BASIC (01-08)

A. Background

When the Field Office (FO) sends a Continuing Disability Review (CDR) case to the Disability Determination Services (DDS), the FO provides the folder that contains medical evidence used to make the most recent favorable medical decision, otherwise known as the Comparison Point Decision (CPD) folder. Further information regarding the CPD folder can be found in The Comparison Point Decision Date and Folder – DI 81010.215. It is extremely important that the FO do everything possible to obtain the CPD folder because it contains the evidence necessary to decide whether the claimant will continue to receive benefits. Adjudicating the CDR without the CPD evidence may result in continuing benefits to a person whose entitlement would have ended had evidence from the CPD folder been available. When the CPD folder is unobtainable, the FO must utilize the following procedures before transferring the case to the DDS.

B. Searching for the paper CPD folder

1. Obtain systems queries

Obtain the proper queries to search for the CPD folder if it is not filed in the FO. Instructions are located in Unable to Locate Medical Folder after Initial FO Search - Detective Work - DI 13015.080. A time-saving tool to obtain queries, the Automated Folder Location Web Site, is available on the home page of the Seattle Intranet (SEANET) site: http://seaapps.sf.ssa.gov/folderRetrievalSystem/index.aspx.

NOTE: You have to be logged into PCOM on the main menu to obtain these queries.

2. Document information in the Certified Electronic Folder (CEF) and the Electronic Disability Collect System (EDCS)

The FO must document all attempts to locate the CPD folder on an eForm SSA-5002 (Report of Contact). At a minimum, the Unable to Locate SSA-5002 must cover the following details:

• Identify what kind of file we have been looking for (Title II DIB, CDB, DWB, SSI, etc.).

• List the locations that the FO has searched for the file or have been eliminated based on queries.

• Address the issue or cross reference SSNs or document that there are no cross reference SSNs.

• Address pertinent name changes by the claimant and that the FO’s that searched for the file were aware of the various names and have searched under all names involved.

The SSA-5002 must be saved in the electronic CDR folder. The Claims Representative (CR) must also fax all pertinent queries into the CEF.

Use one of the following Document Type Codes for the Queries:

NOTE: For a complete list of Document Types identified in the CEF, refer to the Electronic Folder Document Type Chart.

3. Requesting additional information

Advise the claimant that they may be contacted for additional information by the FO or the DDS.

C. Creating a mini-record in EDCS for lost CPD folder cases

Follow the instructions in Creating an EDCS Record for an eCDR - DI 81010.230.

NOTE: For systems reasons, the “CPD date” field in EDCS will be entered by the FO as the date 12 months prior to the CDR interview. Per Identification of the Comparison Point of Medical Evidence - DI 28035.015, the DDS is responsible for establishing the actual CPD date.

D. Transferring the case in EDCS

When transferring a case in EDCS:

• Select the “Transfer” tab at the top of the EDCS page.

• When the transfer page appears, select the box under “All Actions Completed” if the case is ready to send to the DDS.

• Key in the DDS code in the Destination Office box if it has not propagated, and check the “Transfer disability folder to DDS/ALJ” box.

• When the “Transfer disability folder to DDS/ALJ” box is checked, the question regarding the paper folder will become highlighted.

• Select the “Unable to Locate” button.

• Key the following in remarks on the Routing Form: “CDR Lost Folder/Medical Evidence. Follow Disability Determination Services (DDS) Reconstruction of Prior Folder - DI 28035.020. Advise if full reconstruction is necessary.”

• Select “OK” to transfer the case and print the EDCS Routing Form.

  NOTE: Upon transfer, the CR will receive a Confirmation Message stating: “You are transferring a CDR record to <office code> - <office code name>. The paper folder containing the last favorable disability determination has been destroyed or cannot be located. All search efforts are documented in file.”

• Attach the paper SSA-454 (Report of Continuing Disability Interview) or SSA-3368 (Disability Report - Adult) for Age 18 redeterminations), SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA)), and relevant forms to the EDCS Routing Form.

  NOTE: The FO does not fax the SSA-454 into the Certified Electronic Folder (CEF). The DDS will perform this task per Scanning the SSA-454-BK and SSA-3368-BK into the CEF - DI 81020.210. Regional instructions may apply for faxing the SSA-827 into the CEF.

• Mail to DDS.

E. Delayed receipt of CPD folder

If the CPD folder is found or later received by the FO and the case is pending at DDS, the CR must send the CPD folder to the DDS. In such cases, the CR should:

• Create a message in eView stating: “The prior CPD folder has been located and is being mailed by the FO to the DDS on MM/DD/YY.”

• Attach an SSA-408 (Route Slip) to the CPD addressed to the DDS and include the following: “CPD folder found; please associate with CDR sent MM/DD/YY.”

• Mail to DDS.

If the CPD folder is found or later received by the FO and the DDS has made a final decision, the folder must be returned to the DDS as it may change the decision. In such cases, the CR should:

• Attach an SSA-408 to the CPD addressed to the DDS and include the following information: “CPD folder found and case previously closed. Case reactivated by FO on DD/MM/YY. Please review for possible reopening and close reactivated case when complete.”

• Mail to DDS.