DI 11005: Disability Interviews
TN 36 (08-12)
A. Claims development
Contacting military personnel can be difficult due to frequent residence changes. To ensure expeditious handling of MC/WW cases, complete the claimant’s disability application as thoroughly as possible to avoid unnecessary re-contact:
obtain a permanent mailing address and phone number, and
obtain the claimant’s residence address.
The claimant’s residence address, not mailing address determines the Disability Determination Services’ (DDS) jurisdiction.
For determining residence address, see DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS).
1. Modernized Claims System/Modernized Supplemental Security Income Claims System (MCS/MSSICS)
Enter all claims using MCS or MSSICS, or both.
Take full (not deferred) Title XVI applications.
2. Electronic Disability Collection System (EDCS)
Follow the normal interviewing guidelines in DI 11005.000 Disability Interviews, which includes recording the information into EDCS.
For instructions on establishing a claim in EDCS and EDCS exclusions, see DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases.
3. Curtailing completion of the disability report
If you have any doubt as to whether the claim will result in an allowance, it is in the claimant’s best interest to complete an entire SSA-3368-BK (Disability Report – Adult). This action may help to avoid unnecessary re-contact.
If the claimant’s impairment(s) does not meet a presumptive disability category but seems particularly severe, and curtailing completion of the disability report might be appropriate, refer to:
DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms
DI 81010.020F. Curtailing completion of the EDCS 3368 or EDCS 3820
The appropriate Regional Center for Disability Programs for guidance on curtailment, if necessary.
4. DD Form 214 (Certificate of Release or Discharge from Active Duty)
Department of Defense issues a DD Form 214 for each period of active duty service. It contains important information for claims development.
If the claimant submits a DD Form 214(s), place a copy into the Shared Evidence Screen (EVID) or the Non-Disability Repository for Evidence (NDRed), or both.
IMPORTANT: To expedite handling of MC/WW claims, do not delay forwarding these claims to the DDS, even when the DD Form 214 is not readily available. Accept the claimant’s allegation that the disability occurred during military service without the DD Form 214 or other documentation.
For additional information, see GN 00301.310 The Non-Disability Repository for Evidentiary Documents (NDRed) Application—Overview and MSOM EVID 001.002 Shared Processes Menu (SPMN).
B. Military pay and substantial gainful activity (SGA)
Do not evaluate the claimant’s work activity based solely on military wages, without making an SGA determination, since active duty service members usually continue to receive full military pay while receiving medical treatment (for more information on evaluation and development of employment, see DI 10505.001). For example, the claimant may be working in a designated therapy program or on limited duty while receiving treatment. Instead, determine the reasonable worth of a claimant’s actual work activity by comparing it to work activities from people in the civilian work force. Always take into consideration any applicable work incentives (e.g., impairment-related work expenses [IRWE], subsidies or special conditions).
For additional information, see DI 10505.020 Evaluation Guides and DI 10505.023 Military Service.
C. Additional MC/WW considerations
1. Disability insurance benefit (DIB) offset
Military disability benefits do not offset DIB if all military service is after December 31, 1956. For more information on military disability benefits see DI 52130.015.
2. Closed period of disability
Be alert to the possibility of a closed period of disability. Based on the evidence, a disability adjudicator may find that the claimant was disabled for a continuous period of at least 12 months, but at the time of adjudication the claimant is no longer disabled. In order to establish a closed period, the evidence must show a period of disability that has a definite beginning and ending date. In this situation, if he or she meets all other requirements, the claimant may be entitled to a closed period of disability.
For additional information on closed period of disability, see DI 25510.010 Closed Period Under Title II and DI 25510.015 Closed Period Under Title XVI.
Evaluating a closed period of disability always requires careful consideration of the medical improvement review standard. Additionally, adjudicators cannot establish a closed period of disability based on a finding of SGA alone, as the claimant may be entitled to work incentives. For return to work issues, see DI 13010.110 Return to Work.
