TN 4 (02-18)

Citations: Social Security Act, Section

205(b)(2)

20 CFR 404.907 - 404.922, 20 CFR 416.1407 - 416.1422

NOTE: If a claimant files a new disability application and has a prior disability claim for the same title and benefit type pending at any level of administrative review, see DI 51501.001 Procedural Change for Subsequent Disability Applications Effective July 28, 2011.

A. Field office (FO) explanation of the determination and reconsideration process

A claimant who is dissatisfied with the initial determination on his or her claim may call, write, or visit an FO for an explanation of the determination. When a claimant requests an explanation, describe, to the claimant, as objectively as possible, how the Social Security Administration (SSA) handled the claimant's case, the basis for the determination, and his or her appeal rights. Explain that if he or she appeals, SSA can review all issues, including those decided favorably. This means that the claimant’s disability status may change from “disabled” to “not disabled”, or that the established onset date (EOD) may be the same, earlier, or later than the EOD established in the initial determination. See DI 25501.260 Establishing the Established Onset Date (EOD) in Reconsideration and Appeal Claims.

If the claimant decides to request reconsideration after receiving the explanation, follow the instructions in this subchapter to develop and process the request.

EXCEPTION: Reconsideration is not the first level of appeal for a medical determination on an initial claim in Prototype states, unless expedited reinstatement is involved. For additional information, see DI 13050.085 Appeals Process Under Expedited Reinstatement and DI 12015.100 Disability Redesign Prototype Model

When a claimant requests reconsideration of an initial disability determination, the FO explains the reconsideration process and obtains the appropriate appeal forms (the SSA-561 Request for Reconsideration, or the SSA-3441-BK Disability Report-Appeal). The claimant’s case then receives an independent and thorough reexamination of all evidence on record including any new evidence received after the initial determination.

NOTE: To process a request for reconsideration of a medical cessation or an adverse reopening of a favorable initial determination due to medical/vocational reasons, follow the instructions in DI 12026.001 Reconsideration of a Continuing Disability Review (CDR) Based on Medical Cessation or Adverse Medical Reopening.

B. Reconsideration procedure

1. Review the initial claim

Review the certified electronic folder (CEF) or paper modular disability folder (MDF) to ensure that the Disability Determination Services made an initial determination. Also review the Online Retrieval System (ORS) and any pertinent queries for additional information before scheduling an interview with the dissatisfied claimant.

2. Conduct the interview, if necessary

The claimant can submit a request for reconsideration via iAppeal, a written request, or an in-person interview. When the claimant requests a reconsideration in writing or via iAppeal, an interview with an FO employee may not be necessary. Review iAppeal and written submissions for completeness, and, as appropriate, load the reconsideration request information into the Modernized Claim System (MCS), the Modernized Supplemental Security Income Claims System (MSSICS), or both.

When necessary, conduct the interview as discussed in GN 03101.120 Appeals – FO Interview with Dissatisfied Claimant .

Also, explain that the claimant:

• has the right to present additional evidence to support his or her claim and may request FO assistance in determining what evidence is needed and how to get the evidence;

• has the right to representation (see GN 03910.040 Appointment and Revocation of Appointment of Representative); and

• may be required to attend a consultative medical examination (CE). Stress the importance of attending the CE and of cooperating in securing and submitting medical evidence that the DDS may request.

3. Document the appeal request in MCS and MSSICS

Establish the appeal request via the Dallas Appeals Program website at: http://sharepoint.ba.ssa.gov/dco/da/Banana2Appeals/Banana2.html, or manually enter the information into the MCS and MSSICS appeal screens as appropriate.

EXCEPTION: If the claimant submits an appeal of an FO determination (for example, failure to cooperate or substantial gainful activity (SGA)) and the FO reverses the initial denial, see DI 81010.145 Processing Reconsideration Requests of Field Office (FO) Determinations and DI 12005.010 Processing a Reconsideration Request for an Initial Non-Medical or Technical Denial.

• If the deciding issue in concurrent Title II/Title XVI cases is the same (e.g., medical/vocational denial), complete the appeal screens for each title. For exception cases (e.g., MCS or MSSICS exclusions), obtain one form SSA-561 (Request for Reconsideration) and specify in the “CLAIM FOR” text that it applies to both claims.

• If the reconsideration request is limited to one title only, document the claim folder(s) to reflect the reason(s) the claimant is not requesting reconsideration for both claims.

NOTE: If an application involves claiming Title II and Title XVI benefits, or claiming more than one Title II disability benefit, and the claimant appeals any medical issue for any of the benefits, the entire claim is under review, including any favorable determination regarding disability status. Therefore, transfer the case as a concurrent claim to DDS.

The FO may still effectuate the favorable determination, but the claimant should be aware that our determination regarding the medical issue is not final.

If the other claim was a technical denial that is not under appeal, do not forward the technically denied claim to DDS as the issues under appeal are not the same.

• If the claimant has limited the appeal in multiple claim situations (DIB/DWB or DIB/CDB), document this on the appeal request in the space provided for the appeal reason. If in concurrent cases the claimant limits his or her appeal to Title XVI-only, see SI 00510.001 Overview of the Filing for Other Program Benefits Requirement.

• If the issues differ in concurrent claims (e.g., technical denial on the Title XVI claim and medical denial by the DDS on the Title II claim), and the claimant disagrees with both decisions, complete the appropriate MCS and MSSICS appeal screens. If you cannot complete the appeal screens in MCS or MSSICS, obtain an SSA-561 and process the appeals in accordance with the procedures applicable under the respective program.

• If the case is an MCS/MSSICS exclusion, and the claimant has not already submitted a written request as described in GN 03102.100C.2. The Reconsideration Process, obtain an SSA-561.

• If the claimant submits non-medical evidence, refer to DI 81010.135 Storing Non-Medical Evidence in the Electronic Folder (EF).

• If the claimant submits medical evidence, follow DI 81010.125 Receiving Medical Evidence in the Field Office

NOTE: A manually loaded appeal request must be printed and stored on the Print and Store (PRST) screen to ensure that a copy is stored in the Online Retrieval System (ORS). For appeals brought into MCS/MSSICS via the Dallas Appeals Program website at: http://sharepoint.ba.ssa.gov/dco/da/Banana2Appeals/Banana2.html (a.k.a., “banana”) program, the program automatically completes the PRST screen for the user, saving the appeal request to ORS.

C. References

• OS 15010.175 SSA-561-U2, Request for Reconsideration

• OS 15010.180 SSA-561-U2 SP, Request for Reconsideration

• GN 03101.120 Appeals - FO Interview With Dissatisfied Claimant

• GN 03102.100 The Reconsideration Process

• GN 03102.200 Claimant Requests Reconsideration

• DI 13050.085 Appeals Process Under Expedited Reinstatement

• GN 03101.125 iAppeals - General and Title II Instructions

• GN 03102.225 Preparation of Form SSA 561-U2 (Request for Reconsideration)

• SI 04005.035 iAppeals - Title XVI

• SI 04020.020 Requests for SSI Reconsideration

• MS MCS 010.002 Appeal Establishment (NAPP)

• MS MSSICS 020.001 Appeals – Overview