DI 40120: Processing Subsequent Disability Insurance Benefits (DIB), Disabled Widow(er) Benefits (DWB), and Childhood Disability Benefits (CDB) Claims by Processing Centers (PCs)

Effective Dates: 01/07/2013 - Present

BASIC (04-11)

A. Jurisdiction for subsequent DIB, DWB, and CDB claims

1. New disability application when disability previously established and not terminated

The field office (FO) and the Processing Centers (PCs) have jurisdiction for subsequent Disability Insurance Benefits (DIB), Disabled Widow(er) Benefits (DWB), or Childhood Disability Benefits (CDB) applications filed by an individual with currently established Title II disability.

The PCs transfer claims (except Railroad annuitant cases) that require additional development relating to onset for disability benefits or continuance of disability to the Disability Determination Services (DDS).

SSA has jurisdiction of DIB only claims requiring a determination that the established period of disability has continued up to, and including, the date of adjudication.

The FO has jurisdiction of DIB, DWB, or CDB claims for an individual who is a Supplemental Security Income (SSI) disability/blindness recipient.

The DDS has jurisdiction for a Title XVI disability claim filed by a Title II disability beneficiary when the individual alleges blindness and was not previously determined to be statutorily blind, or there is a continuing disability issue on the Title II claim. Otherwise, the FO has jurisdiction over the subsequent SSI claim.

See Also

DI 20101.001 - Disability Determination Services (DDS) and Social Security Administration (SSA) Jurisdictions for Initial and Subsequent Cases
DI 11020.055 - Routing Paper Childhood Disability Benefit (CDB) Cases to a Disability Determination Services (DDS) or Program Center (PC)
DI 81000.000 - Electronic Disability Guide (eDG) Procedures for the Electronic Process

2. Processing subsequent claims

If an individual with a currently established Title II disability files a DIB, CDB, or a DWB claim the FO determines whether collateral estoppel applies to the subsequent claim.

If the established disability folder is in the PC, and the FO cannot adopt the prior determination, associate the established folder with the new claim and forward to the Disability Examiner/Disability Processing Specialist (DE/DPS). If it is appropriate to adopt the prior disability determination, the DE/DPS will prepare any necessary SSA-831 (Disability Determination and Transmittal) and forward the claim to the Claims Authorizer/Claims Technical Examiner. The PC making the adoption decision will process the new claim to completion, effectuating payment and releasing the notice.

If the claim is pending in the Office of Disability Adjudication and Review (ODAR), contact ODAR to determine the issue under appeal.

Follow these instructions:

DI 12045.010 - Processing Disability Claims at Different Levels of Appeal, Title II and Title XVI – Common Issues Cases
DI 20101.025 - Subsequent Claim Filed, or Reconsideration on a Subsequent Claim is Requested While Hearing, Appeals Council (AC) Review, or Court Action Pending on Prior Claim.

3. Rules for applying collateral estoppel to subsequent claims

Although the adoption of prior determinations will be rare in the PC, to determine if the prior favorable determination can be adopted, you must be familiar with the collateral estoppel instructions in:

DI 11011.001 - Collateral Estoppel – General
DI 27515.000 - Collateral Estoppel Subchapter Table of Contents
DI 27515.015 - Questioning the Prior Disability Determination

a. Collateral estoppel is possible when:

The same rules for determining disability apply, and
The same time period is covered, and
There is no reason to question the prior determination, and
There is no “new and material evidence”.

b. Exceptions to collateral estoppels

Prior determination cannot be adopted when:

The claimant has engaged in substantial gainful activity (SGA) since the date of onset (see also DI 11011.001B.1.d. and EM-01204 SEN)
The claimant is currently engaging in SGA,
Different rules for determining disability apply (e.g., blindness or childhood disability),
There is a reason to believe the prior determination is wrong see DI 27505.010,
Non-rollback conversion claims for which no subsequent disability determination has been made under federal disability criteria,
Medical improvement is indicated, or
In an initial claims situation, the claimant makes an unsuccessful work attempt (UWA) after the alleged onset date. (In this instance, the DDS has jurisdiction. The FO recommends the work as a UWA, and the DDS makes the final determination.)
For subsequent claims with work activity after the latest determination, route the claim (including any prior paper folders) to the servicing FO with instructions to document work activity before routing the claim to the DDS. The DDS has final responsibility for determining whether a period of work was a UWA per DI 24005.001.

NOTE: Collateral estoppel does not apply to denials.

