POMS Reference

DI 28035: Processing of Lost Folders/Medical Evidence

TN 2 (09-14)

IMPORTANT: These instructions incorporate policy and procedure for both electronic continuing disability review (eCDR) and eCDR exclusion (paper) cases when there is a lost or destroyed folder involved.

A. Background on eCDR procedures for lost or destroyed folders

The law requires that we periodically review the continuing eligibility of all disability beneficiaries and recipients. In performing this review, we compare the severity of the beneficiary or recipient’s current medical condition to the severity of the most recent favorable medical decision (i.e., comparison point decision (CPD)).

B. Field Office (FO) requirements for lost or destroyed cases prior to transfer

Before transferring a CDR case to the DDS, the FO must make every effort to locate the CPD folder(s). The CPD folder could be a certified electronic folder (CEF) or a paper folder. A CEF cannot be a lost or destroyed folder because it is stored electronically. For further instructions regarding FO search and detective work that may be necessary to locate a medical folder see DI 13015.080.

NOTE: If the CDR is an age 18 redetermination, the CPD is not required but the FO will obtain and forward it if the folder is readily available.

For information on associating the CEF CPD folder with an electronic continuing disability review (eCDR), see DI 81010.235.

1. Paper CPD

If the CPD is a paper folder, the FO mails the CPD folder to the DDS when it transfers the case in EDCS. If the FO cannot locate the paper CPD folder, the FO must document all attempts to find the folder, including follow up requests, on Form SSA-5002 (Report of Contact).

The Form SSA-5002 must:

  • identify the type(s) of file the FO attempted to locate (Title II Disability Insurance Benefits (DIB), Childhood Disability Benefits (CDB), Disabled Widow(er) Benefits (DWB), Supplemental Security Income (SSI), etc.);

  • list the locations searched or eliminated based on queries;

  • document a follow-up to the original search request(s) was completed;

  • address the issue of cross-reference social security numbers (SSNs), or document there are no cross-referenced SSNs;

  • address pertinent name changes by the beneficiary and that the office searching for the folder was aware of and searched under all names involved.

2. Developmental evidence

The FO obtains the following developmental evidence:

  • Form SSA-454 (Report of Continuing Disability Interview) – the FO is encouraged to key the Form SSA-454 into EDCS;

  • Form SSA-3368 (Disability Report-Adult) for age 18 redeterminations – the FO must key the SSA-3368 into EDCS, unless there is an eCDR exclusion. See DI 81010.210 for eCDR exclusion cases;

  • Form SSA-3881 (Questionnaire for Children Claiming SSI Benefits) and the age-appropriate Function Report (Forms 3375 through SSA-3379) for child CDRs;

  • Form SSA-827 (Authorization to Disclose Information to the Social Security Administration), see DI 11005.056 for signature requirements; and

  • supporting documentation (e.g., queries, beneficiary supplied documents, etc.) including Form SSA-5002 documenting the attempts to locate a missing CPD if necessary.

Once the FO completes development, it transfers the case to the DDS.

NOTE: FO’s should accurately complete the paper folder indicators prior to EDCS transfer per DI 81010.235.

C. DDS procedures for receipting CDR folders

Prior to receipt, the DDS must review CDR cases for:

  1. CPD folder documentation, which can be any of the following:

    1. a linked CEF CPD;

    2. a paper CPD folder; or

    3. Form SSA-5002 documenting all FO search activity for a lost or destroyed folder.

NOTE: The FO includes a remark “Lost Folder” on the Electronic Disability Collect System (EDCS) routing form, and selects “Unable to Locate” as the CPD paper folder indicator per the instructions on receipting an electronic continuing disability review (eCDR) in DI 81020.205.

  1. supporting documentation (e.g., queries).

  2. the CPD date, established by the FO as the date 12 months prior to the CDR interview and

NOTE: The FO enters a CPD date in EDCS that is 12 months prior to the interview for lost or destroyed folder cases. It is the DDS responsibility to establish the actual CPD date.

The DDS follows instructions on scanning the Form SSA-454 into the CEF. See DI 81020.210.

If the FO forwards a CDR folder that does not contain documentation of efforts to locate the CPD folder, reject the case back to the FO and include a reject reason “attempts to locate CPD folder not documented.”

If the DDS receipts the case before discovering the missing CPD development, transfer the case back to the FO for CPD development.

NOTE: To ensure proper credit in workload assistance cases, when requesting assistance from another disability-processing component, the DDS must use Transfer (TR) decision code rather than an ND decision code. The DDS must route the claim using TR regardless of whether the DDS has already performed substantive work on the case. See POMS SM 06001.355 and DI 81020.127.

D. DDS procedures for developing prior medical evidence

1. Residual file material

  • obtain any residual file material (e.g., records of determinations or decisions, consultative examination dates, etc.), and

  • annotate Form SSA-5002 to show the availability of residual file material.

2. Title XVI conversion

Attempt to locate the prior State records because two CPDs may apply. The actions taken vary on a State-by-State, and case-by-case basis. For additional information, see DI 28010.105.

E. DDS procedures for developing current evidence

When developing current evidence:

  • review Form SSA-454;

  • develop all current medical evidence and any necessary non-medical evidence (12 months before the date of the SSA-454 to the present); and

  • order a consultative examination(s), if necessary.

For additional case development procedures, see DI 28030.020.

F. References

DI 11005.056 Signature Requirements for Form SSA-827

DI 13015.080 Unable to Locate Medical Folder after Initial FO Search – Detective Work

DI 28010.105 Comparison Point Decision

DI 28030.020 Development of Medical Evidence

DI 81010.210 Electronic Continuing Disability Review (eCDR) Exclusions

DI 81010.235 Associating the Comparison Point Decision (CPD) Folder with an Electronic Continuing Disability Review (eCDR)

DI 81020.127 Processing “No Determination” (ND) Claims

DI 81020.205 Receipting an Electronic Continuing Disability Review (eCDR)

DI 81020.210 Scanning the SSA-454-BK (Continuing Disability Review Report) into the CEF

DI 81020.225 Linking and Unlinking the Comparison Point Decision (CPD) Folder

SM 06001.355 – Transfer Cases