TN 5 (07-10)

Some disability claims are excluded from the Electronic Disability Collect System (EDCS) (the method by which they are entered into the CEF), and cannot be processed completely electronically. For a discussion of what constitutes a CEF Exclusion, see DI 81010.030. In other instances, a processing limitation occurs that removes a case from electronic processing. The field office (FO) must establish a paper folder if any EDCS exclusions or limitations are present for any claim associated with a case. The following subsections discuss processing paper cases via the Modular Disability Folder (MDF).

A. Using the paper MDF

Except for those claims that are known to be technical denials from the beginning, the MDF is used in most initial disability claims filed in FOs that are excluded from electronic processing.

When any section of the MDF becomes full (e.g., the section that holds the medical records), accommodate additional material by filing the most recent records in a two-part brown folder and stapling that folder to the back of the MDF. See DI 70005.005E in this section.

1. Title II or Title XVI only claims

• For Title II only or Title XVI only disability claims that are excluded from EDCS processing, the MDF becomes the sole folder to house the medical and non-medical material. In most instances, the FO routes the entire folder to the Disability Determination Services (DDS) or other adjudicating component since you can view most non-medical information in the Modernized Claims System (MCS) or the Modernized SSI Claims System (MSSICS).

• In the rare situation when the FO believes a non-medical file should remain in the FO, house the non-medical material in a temporary jacket and forward the medical material to the DDS in the MDF.

• When the folder returns from the DDS, the FO files the non-medical material in the proper section(s) of the MDF.

2. Concurrent claims

The MDF always houses medical records and related disability documents.

a. Procedure for concurrent Title II/Title XVI cases filed simultaneously

• File the Title II non-medical material in the MDF in the appropriate sections.

• File the Title XVI non-medical material in a two-part brown folder, and staple it to the back of the MDF.

• Do not file the Title XVI non-medical portion of a concurrent Title II/XVI case in the MDF. If there is a medical allowance by the DDS, route the MDF containing the Title II non-medical material and medical material to the FO or processing center (PC) for processing and storage.

• Adjudicate and retain the Title XVI non-medical material in the FO until it is shipped for storage.

IMPORTANT: Title II and Title XVI non-medical claims material usually are not filed together in the MDF.

EXCEPTION: Place a copy of the Title XVI SSA-831 in the Title II folder, and place a copy of the Title II SSA-831 in the Title XVI folder.

b. Procedure for concurrent Title II/Title XVI cases filed sequentially

When the FO has a Title XVI only claim filed in the MDF and later takes a Title II claim that requires a medical determination, take the following actions:

• If the Title XVI folder is still in the FO, transfer the Title XVI non-medical material to a two-part brown folder and file the Title II non-medical material in the MDF.

• If the Title XVI folder is in the DDS when the Title II claim is filed, hold the Title II non-medical information in the FO and take the action outlined in DI 70005.005A.2. in this section after the DDS returns the MDF.

Follow local procedures for notifying the DDS that a claim was filed on the other title.

When the DDS makes a medical determination on a concurrent case in which the Title II claim is denied and the Title XVI claim is allowed, the FO makes adjustments to the folders. Examples of this situation include:

• The established date of onset is after the date last insured (DLI).

• Blindness cases that result in different medical determinations because of the difference in the definition of blindness between the two titles.

When this occurs, transfer the Title II non-medical material to a two-part brown folder. After the FO receives the file from the DDS, FO staff will place the Title XVI non-medical material in the MDF with the medical evidence. The medical evidence is available at the time of a Continuing Disability Review (CDR) on the allowed claim. For a discussion of the disposition of common disability material when splitting concurrent Title II/Title XVI, cases, see DI 11010.370B.3.b.

When a claimant or his or her representative files a hearing request on a concurrent Title II/Title XVI case, staple the Title XVI non-medical folder to the back of the MDF prior to routing the case to the Office of Hearings Operation (OHO).

c. Procedure for multiple entitlement: Title II cases (e.g., HA/Childhood Disability Benefits (CDB), HA/Disabled Widow(er) Benefits (DWB), etc.)

• File the non-medical portion of an HA (DIB) claim in the appropriate section(s) of the MDF with the medical material. For a description of the parts of the MDF, see DI 70005.005B in this section.

• Place the non-medical portion of the claim filed on another account number (i.e., CDB, DWB, etc.) in a two-part brown folder, and staple it to the back of the MDF.

3. Procedure for technical denials

a. Single title cases

Place a Title II only or Title XVI only case, adjudicated as a technical denial, in a two-part brown folder. Do not use an MDF.

