

• foreign claim cases, and

• railroad cases.

3. Adverse reopening notices

Follow these procedures:

1. When an initial CDR determination is reopened and adversely revised based on medical factors, we must send a notice to the individual containing appeal rights to a reconsideration. The DDS prepares these determinations and notices.

2. Before a reconsideration CDR determination is adversely reopened and revised based on medical factors, the DHU sends a notice to the individual advising him or her of the proposed revision and his or her right to request a disability hearing before issuing a revised decision. For more information on DHU notices, see DI 33020.025.

C. References

• DI 27001.001 The Reconsideration Process

• DI 27501.001 Reopenings and Revisions: Pertinent Definitions and Related Policy

• DI 27501.005 Reopening and Revising a Determination or Decision

• DI 27525.001 Due Process Notification for Adverse Reopenings

• DI 27525.010 Providing Due Process in Adverse Reopenings Involving Title XVI and Concurrent Title II and Title XVI Cases

• DI 27540.040 Reopening and Revision at the Reconsideration Level

• DI 28501.020 Unfavorable Reopening of Prior Continuance Determination

• DI 29005.020 GLPSC - Career Railroad and Railroad Annuitant Cases

• DI 33020.025 Reopenings