3. Potential Onset Date (POD)
When appropriate, develop for an earlier POD. The POD may be the same, earlier or later than the alleged onset date (AOD). When evaluating a claimant’s work, make sure to consider work incentives (e.g., IRWEs, subsidies, special conditions) when determining the reasonable worth of the work. When the POD is earlier than the AOD, develop and document any work issues after the AOD, or after the POD, using form SSA-821-BK (Work Activity Report – Employee), or the SSA-820-BK (Work Activity Report – Self-Employment).
Complete the SSA-823 (Report of SGA Determination-For SSA Use Only) in all initial claim determinations that require an SSA-820-BK or SSA-821-BK.
For more information on completing work activity reports and claims development, see:
DI 10505.035 Documenting Employment Cases Using the SSA-821-BK (Work Activity Report-Employee) and the SSA-823 (Report of SGA Determination-For SSA Use Only),
DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only),
DI 10005.005 Field Office (FO) Disability Development, and
DI 11005.045 Completing the Paper Form SSA–3367–F5 (Disability Report-Field Office)
D. Claims documentation
1. Development worksheet (DW01) screen in MCS/MSSICS
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Establish a UNIT code of “___XRQ” on the DW01 screen for claimants who meet the MC/WW definition in DI 11005.003A.1.
Use the first three characters of the unit code per local instructions (e.g., unit number, initials).
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Establish an ISSUE of “MC/WW Case” to track the case, following the instructions about tracking TERI cases in DI 11005.601D.3.d.
Although MC/WWs are expedited following the same procedures as TERI cases, do not use the TERI flag unless the claim meets the TERI guidelines in DI 11005.601 The Disability Interview-- Identifying Terminal Illness (TERI) Cases; i.e., there is evidence of a terminal illness.
2. Decision input (DECI) screen in MCS
Establish a listing code of 108 (for a list of the codes see GN 01040.100).
3. MC/WW flag
a. Certified electronic folder
If the MC/WW flag does not automatically propagate to the claim in EDCS, follow instructions in DI 81010.080B Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS) to create an MC/WW flag in EDCS. The flag will alert the DDS to expedite processing of the claim.
b. Paper modular disability folder (i.e., EDCS exclusion)
Attach an MC/WW flag to the front of the folder before sending to the DDS. (See an exhibit of the MC/WW flag in DI 11005.006I in this section.)
E. Sending an MC/WW to the DDS and tracking status
MC/WW claimants may be hospitalized when you are ready to transfer the claim to the DDS. To ensure that you send the claim to the correct DDS office, verify the claimant’s actual or last known physical residence address. DDS jurisdiction is not based on the claimant’s mailing address.
For information on determining the DDS with jurisdiction of the claim, see DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determination Services (DDS).
1. Sending an MC/WW claim to the DDS
When sending an MC/WW claim to the DDS, take the following steps:
EDCS claims: Annotate the EDCS remarks section with the words “Military Casualty/Wounded Warrior Case.” For instructions on transferring a EDCS case, see DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS).
EDCS exclusions: Send the paper case in a priority mail envelope with a “Military Casualty/Wounded Warrior Case” designation on the outside of the envelope. For a listing of EDCS exclusions and limitations, see DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations.
2. Verifying DDS receipt and tracking status of the claim
Obtain a DDS Query (DDSQ) two days after the claim is transmitted to verify DDS received the claim. For paper cases, obtain a DDSQ seven days after the claim is transmitted. If the claim is not on the DDSQ, contact the DDS by telephone or fax to verify receipt.
Use the guidelines and procedures for tracking TERI cases in DI 11005.601D.3.d. The Disability Interview-- Identifying Terminal Illness (TERI) Cases.
F. DDS makes a determination
For favorable DDS determinations, expedite payment action for Title II and Title XVI claims. If a Title II allowance is an earnings computation processing exclusion, take the following actions:
Complete an A101/EF101 and route to the appropriate processing center (PC).
Annotate the A101/EF101 in remarks indicating that it is an MC/WW case.
Monitor the claim(s) through all stages of development and adjudication.
NOTE: PCs follow the special handling procedures for TERI cases. For identifying TERI cases, see DI 11005.601E. The PC Inquiry and Expediting staff is responsible for payment processing.
