BASIC (08-03)

A. Policy

1. General

ODAR Headquarters will screen the claims for class membership eligibility for relief. If it is determined that the individual is a class member eligible for relief, ODAR Headquarters will forward the claim via Grant route slip to the appropriate HO. The HO will schedule a new hearing, or, if necessary, forward the claim file to the appropriate FO for needed development if the evidence of record is insufficient to make a redetermination. If the HO determines that the claimant is disabled during the redetermination period, the FO will update the medical history and sources of medical evidence in the file and forward the file to the DDS to secure any updated medical evidence. After the DDS has updated the medical evidence in the file, it will forward the file back to the appropriate HO for readjudication.

2. Supplemental development

The HO may request the DDS to develop medical evidence of record (MER) if they determine that updated MER is necessary. Otherwise, the HO will consider the evidence in the file and any newly obtained evidence related to the period covered by the Grant claims. The individual eligible for relief may submit additional evidence relevant to the period covered by the Grant claim(s).

B. Procedure - systems operating procedures

1. Case receipt

Enter cases received from ODAR as receipts on the National DDS System (NDDSS) DRES screen with the following information. (See SM 06001.100 for a discussion of the DDS receipt (DREC) process.)

2. Folder location or status request

Obtain folder location or status request (and request folders) via the DDS query (DDSQ) facility. (See SM 06002.001.)

3. Case clearance

1. Follow SM 06001.350 to enter on the NDDSS.

2. Input a systems override (SO) code of “C” to indicate case control clearance only.

3. Input “846” in the first available LIT field, if it is not displayed.

4. Route the case to the servicing hearing office (“HO”).

C. Procedure - development

1. Medical development

In cases where development is necessary, the HO will provide information regarding the development needed and the time period under consideration. As necessary, contact the individual and/or his or her representative to obtain information regarding the claimant's medical history and medical sources.

1. MER

   The beginning of the time period to be developed is as follows:

   • Title II Claims

     From the alleged onset date (AOD) in the earliest class claim through the period covered by the Grant claim(s). However, if it is determined that the claimant is disabled during the period covered by the Grant claim(s), development should occur through the date of the new hearing decision, or the date of the later allowance or the date that the claimant attains full retirement age, whichever is earlier.

   • Title XVI Claims

     From the date of application in the earliest class claim through the period covered by the Grant claim(s). However, if it determined that the claimant is disabled during the period covered by the Grant claim(s), development should occur through the date of the new hearing decision, or the date of the later allowance or the date that the claimant attains full retirement age, whichever is earlier.

   • Cessation Cases

     From the date of termination through the current date of adjudication (or the established date of onset of a subsequent allowance).

2. Duration and ODAR Assistance Requests

   Follow the procedures in DI 25505.000 and DI 29501.000.

3. Obtain and Develop Necessary Evidence

   Make every reasonable effort to obtain and develop the necessary evidence. (See DI 22505.001A.3.)

4. Document Development Efforts

   Document all development requests on the DDS development worksheet per DI 20503.001C.

5. Route Folder(s) to Identified HO

   Send the file to the HO identified on the file for readjudication after development of MER is completed.

2. Folder reconstruction

After the FO completes folder reconstruction, the FO forwards the reconstructed claim to the DDS. Take the following actions:

1. Develop the evidence for the period covered by the missing claim and secure MER as in DI 52530.020C.1. In title II only cases, do not secure medical evidence for periods beyond full retirement age or after the date last insured.

2. Document the file with all efforts to secure MER.

3. Route the file to the HO identified in the file for readjudication.

3. Whereabouts unknown

If the claimant's whereabouts are unknown anytime during the medical documentation process:

1. Follow DI 23005.001 for instructions on processing whereabouts unknown cases.

2. If, after undertaking the required development, the claimant's whereabouts remain unknown, document the efforts to locate the class member and return the file to the HO identified in the file for readjudication.

4. Class member dies before revised determination is made

If a class member dies prior to completion of medical adjudication, request the FO to determine if an underpayment is payable per GN 02301.055A and SI 02101.003, as appropriate. The FO will recall the claim if no underpayment is payable and will return the file to the HO.

5. Failure to cooperate

In failure to cooperate situations:

1. Follow DI 23010.005, DI 23007.005 and DI 28075.005.

2. Document efforts to obtain evidence and return the file to the HO identified in the file for redetermination.

NOTE: In failure to cooperate situations, it is not necessary for the DDS to prepare a determination as ODAR is the component responsible for redetermination.