If the technical denial is reversed upon appeal and a medical determination is required, transfer the case materials to an MDF prior to routing the case to the DDS (or other appropriate component) for a medical determination.

b. Concurrent cases

When both the Title II and Title XVI claims are technical denials, place them in separate two-part brown folders. Do not use an MDF.

When the Title II only claim requires a medical determination, file the Title II non-medical material in the MDF along with the medical material. Place the Title XVI non-medical material in a two-part brown folder whether or not the Title XVI claim requires a medical determination.

When the Title II claim is a technical denial and the Title XVI claim requires a medical determination, place the Title II non-medical material in a two-part brown folder, and file the Title XVI non-medical material in the MDF along with the medical material.

4. Procedure for folder preparation and routing

Prepare and route the MDF (with name and SSN) to the appropriate component (e.g., to DDS, to OHO, to storage site, etc.). Staple transmittal sheets and special case flags to the front of the folder, as usual.

5. References

• DI 11010.375 - Transmitting Paper Case Folders

• DI 32001.000 - Folder Preparation and Movement

• DI 32005.000 - Routing - Initial/Reconsideration/Reopening Cases

B. Procedure for filing in the MDF

The MDF contains six color-coded labeled sections to facilitate filing. The divider tabs list examples of the documents filed in each section. The lists are not all-inclusive. Exercise judgment about where to file documents that are not listed.

The folders are color - coded as follows:

1. Yellow (Front) -- payment documents/decisions

File materials in the Yellow (Front) section in chronological order (i.e., oldest document on the bottom and newest on the top). The Yellow (Front) section houses documents pertaining to entitlement and payment of benefits. The SSA-831 (Disability Determination and Transmittal), and Administrative Law Judge decisions are a few examples of documents filed here.

2. Red -- jurisdictional documents/notices

File materials in the Red section in chronological order (i.e., oldest document on the bottom and newest on the top). The Red section contains notices and appeal requests that document the current level of adjudication. You also may file the SSA-1696 (Appointment of Representative) and other similar documents in the red section.

3. Green -- current development/temporary

File materials in the Green section in any order because the Agency eventually will purge or move these materials to another section.

The purpose of the Green section is to encourage users to discard extraneous material when transferring the file. The green section is the “work in progress” section.

For example, file a letter requesting medical records from a treating source in the Green section. When the records arrive, discard the request letter. If the records are not received by the time the disability determination is made, move the request letter to the Yellow (Back) section (Medical Records) to document the request.

NOTE: Each component user is responsible for determining what is pertinent and what to discard... For example, a disability examiner (DE) in a DDS may decide to retain the letter requesting medical records even though he or she has received the records. The DE files the request letter with the medical records in the Medical Records section to document that the treating source did not provide all of the requested documents or information. Subsequent reviewers should not discard the letter as it may contain fiscal information for the DDS audit process.

Guidelines for determining what is extraneous are in DI 20503.001C for DDS; in GN 01050.150B, GN 01050.240, and GN 01050.245 for Title II claims; and in GN 00301.290 and GN 00301.295 for all claims.

Normally, the Green section is empty when the folder moves to another component for processing or filing.

EXCEPTION: One component starts an action, and another component completes it. For example, you may send a case to one DDS, but the case is transferred to another DDS before it is adjudicated because the claimant moves, etc. In such a case, some information requested or begun in the first DDS may remain in the Green section until the folder reaches the new DDS for completion.

4. Orange -- non-disability development

The Orange section houses claim applications, non-medical evidence, earnings records, essential queries, documentation of earnings, non-disability postentitlement development, congressional inquiries or responses, etc.

For the Title II assembly order applicable for this section of the MDF or for the two-part brown folder, see GN 01050.190A.1. through GN 01050.190A.8.

5. Blue -- disability related development and documentation

File materials in the Blue section in chronological order (i.e., oldest document on the bottom and newest on the top). File disability questionnaires, such as the SSA-3368 (Disability Report – Adult), SSA-3441, (Disability Report – Appeal), SSA-820, (Work Activity Report -- Self Employed Person), and the SSA-821, (Work Activity Report -- Employee) in this section. Disability-related correspondence and forms such as the SSA-827 (Authorization to Disclose Information to the Social Security Administration) also belong in the Blue section.

As an exception to the chronological filing order in the Blue section, the FO will place all completed SSA-827s on top when routing the folder to the DDS.