4. Completing the SSA-831 for adopted decisions

If collateral estoppel applies to the subsequent claim, complete SSA-831. Refer to these instructions:

DI 11011.020 – Completion of Form SSA-831-U3 In Adopted Decisions
DI 26510.001 – Completing Form SSA-831 (Disability Determination and Transmittal)
DI 81000.000 – Electronic Disability Guide (eDG) Procedures for the Electronic Process

Take the following actions:

In item 17, enter the diary date from the prior determination unless this date is past due or will be due within 3 months per DI 11011.005 C.
In item 34 insert the remark, “See SSA-831 dated ________ , SSN ___________.”
Attach a copy of the prior SSA-831 and any subsequent SSA-833 to the new SSA-831
If adopting a favorable disability determination from a prior claim to a subsequent claim, item 17 of the new determination must reflect the same diary date shown on the prior determination.

B. Adoption of subsequent DIB, DWB, or CDB claims

PC adjudicators must be familiar with the following POMS instructions for DIB, DWB, and CDB claims before determining whether to apply collateral estoppel:

DI 11010.085 - Multiple Type Title II Claims
DI 11015.001 - Rules for DIB-DWB Claims
DI 11055.100 - Adopting a Determination or Decision When a Claimant Previously Entitled to Childhood Disability Benefits (CDB) or Disabled Widow(er) Benefits (DWB) is Terminated for a Non-Medical Reason
DI 27515.000 - Collateral Estoppel - Subchapter Table of Contents
DI 27515.015 - Questioning the Prior Disability Determination
DI 27515.040 - DWB Claim Filed – Prior Disability Has Not Ceased

C. Adoption of DIB determination for DWB or CDB claims

1. DWB claim filed

DEs/DPS receipt and associate the DIB-DWB claims, then examine the evidence in the DIB folder to determine if the latest disability determination contains the findings necessary for a favorable DWB determination.

Can adopt

If the PC can adopt the prior favorable Title II disability determination under the rules of collateral estoppel, refer to these instructions:

DI 27515.040 - DWB Claim Filed – Prior Disability Has Not Ceased
DI 11011.005 - FO Adoption Decision, A. Procedure – FO Adoption
DI 11011.015 - FO Adjudication of Adopted Claims

Cannot adopt

In situations where the PC cannot adopt the prior determination;

Send both folders to the DDS via the SSA-847 (Social Security Administration Request for Case Action) with the electronic claim download, along with any prior paper folders.
Provide the DDS with the beginning and ending dates of the prescribed period by completing item B2 of the SSA-847.

Questionable determination

When there is reason to question the prior determination see, DI 27515.015.

Request the DDS to prepare an initial determination on the DWB claim.
If the prior DIB established onset date is after the end of the prescribed period, direct the DDS to develop onset evidence for the subsequent DWB claim.
For subsequent claims with work activity after the latest determination, route the claim (including any prior paper folders) to the servicing FO with instructions to document work activity before routing the claim to the DDS. The DDS has final responsibility for determining whether a period of work was a UWA per DI 24005.001.

If onset rules are not met or there is SGA since the prior determination, request the DDS to prepare a continuing disability review (CDR) determination on the DIB claim and an initial determination on the DWB claim.

NOTE: If the claimant has worked since the latest determination, you must develop the work issues. Request the DDS to forward both folders to the FO servicing the DWB claim upon completion of their actions.

2. CDB claim filed

When the prior DIB and subsequent CDB claims are associated, the DE/DPS will examine the evidence to determine whether the latest disability determination supports a favorable CDB determination.

If the PC determines that it can adopt the prior favorable Title II disability determination under the rules of collateral estoppel, refer to the adoption decision chart in DI 11011.005, FO Adoption Decision. For FO Adjudication of Adopted Claims also refer to DI 11011.015.

If the PC cannot adopt the prior determination, or there is reason to question the prior determination, the DE/DPS will route the claim to the DDS to resolve initial claim and continuing disability issues. Request the DDS prepare a continuing disability review (CDR) determination on the DIB claim and an initial determination on the CDB claim. If the claimant has worked since the prior determination, you must develop the work issue.

For subsequent claims with work activity after the most recent determination, route the claim (including any prior paper folders) to the servicing FO with instructions to document work activity before routing the claims to the DDS. The DDS has final responsibility for determining whether a period of work was a UWA per DI 24005.001. When the adopted disability determination is not fully favorable on the new claim, the FO prepares a partial award and processes the case to pay before routing the case to the DDS.