G. MC/WW appeals process
All MC/WW appeals receive priority handling and should be coded as instructed in DI 11005.006D.1. through DI 11005.006D.3. in this section.
1. EDCS claims process
a. Reconsideration request process
Follow these steps for processing reconsideration requests:
Non-prototype states: process the request using the same instructions for initial claims.
Prototype states (i.e., where the first level of appeal is the hearing): do not complete the reconsideration. Follow hearing request procedure in DI 11005.006G.1.b. in this section.
b. Hearing request process
Follow these steps for processing hearing requests:
Send the request directly to the Office of Disability Adjudication and Review (ODAR) as indicated in DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS).
If the MC/WW flag is not automatically attached to the case in EDCS, attach the flag to alert ODAR to expedite appeal processing (See DI 11005.006D.3. in this section).
c. Request for Appeals Council (AC) review process
To process requests for AC review, send the request directly to the AC as indicated in DI 81010.150 Processing Claims Appeals of Medical Decision in Electronic Disability Collect System (EDCS) and DI 12020.001 Appeals Council (AC) Review.
If the MC/WW flag did not automatically propagate to the case in EDCS, attach the flag to alert the AC to expedite review (for information on MC/WW flagging, see DI 11005.006D.3. in this section).
2. EDCS exclusions process
Complete and add the MC/WW flag to the front cover of the claims paper folder. (See an exhibit of the flag in DI 11005.006I in this section.)
Reconsideration request process: Refer to DI 12005.005 Processing a Reconsideration Request for a Medically Denied Initial Disability Claim, and DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial.
Hearing request process: Follow assembly and routing instructions in DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing.
Request for Appeals Council (AC) review: Follow instructions in DI 12020.001 Appeals Council (AC) Review.
H. References
DI 10005.005 Field Office (FO) Disability Development
DI 10505.001 General – Evaluation and Development of Employment
DI 10505.020 Evaluation Guides
DI 10505.023 Military Service
DI 10505.035 Documenting Employment Cases Using the SSA-821-BK (Work Activity Report-Employee) and the SSA-823 (Report of SGA Determination-For SSA Use Only)
DI 10510.025 Documenting Self-Employment Cases Using the SSA-820-BK (Work Activity Report-Self-Employment) and the SSA-823 (Report of SGA Determination- For SSA Use Only)
DI 11005.000 Disability Interviews
DI 11005.003 Field Office (FO) Instructions for Identifying Claims, Applicable Terms, and Scheduling Appointments for Military Casualty (MC)/Wounded Warrior (WW) Cases
DI 11005.020 Curtailing Completion of the SSA-3368 (Disability Report-Adult) or the SSA-3820 (Disability Report-Child) Forms
DI 11005.045 Completing the Paper Form SSA-3367–F5 (Disability Report-Field Office)
DI 11005.601 The Disability Interview – Identifying Terminal Illness (TERI) Cases
DI 11010.255 Sending Initial Disability Insurance Benefits (DIB), Freeze Claims to the Disability Determinations Services (DDS)
DI 12005.005 Processing a Reconsideration Request for a Medically Denied Initial Disability Claim
DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial
DI 12020.001 Appeals Council (AC) Review
DI 13010.110 Return to Work
DI 25510.010 Closed Period Under Title II
DI 25510.015 Closed Period Under Title XVI
DI 52130.015 Military Disability Benefits
DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases
DI 81010.020 Curtailing Completion of the EDCS 3368 or EDCS 3820
DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations
DI 81010.080 Alerts, Flags, and Messages in the Electronic Disability Collect System (EDCS)
DI 81010.085 Transferring Cases in the Electronic Disability Collect System (EDCS)
DI 81010.150 Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS)
MSOM EVID 001.002 Shared Processes Menu
GN 00301.310 The Non-Disability Repository for Evidentiary Document (NDRed) Application—Overview
GN 01040.100 Listing Codes
DI 12010.010 Assembly and Routing of Folders for Administrative Law Judge (ALJ) Hearing
I. Exhibit of MC/WW flag
To flag MC/WW cases, use the following printable flag.
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