6. Yellow (Back) -- medical records

File all medical records in the Yellow (Back) section in receipt-date order or treatment-date order, at the initial and reconsideration levels. This includes hospital records, laboratory reports, physician's records, outpatient notes, RFC forms, comments, and analyses of program physicians and psychologists, etc. Keep cover letters together with the accompanying records, as they help identify the source. DDSs will place their worksheets and development records on top of this section.

NOTE: File any Cooperative Disability Investigations (CDI) Report of Investigation on top of all material, including the DDS worksheet, in this section.

C. Description of how to file medical records

DDS users can file medical records in receipt-date order or treatment-date order, at the initial and reconsideration adjudication levels. If there is a medical denial at the reconsideration level (of an initial claim or CDR), and the claimant or his or her representative files a request for a hearing, support staff in the hearing office will organize the relevant documents for the hearing.

1. Receipt-date order

Receipt-date order means as you receive records, file the records in the appropriate section, so that all new evidence is filed on top of the evidence already in the file.

2. Treatment-date order

Treatment-date order means filing medical records according to the dates of treatment, with the oldest treatment record on the bottom and the most recent on the top. This does not mean, however, to file every single record of medical evidence as a separate document. For example:

• Keep together hospital records pertaining to one period of hospitalization. This may include an admission summary, laboratory reports, progress notes, surgical procedures, and a discharge summary.

  If a hospital provides records for multiple periods of hospitalization, treat the records for each stay as separate records and interfile them with other records in treatment-date order.

• If a claimant was seen only as an outpatient at a hospital (such as in a clinic or emergency room), keep his or her records together with the oldest on the bottom and the newest on top.

• File as one document, claimant’s medical source(s) records that include laboratory reports or x-rays.

• Keep together multiple records from one physician that covers a period of time, with the oldest treatment date on the bottom.

  The controlling date for interfiling records is the most recent date of treatment, in the topmost record of each set. (See the following example).

  EXAMPLE: The proper filing for the following set of medical records is:

• On the bottom - Hospital records from County Hospital for a stay from 7/24/2001 through 7/31/2001.

  Medical reports from Dr. Kildare with attached laboratory reports that cover from 7/2/01 through 8/1/02.

  Hospital records with an electrocardiogram (EKG) for a hospital stay at County Hospital from 9/15/02 through 9/19/02.

  VA Hospital outpatient records covering 7/29/02 through 10/14/03.

• On the top - A consultative examination performed by Dr. Casey on 8/9/04.

D. Description of extraneous materials

For maximum efficiency and productivity, do not file duplicate or other unnecessary material in the folder. This is vital. If it is unclear if you should retain material , file the material in the Green section (Current Development/Temporary).

Purge the Green section when all actions are complete, by either discarding the material or filing it in another section for documentation purposes. Because duplicate medical records are the most common source of extraneous material, check each incoming medical record against existing records to determine if it is already wholly or partially in file. If so, discard and destroy the duplicate material, keeping the most legible copy. Ensure that the discarded copy does not contain additional entries or annotations.

E. Procedure for filing in a full MDF

When an MDF becomes full:

• File any additional medical records in a two-part brown folder.

• Annotate that folder with the number holder’s (NH's) name and social security number (SSN).

• Staple that folder directly to the back of the MDF.

• Staple concurrent claims (Supplemental Security Income (SSI)/DWB/Childhood Disability Benefits (CDB)) to the back of the overflow folder. Place the most recent medical records in the two-part brown folder to eliminate excessive re-filing of material.

• Locally reproduce the flag in DI 70005.005G in this section, and place it on top of the medical records in the Yellow (Back) section (Medical Records). The flag will prevent anyone from filing additional records in that section and will alert the user that he or she can find more recent records in the attached two-part brown folder.

F. List of standardized claim file forms

The following is a partial numerical list of standardized Title II and Title XVI claim file forms and includes the color-coded section of the MDF where you should file the form.

An asterisk (*) identifies Title XVI forms. For a Title XVI only disability claim, file these forms in the MDF. For a concurrent claim, these forms will remain in a separate two-part brown folder housing the Title XVI non-medical material.

G. Exhibit of flag

Use the following flag when the MDF is full and it is necessary to file additional medical records in an attached two-part brown folder. Place this flag on top of the Medical Records section of the MDF, and fill in the time period covered by the records in that section.

DO NOT FILE ANY MORE RECORDS HERE

More Recent Medical Records are filed in a Two-Part Brown Folder Attached to this Folder

This Section is full. File any additional medical records in a two-part brown folder and attach it to the back of this folder. Continue to file the most recent records on top in the two-part brown folder.

This section contains medical records for the period __(date)______ through ____(date)___.