TN 1 (12-17)

A. Prior favorable initial determination

When a prior favorable initial determination is incorrect, reopening is appropriate when there is “good cause” and the rules of administrative finality allow. For example, good cause for reopening exists when there is new and material evidence or there is an error on the face of evidence. For more information on errors on the face of evidence or new and material evidence, see DI 27505.010, DI 28020.355, and DI 28020.365.

We do not require good cause when reopening of an incorrect determination occurs within one year from the date of the notice of the initial determination. However, certain adverse reopenings and revisions cannot occur unless the medical improvement (MI) regulations allow a finding that disability has ceased or does not exist. For more information about MI in CDR cases, see DI 28005.001.

B. Prior favorable CDR determination

The Disability Determination Services (DDS) may reopen a case if a prior favorable CDR determination is incorrect and such action is not precluded by the rules of administrative finality.

Reopen the case only when the prior favorable CDR determination is wholly unsupported by the evidence, not because of a difference in judgment.

C. Administrative finality does not allow reopening

When the rules of administrative finality do not allow reopening, the disability examiner must initiate a CDR claim and prepare a determination of continuance or cessation using the usual CDR procedures.

D. References

DI 27501.001 Reopenings and Revisions: Pertinent Definitions and Related Policy

DI 27501.005 Reopening and Revising a Determination or Decision

DI 27505.015 Fraud of Similar Fault - Reopenings

DI 81030.120 Reopenings – Certified Electronic Folders (CEF)

GN 04020.010 Unrestricted Reopening for Determinations or Decisions Involving Fraud or Similar Fault

GN 04440.250 Reviewing Cases That Have Been Inadvertently Effectuated