DI 28035: Processing of Lost Folders/Medical Evidence
TN 2 (09-14)
A. Background
The DDS ensures that current documentation is complete and, in the absence of current substantial gainful activity (SGA) or Group II medical improvement exceptions, prepares a determination to continue disability if:
disability is not continued based on current medical or vocational evidence; and
you cannot reconstruct the prior medical records as described in DI 28035.020.
REMINDER: You must ensure a completed SSA-538 (Childhood Disability Evaluation Form) is in file in all title XVI child cases.
B. Documentation for not reconstructing prior folder
When the DDS determines not to reconstruct a prior lost or destroyed paper CDP folder, the DDS must document the reason for the determination on Form SSA-5002 or similar form. See Report of Contact Form SSA-5002.
C. Title XVI and extended period of eligibility (EPE)
In Title XVI and EPE impairment severity determinations, prepare a continuance of disability determination if there are no Group II medical improvement exceptions. The performance of SGA is not a basis for an unfavorable continuing disability review (CDR) determination. For additional information on medical improvement exceptions, see DI 28005.015.
NOTE: The field office (FO) will pay retroactive benefits after it fully develops all non-disability factors of entitlement, including work issues.
D. Completing the SSA-832/833-U3 (Continuance or Cessation of Disability or Blindness Determination and Transmittal – Title XVI/Continuance or Cessation of Disability or Blindness Determination and Transmittal – Title II)
Complete Forms SSA-832/833 according to instruction in DI 28085 and DI 28086 including.
Item 12, enter basis code:
37 for Title II (DI 28084.020); and
enter list code 256 in item 34 of the SSA-832/833-U3 for both cessations and continuances.
E. Scheduling a medical reexamination diary
Schedule the medical reexamination diary based on the type of impairment(s) involved and whether changes in the impairment could result in a cessation when the medical improvement review standards is applied in future CDRs.
F. Title XVI conversion cases
You must carefully evaluate Title XVI conversion cases, as there may be two comparison point decision (CPD) folders. If evidence from one CPD (e.g., the State CPD) is not available and a continuance is processed under other rules, (e.g., under the Federal criteria), include a determination of continuance under these provisions (e.g., insufficient evidence to assess medical improvement under the State criteria).
Process the current continuance under both Federal and State criteria, and use the current CDR as the CPD for both Federal and State parts in future reviews. Medical improvement regulations provide that current documentation must provide the basis for any future reviews. For additional information on conversion cases, see DI 28010.105D.4.
G. References
DI 28005.015 CDR Evaluation Process – Step by Step Discussion
DI 28035.020 Disability Determination Services (DDS) Reconstruction of Prior Folder
DI 28084.020 Reason for Continuance Codes