POMS Reference

DI: Disability Insurance

TN 1 (02-08)

A. Background

Collateral estoppel cases can now be processed in EDCS via the Field Office (FO) Determination page. There is no change in policy on when FO can adopt prior medical decisions for current disability claims. For detailed instructions on these claims, see Collateral Estoppel DI 11011.001 through Special Notification Required DI 11011.025.

B. Establishing Collateral Estoppel Cases in EDCS

Once the Claims Representatives (CRs) identifies a potential collateral estoppel case, follow these procedures when adopting either a Title II or a Title XVI decision:

  • Establish the new claim in Modernized Claims System (MCS) or Modernized Supplemental Security Income Claims System (MSSICS);

  • Record non-medical development on MCS/MSSICS/Shared Processes as appropriate. See Electronic Evidence Documentation and Retention GN 00301.286;

  • Create a new claim in EDCS using the BOAN. Select key data but do not complete the 3368, etc.;

  • Select the Claims Actions tab;

  • Select Add FO Determination; and

  • Select Collateral Estoppel/FO Adoption radio button.

1. Completing the fields on the FO Determination – Collateral Estoppel Page

Certain data propagates to the FO Determination – Collateral Estoppel page, such as the Claim type, SSN of the claimant or beneficiary, and the Regulation Basis Code of ACE. The CR should manually complete the following mandatory fields:

a. Source of Information

  • Select the prior decision you are adopting for the current claim. If adopting a prior Title II decision, enter the Number Holder SSN and claimant BIC.

    NOTE: If adopting a Title XVI decision, the SSN is pre-filled;

  • Enter the date of the systems query or SSA-831(Disability Determination and Transmittal/SSA-832 (Cessation or Continuance Title XVI/SSA-833 (Cessation Or Continuance Title II) that documents the prior decision. If the date of the document is unknown, check the “if unknown” box.

b. Disability Information

  • Enter the date the disability began from either the systems query or item 15A of the SSA-831/832/833;

  • Enter the 4-digit Primary Diagnosis Code from the systems query or item 16A of the SSA-831/832/833. If a code is not available, check unknown and the code of 2480 will automatically propagate;

  • For establishing the Diary type and diary date see DI 11011.005C. FO Adoption Decision.

c. Remarks

  • The system will automatically propagate remarks from the “Determination adopted from” field in the Source of Information section;

  • If the decision was adopted from an SSA-831 that is in a Certified Electronic Folder (CEF), add the following in the remarks section of the Disability Information section:

    “Original SSA-831 contained in CEF”

  • If the determination was adopted from a systems query (MBR/SSR) or from an SSA-831 that is NOT in a CEF, add the following in the remarks section of the Disability Information section:

    “Paper SSA-831 (or systems query, as appropriate) from original determination faxed into current CEF.”

d. Current Filing

Always select “A certified electronic folder (CEF).”

2. Additional File Documentation for Collateral Estoppel Cases

If the decision being adopted:

  1. Is stored in a CEF

    It is unnecessary to fax the source of the adoption into the current CEF. Enter the remark “Original SSA 831 contained in Certified Electronic Folder”

  2. Is from a paper folder or from a query

    Create a barcode coversheet and fax the document (i.e., 831/832/833, MBR, etc) into section A. Payment Documents/Decisions (Yellow Front) of the current CEF using document type 0035 and the appropriate Regional DMA fax number. (See Faxing Documents into the Certified Electronic Folder (CEF) Using Barcodes - DI 81010.090C. for a list of Regional DMA fax numbers.).

Do not fax copies of medical evidence from the prior paper folder into the current CEF.

3. Data Copy of the SSA-831

Because the collateral estoppel data will be stored in EDCS, do not print the collateral estoppel SSA-831 or mail it to Wilkes-Barre Direct Operations Center (WBDOC).

4. If Action is needed by the Processing Center (PC)

If action is required in the PC the following is needed in addition to faxing into eView:

  • Use the SSA-3601 (Claims Routing) to notify the PC of the action to be taken. Clearly identify the actionable material so it can be assigned an appropriate TOEL.

  • Annotate the SSA-3601 with a remark indicating the collateral estoppel material has been stored in the designated section in eView

  • Fax the SSA-3601 to the PC’s Paperless Processing Center System (PPC) using the Paperless fax number. PC fax numbers are available here.

IMPORTANT NOTE: eView will not alert the PC to take an action on the document. This is why you must fax the SSA-3601 to the PC’s Paperless fax number.